Placebo component analysis in BMJ

[Deetee]

Today's BMJ has an article on the placebo response.
The study assessed the response of patients with irritable bowel syndrome to 3 interventions - observation only, sham acupuncture (limited placebo intervention) and sham acupuncture with 45 minutes empathetic practitioner input (augmented placebo intervention).

They found a clear and impressive dose-response relationship: the second group improved significantly more than the first group but significantly less than the third, who improved by 37%.

There is an accompanying editorial, only available to subscribers.

It is already widely assumed by sceptics that most if not all of the benefit of "alternative" or integrative medicine comes from the placebo effect. It is then assumed that demonstration of a powerful placebo effect, without proving a specific effect, is enough to consign the treatment to the realm of quackery.

But what if we asked a different question? Is it possible that the alternative medical community has tended historically to understand something important about the experience of illness and the ritual of doctor-patient interactions that the rest of medicine might do well to hear? Many people may be drawn to alternative practitioners because of the holistic concern for their wellbeing they are likely to experience, and many may also experience appreciable placebo responses. Why shouldn’t we try to understand what alternative practitioners know and do, as this may help explain why so many patients are prepared to pay to be treated by them, even when many of the treatments are unproven?5

They seem to draw a clear therapeutic distinction between the interventive component of the "placebo response" and the response due to the practitioner interaction, which I have always regarded as an integral component of the overall placebo response. I am not so sure there is a lot the medical profession can learn from sCAMmmers in this regard. It is already appreciated that a good doctor-patient interaction is helpful to the consultation outcome.

I think the editorial writers misunderstand the motivation of many alternative practitioners (and the people who go to them). Some practitioners behave rather like Dr Rashid Buttar in the USA, using his status and reputation to rip people off, often without ever laying eyes on them but ordering humungously expensive and useless treatments for their cancer, or fatal chelation therapy for their autism.

Also worth a read - another article by the study authors on the rituals of placebo. (although it looks like they specifically designed the current study to prove this earlier hypothesis!)