I’ve often had discussions with friends and patients that go something like:
Friend/relative/patient: “I went to [blah blah] alternative therapy the other day. I feel great. You should recommend [blah blah] alternative therapy to all your patients.”
Me: “But [blah blah] natural therapy is a sham. There’s no good quality evidence to prove that it’s better than a placebo.”
Friend/relative/patient: “But I feel better, and so does Jo Bloggs who lives two doors down. She said it cured her bad back that she’s had for twenty years.”
Me: “Well, that’s great for Jo Bloggs. It still doesn’t mean that it’s any better than a placebo.”
Friend/relative/patient: “I don’t care whether there is any evidence for [blah blah] alternative therapy. I feel better. That’s all the evidence that I need.”
As they walk away from this conversation, most people think I’m an arrogant unsympathetic retard because I didn’t gush with enthusiasm for their miracle cure. I’m not unhappy for them. But placebo therapy is a pet hate of mine that tends to overshadow any deeper joy.
A placebo is any medical treatment that is inert or inactive. Around one third of people who take placebos will experience an end to their symptoms. This is called the placebo effect.
Placebo therapy is my own description for any treatment which is marketed as having amazing healing properties, but in reality, the only healing it provides is through the placebo effect. To me, profiting from such therapies is tantamount to fraud.
Some would disagree. After all, the pillars of medical ethics are, “First, do no harm” and, “Do good.” If the therapy they offer does no harm, and does some good, then what’s the problem? The end goal was to make the patient feel better, and if they do, what does it matter that it was the treatment or the placebo effect?
Here’s a hypothetical. Imagine if I go into a hardware store and ask for a hammer so that I can make some minor repairs to my house. The store only had baseball-sized rocks, and sold one to me. I could use the rock to knock out some walls, nail some bits of wood together. It just so happened to help me. But it isn’t a hammer. It’s barely even a tool. To sell it as a tool or specifically a hammer would still be fraud, despite the eventual outcome.
What if a drug company were to market a sugar pill, claiming a medicinal benefit. The placebo effect would guarantee that one third of the people who used it would feel better for it, but it would still be fraud. Our community would be outraged. Imagine the scathing media reports and the indignation from political and community leaders. There would be calls for jail time for the executives who profited by misleading the public, and rightly so.
The market for herbal supplements in Australia alone is worth billions of dollars. Yet there is a paucity of rigorous scientific trials of these herbs. I could count on one hand the number of herbs that have evidence that they’re better than a placebo. The other thousand or so unproven herbal supplements are no better than mass-marketed sugar pills.
Any herb, supplement or other treatment needs to show that it has a better outcome than a placebo before it can claim to be therapeutic. To claim otherwise is fraudulent, and even though I may seem like an arrogant unsympathetic retard, I think people deserve better than being mislead by claims that can not be fully substantiated.
More information on the placebo effect can be found here – http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Placebo_effect?open