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Wednesday, July 7, 2010

Placebos and Power

My research is very much focused on placebos. Therefore, I'm at least tangentially interested in homeopathy and its use. Recently, the BMA came out against homeopathy (and by extension, the placebo). This has been picked up by a BMJ blogger and the Guardian

Now, this is obviously a subject of great interest to me, regardless of the efficacy or otherwise of homeopathy. The placebo has been demonstrated to be very effective in relieving pain, depression and ulcers. The issue then becomes, if one is aware that placebo can help, what is the grounds for denying this effective treatment to a patient?

Many doctors would argue that the use of placebos has the possibility to diminish trust, and research has shown that this trust can be a powerful healing force (the therapuetic alliance, as it were).

However, in this case, they should probably not have come out against homeopathy, and indeed should probably encourage people to try alternative medicines more generally. My reasoning for this is as follows:
a) Doctors do not wish to prescribe placebos due to the deception
b) Even if they did, their knowledge that they were doing so would probably reduce the efficacy of the placebo
c) Homeopathy is a placebo (just assume this is true for the moment)
d) Homeopathists beleive in their treatments.

Therefore, its a win win for doctors to encourage (privately of course) patients to see homeopathists. The patients will gain some benefit, the homeopathist will be able to give them more time and attention (which is critical for placebo) and the doctors need not engage in any unethical behaviour.

Its simple really, but I'm not really surprised that the BMA didnt go for it. The placebo and this kind of stuff pushes against most of what doctors believe, and its very difficult to go against one's beliefs, even for the best of causes.

1 comment:

  1. I used to agree with you until I encountered some additional research on this. The problem is much bigger than just entrenched views.

    One example is Singh's experiment, where he sent several students to various homeopaths. The students would say that they are traveling to Africa, and they need protection from malaria. ALL homeopaths prescribed (completely ineffective) homeopathic antimalarials, and NONE advised going for effective mainstream preventatives. Needless to say, if they followed this advice, they would be at great risk, as placebo cannot prevent malaria.

    This illustrates the center of the problem. I agree with you that placebo is powerful and underused.

    Unfortunately, homeopathy and most similar placebo-based approaches present a clear and direct danger to public health. Namely, if a person believes in homeopathy strongly enough to get a good placebo effect for a headache, he'll try homeopathy for a much more serious problem as well - one where placebo effect isn't sufficient.

    What we need is some kind of methodology that would allow us to access placebo effect where it is effective, without concurrently creating a wider public health problem.