Does the ‘placebo effect’ justify the use of alternative medicine?

    11 November 2019

    The placebo effect is a complex and fascinating phenomenon. Thanks to plenty of brilliant research, our understanding of it has recently increased considerably. Several biochemical pathways, including endogenous opioids and cannabinoids, have been found to be involved. Dopamine and the basal ganglia circuitry have been found to mediate placebo responses in Parkinson’s disease. The exact meaning of this may not yet be crystal clear, but such findings show that placebo effects are not ‘just in the mind’ of the patient; they are real and lead to quantifiable changes in our bodies.

    This is music to the ears of those who advocate the use of so-called alternative medicine (SCAM) such as acupuncture, chiropractic, homeopathy, reflexology or Reiki. Many studies show that the apparent benefit SCAMs rely heavily, if not entirely, on the placebo effect. Unable to produce convincing evidence that their treatment is effective beyond a placebo effect, many SCAM practitioners now admit that their therapies work mostly or entirely via a placebo effect. However, they are keen to add that this is perfectly fine, because it is just an explanation as to how it works.

    Crucially, they claim that such evidence proves that their SCAM is effective. If that is so, enthusiasts insist, there is no reason to dismiss SCAM simply because it operates solely or mainly via a placebo response. In other words, the rigorous science around placebo is being highjacked as a proof for SCAMs which, by conventional standards, are not effective.

    This argument is, however, a huge leap of faith and would amount to a revolution in healthcare. If we were to adhere to this logic, it would be hard to think of a treatment that can ever be considered to be ineffective. Imagine a pharmaceutical firm that markets a drug which has no effect beyond placebo. We might say that they should not be allowed to ask money for such a useless medicine. Yet, according to the above logic, the company could counter that, prescribed with compassion and empathy, their drug will generate a placebo effect. As the placebo effect relies on rigorous science, their drug does so as well; therefore, it should be considered to be both legitimate and effective.

    Fabrizio Benedetti is the foremost researcher in the realm of placebo; much of the excellent science in this area comes from his laboratory. Prof Benedetti agrees that his ground-breaking discoveries have lent support to SCAM:

    The number of nonmedical organizations and healers that rely on this hard science, and actually justify their odd and bizarre procedures, has increased over the past few years. The main claim is that any procedure boosting patients’ expectations, which represent the main mediator of placebo effects, is acceptable because it can activate the same biochemical pathways and neural networks that have been made credible by hard science…

    The crucial point here is that when hard science started investigating placebo effects, it unconsciously produced a shift in quackery thinking. In fact, charlatans are becoming more and more aware that their bizarre interventions could work through a placebo effect. Indeed, whereas hard science has so far denied any scientific basis for nonconventional therapies, now the very same hard science certifies that the placebo effect has scientific grounds. Therefore, quacks are no longer interested in showing that their pseudo-interventions work; rather, they justify their use on the basis of the possibility that these bizarre interventions may induce strong placebo effects…

    However well we understand what placebos do to our brain, and however elegant this research may be, the value of placebos as a means to treat disease is extremely limited. Placebos may alleviate some symptoms, but such effects are neither strong nor long-lasting. Crucially, placebos never cure any disease. The usefulness of placebo therapies is therefore more than doubtful.

    All claims by SCAM practitioners that their therapy offers a cure are based not on fact but on wishful thinking. More importantly, we do not need placebos for producing placebo effects. All treatments, also of course conventional therapies that work beyond placebo, generate placebo effects when given with compassion, empathy and understanding.

    If a clinician administers an effective therapy (one that works beyond placebo), her patients benefit from the specific effect of this treatment plus from a placebo effect. If a clinician administers a SCAM that only works via a placebo effect, her patients lose out, as they cannot not benefit from arguably the more important part of any medical treatment: its specific effect. What follows is simple: placebo effects may be real, but, as a justification for so-called alternative medicines, they are hopeless.