Questionable Motives

January 9, 2012

What are the beer goggles of medicine?

Filed under: CAM,Medicine,placebo/nocebo,Science — tildeb @ 11:11 am

In a word, placebo.

As the slang term indicates, the more one drinks in claims of complementary and alternative medical efficacy through the ‘power’ of placebo, the less inhibition and discretion one seems to exercise in critical thinking, making the blurred claims of alternative ‘therapies’ seem all the more attractive.

We describe this power of placebo by a common term: the placebo effect. So let’s take a moment and review what that effect actually is:

changes in how pain or subjective symptoms are perceived, not any physiological change that concretely affects the course of a disease.

Does this mean we can control health outcomes with our minds through belief? No. Placebo effects do not shrink tumors or change the underlying pathophysiology of disease. To be clear, there is no good evidence for any objective responses due to placebo; the placebo effect is the change of a patient’s subjective perception to his or her symptoms. Note the emphasis on perception and not on any change to symptoms themselves. This is the repeated mistake people make about understanding the placebo effect: all we are talking about when we talk about the placebo effect is the change to perceptions.

The CAM (complementary and alternative medicine) schtick is to pretend that the substances and treatments being sold cause symptomatic changes through the placebo effect. There is no good evidence to back that up and much good evidence contrary to it. To be clear, the efficacy of CAM rests not in the treatments but in the beliefs of its patients.

In medicine, when a treatment performs no better than placebo, it means that treatment doesn’t work.

Got that? Placebo means it doesn’t work.

Believers and practitioners of CAM, however, forget – and often intentionally – that placebo treatments are physiologically inert and present them to patients as if they were real efficacious medicine. But they know it’s not. And yet we in the public continue to be inundated with messages that they do. Obviously, something here is out of whack, and it rests with the CAM crowd.

The underlying assumption associated with CAM products and treatments that the use of placebo causes no harm is just as risky as my pathetic little beer goggle analogy; one may think one is going home with a fox (of both genders, let me be clear) but wake up to a coyote ugly morning. The same is true with CAM: that patients are going home with a placebo but wake up to a nocebo ugly morning. By this I mean that promoting belief in placebo efficacy also means promoting belief in nocebo efficacy, which refers to harmful, unpleasant, or undesirable effects a subject can also manifest through perception.

The sum total of the medical efficacy complementary and alternative treatments and many nostrums pretends to have (with the exception of herbal substances that possess chemical properties that can interact with our biology in both positive and negative ways), rests not on the treatments themselves but on the double edged sword contained within the beliefs of its patients. Seeing the world through such faith-based beliefs is not an inherently good, positive, or even neutral perspective but an inherently dangerous one.

How so?

Well, the very real side effects of investing faith in such subjectively sensitive beliefs and acting on them as if they were true in reality can be life-altering when a negative drug interaction occurs because a patient forgets to tell a doctor about some CAM herbal nostrum, or postpones  (like Steve Jobs) real medical intervention in favour of trying out some naturopathic treatment first, mistakenly hoping that wishful thinking through investing in faith-based belief will cause symptomatic changes, or that not vaccinating children will protect them from a perceived inoculation danger far smaller in reality than the very real and larger danger of an actual and highly contagious disease. These are some of the very real dangers faith-belief in CAM promotes. We need to take off our belief-based beer goggles before we do something stupid based on misunderstanding what placebo effect really means.

(h/t SBM)

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