The false narrative of placebo “healing”

Can the mind really heal the body? The false narrative of placebo “healing” revisited – By David Gorski – sciencebasedmedicine.org – December 2016

While I know that some alternative treatments work for some people for some ailments some of the time, I have to question why the CDC recommends all these practices for all people for all pain all the time.

Pain patients need to try many treatments to find a combination that works for them, but implying that the pain relief achieved from alternative treatments is equivalent to opioids is absurd. So I was delighted to read this irreverent article.

We at SBM write a lot about placebo effects. Of course, part of the reason is that placebo effects are just plain interesting from a scientific perspective

Of course, as we’ve discussed time and time again, pretty much all “complementary and alternative medicine” (CAM) or “integrative” medicine modalities that are not herbal medicine, nutrition, or exercise (which can have measurable physiological effects due to understandable physical mechanisms) have no detectable effects above and beyond placebo effects, no matter how much proponents of integrative medicine try to show that they do. 

I consider it a truism that, as more and more rigorous clinical trials with proper blinding and controls show that popular alternative medicine modalities like acupuncture, reiki, and the like that are furiously being “integrated” into medicine have no detectable specific effects on any disease or condition distinguishable from placebo effects,

Increasingly, integrative medicine proponents have shifted to arguing that that’s OK, that these modalities actually work through the “power of placebo.”

Thus was born what Steve Novella has referred to as the “placebo narrative.” I like that term, but I sometimes refer to the placebo narrative as the myth that thinking makes it so,” which is the basis for the rebranding of integrative medicine as harnessing “the power of placebo” or, alternatively, the power of positive thinking.

Never mind that it’s highly questionable whether it’s ever worthwhile to do so and that trying to use placebo effects to intervene in real disease processes could potentially have deadly consequences by making the patient think he feels better without actually affecting the underlying pathology.

Still, those who still think various highly implausible alternative medicine treatments actually work notwithstanding, increasingly the placebo narrative has become the dominant message among integrative medicine advocates to explain how the woo in integrative medicine “works.”

Basically, any time you hear someone referring to the “mind-body” connection, they’re invoking a disguised form of the placebo narrative, wrapped in discredited mind-body dualism to boot.

The problem with the placebo narrative

here’s a problem with the placebo narrative—many problems, actually. These fall into two categories, in general: The scientific and the ethical. The ethical problem is easy to understand, and it’s very, very daunting for the promoters of the placebo narrative. Basically, in medicine it is very unethical to lie to patients, and inducing placebo effects requires lying to patients. Period.

None of this doesn’t mean that the science of placebo effects isn’t worth studying. The problem is that integrative medicine proponents have taken over much of the research and tried to make it conform to their preferred narrative

The illusion of placebo effects

One thing not mentioned here is that placebo effects can only be quantified in clinical trials, which are, by their nature, highly artificial treatment situations

Much of what is lumped together as “the placebo effect” include study artifacts that have little or no bearing on real world outcomes and/or modulation of the patient’s perception of his symptoms.

Indeed, there are those who question, based on evidence, whether there is even such a thing as placebo effects. For example, in 2001 Hróbjartsson and Gøtzsche published an article in which they asked whether the placebo was powerless based on 214 studies with a total of 8,525 patients in which they concluded:

We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.

The seductiveness of the placebo narrative

Paul Ingraham summed up placebo effects well:

“I am interested in the biology and psychology of placebo, but it is not a magical mind-over-matter phenomenon, or even a good consolation prize when treatment is otherwise ineffective.

Many medical problems are entirely immune to positive thinking and expectation (try treating tuberculosis with a sugar pill and see how many Nobel Prizes you pick up for that innovation).

The power of belief is strictly limited and accounts for only some of what we think of as “the” placebo effect. There are no mentally-mediated healing miracles. But there is an awful lot of ideologically motivated hype about placebo…”

There’s a reason for this hype, though.

First and foremost, it taps into a deep, longstanding aspect of humans. Specifically, the placebo narrative offers the patient—and, truth be told, the physician as well—an illusion of control

However, part of the appeal of being a physician is actually rooted in paternalism (these days, disguised under the term “patient-centered care,”) where we are the nearly all-knowing physician who does what is necessary to heal the sick and the patient simply accepts whatever we deem necessary.

We don’t have to tell them everything, and they don’t expect to be told everything.

There is also a very real appeal to being a “shaman-healer,” who takes care of the “whole patient” spiritually as well as physically.

Being able to perceive oneself as teaching a patient to “heal himself” could thus be very tempting, and there’s a reason why anthropologists are attracted to alternative medicine.

As for patients, placebo medicine literally tells them that their mind—and therefore they—can relieve their symptoms and “heal” their bodies just by unleashing some innate power within oneself to heal the body.

You don’t have to have chronic pain or a serious illness to understand how appealing such an idea is

Placebo research can be valuable, but it has, unfortunately, been largely hijacked by integrative medicine, whose adherents want to demonstrate that alternative medicine works and that placebo medicine is efficacious and therefore worthwhile. (Would that it were true!)

What placebo research has shown us is not that alternative medicine works, nor has it shown us that the brain is the body’s “pharmacy” that can be tapped at will to heal all manner of ailments. Rather, what it has done is to reinforce something known since ancient times, the importance of empathy and a trusting practitioner-patient relationship. That’s more than good enough.

Author: Dr. Gorski’s full information can be found here, along with information for patients.  David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski’s biographical information, disclaimers regarding his writings, and notice to patients here.

The website where this article appeared provides interesting and unconventional views on what’s going on in the world of medicine (of which we see far too much).

About SBM – Science-Based Medicine

Exploring issues and controversies in the relationship between science and medicine

Science-Based Medicine is dedicated to evaluating medical treatments and products of interest to the public in a scientific light, and promoting the highest standards and traditions of science in health care.

Online information about alternative medicine is overwhelmingly credulous and uncritical, and even mainstream media and some medical schools have bought into the hype and failed to ask the hard questions.

We provide a much needed “alternative” perspective — the scientific perspective.

Evidence-based medicine (EBM) is a vital and positive influence on the practice of medicine, but it has limitations and problems in practice: it often overemphasizes the value of evidence from clinical trials alone, with some unintended consequences, such as taxpayer dollars spent on “more research” of questionable value.

The idea of SBM is not to compete with EBM, but a call to enhance it with a broader view: to answer the question “what works?” we must give more importance to our cumulative scientific knowledge from all relevant disciplines.

SBM’s authors are all medically trained and have spent years writing for the public about science and medicine, tirelessly advocating for high scientific standards in health care.  

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