Guest guest Posted March 5, 2003 Report Share Posted March 5, 2003 I love to discuss placebos- because we can talk about the intersection of eastern and western medicine, and research vs. clinical medicine. The placebo effect is unavoidable in the clinic. Research should attempt to achieve objectivity, but clinical practice should be aimed at healing. RCT's attempt to reduce or eliminate its effects to determine how much of a therapy's success is due to the therapy alone. Without RCT's, we have no idea. Does that matter? I think it does- if you want to do the most effective things for your patients. So what is the placebo effect? Over Christmas I read a great book called the Placebo Response by Howard Brody, MD, PhD. It didn't do too well, so it may be out of print, and I got it for $8. But it summarizes quite a bit of research on this topic. According to Brody, the placebo effect can be a number of things, and is hard to define. But he puts forward his own definition, which is: " In med research, a placebo is an intervention designed to mimic the modality or process being studied, but without any of its non-symbolic healing properties, so as to serve as a control in a double-blind trial (in which the control group gets a dummy treatment, and neither the subjects nor the investigators know which group gets the active treatment and which gets the dummy. " In therapeutic healing, a placebo is a treatment modality or process administered with the belief that it possesses the ability to affect the body only by virtue of its symbolic significance. " He mentions a study where people who knew they were getting placebo still responded well- for a number of reasons including distrusting the physician who said it was placebo, and using the placebo-taking-time as an opportunity to affirm the idea of their healing. James Rotchford, MD, MPH wrote a great article in Acupuncture Today about some of this (Research in Acupuncture: An Oxymoron? http://www.acupuncturetoday.com/archives2003/mar/03medical.html) He talks about how acupuncture itself may amplify the placebo effect. Another interesting thought is that since people don't understand CM very well, that might increase the placebo effect. My suspicion is that: 1. Some therapies, points, herbs, etc. do have specific objective effects 2. Some may have more general effects 3. Some may have no effect and rely on placebo If through research, we can differentiate these, it will help us in decision-making in the clinic. Even if all of them were in category #3, I think we could still demonstrate a substantial enough healing through the placebo effect to warrant practice and still get patients. It doesn't make sense to say " it's only placebo, " because there is still healing taking place, and in some cases there is no medicine yet discovered that objectively and specifically cures. Dismissal: " It's only placebo. " Retort: " It's still healing. " It would be irresponsible for our profession not to take up the duty of researching, distinguishing those 3 categories above, and improving the objective specific effects of our interventions. Likewise, it is cruel to practice clinical medicine without doing our best to improve the healing atmosphere, the appearances, the trust, compassion, listening, etc. that all foster healing. B Brian Benjamin Carter Editor, The Pulse of Oriental Medicine Columnist, Acupuncture Today The PULSE of Oriental Medicine: Alternative Medicine You Can Understand http://www.pulsemed.org/ The General Public's Guide to Chinese Medicine since 1999... 8 Experts, 100+ Articles, 115,000+ readers.... Our free e-zine BEING WELL keeps you up to date with the latest greatest PULSE articles. Sign up NOW. Send a blank email to: beingwellnewsletter- > > Message: 3 > Tue, 04 Mar 2003 19:15:34 -0000 > " walmart_hurts <jcc " <jcc > Questions on Placebos > > After reading the recent train of discussion, I was curious as to the > opinions of the members of this group on the use of placebos in TCM; > should they be avoided? If they are effective, does it matter? > > I had read that educated TCM doctors of old still continued to > perform shamanic rituals, despite " knowing better. " When questioned > on this, they explained something remarkable similar to the placebo > effect, saying that while they indeed offered no physical benefits, > the rituals put the patient in the correct frame of mind, or assisted > in curing psychologically, which made the treatment more effective. > TCM seems to make less of a distinction between psychological and > physical treatments than Western medicine does. > > On the other hand, some placebos can have dangerous side effects, are > costly to produce, etc. Also, I would suspect that some patients > would be quite disillusioned if they discovered that large portions > of their treatments didn't really " do anything. " > > Any comments would be appreciated. > > Mbanu Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2003 Report Share Posted March 9, 2003 > The placebo effect is unavoidable in the clinic. Brain, please be very careful when considering placebo effects. The group of patients most likely to respond to placebos are those suffering from hysteria (or conversion reaction or whatever the DSM is calling it these days). Sometimes healer may thing something is a placebo effect, but it isn't really. For example, a patient may do something on his or her own that starts to make a different. Like changing the diet or adding a daily walk or telling off an in-law or whatever. Patients are especially more likely to start looking for things they can do if a good healer inspires hope in them. Also, there is still a lot that is not known in TCM, and no individual TCM healer knows all of what is known. For example, a healer may not know that LI (Large Intestine) 4 also has an antihistamine effect. The healer treats the client's constipation, and the client reports his/her allergies are better. This is not a placebo effect, the point has an antihistamine effect in addition to promoting intestional mobility. Also, not all analyzing is conscious. Sometimes a healer may think to try a point (or an herb) without realizing that a long time ago s/he read about the use of that point for that very thing. The healer may not consciously remember reading it, but the information is there to draw from. This is not a placebo effect. Sometimes healers reason out the correct thing to do. A lot of TCM is very logical, especially a lot of 5 Elements Theory. This has happened to me a lot of times. I reason out what to try, and then later I find documentation that it's standard practice going back centurires. A healer may think s/he's just prescribed a placebo or the good effects are due to a good bedside manner when in reality the healer has stumbled upon via logic or unconsciously remembered a standard TCM treatment. Or, the client has hit upon something on his or her own that works. Personally, I think it's a good idea to err on the side of assuming a physical cause. I find this is what leads to discoveries and greater understanding. When healers just attribute the positive results to a placebo, they rarely go any futher in trying to understand. They rarely think to ask the right questions. Some things in TCM do not lend themselves well to double-blind studies. Some do. Also, something else to consider about double-blind studies is that their greatest strength is also their greatest weakness. They are very good at demostrating one to one correspondences, but break down when something is due to a combination of factors or need a combination of factors to be healed. Victoria Quote Link to comment Share on other sites More sharing options...
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