When it comes to alternative medicine, there is arguably no greater misunderstood phenomenon than the placebo effect. It’s not uncommon to hear it feature as a defence supporting the efficacy of treatments that otherwise have no evidence for performing as claimed. It is the modicum of benefit that is proferred when it has been scientifically determined that a touch, tincture or totem has been shown otherwise impotent.
Much of the present common understanding of the effect stems from a 1955 book titled The Powerful Placebo by Henry Beecher – an American anaesthiologist who stressed the need for double blinding in clinical testing and was the first to attempt to quantify the placebo’s action. While the placebo effect is argued to be a significant confounding factor in determining useful from useless treatments, Beecher presented the placebo effect as clinical, citing data that demonstrated a percentage of patients were ‘satisfactorily relieved’ by sham treatments.
Since then, other studies have suggested the placebo effect is physiological – that in spite of having zero bioactive components, the act of treatment alone can still help improve a patient’s biophysical functioning. For example, in a 1977 study stomach ulcers were found to have decreased in size following a placebo treatment.
On such evidence, it seems that the mind truly holds sway over the body’s matter. By merely perceiving a treatment works, an individual’s biology will make a greater effort to fix itself.
Yet there is an increasing amount of evidence showing that the placebo effect – or at least, this interpretation of it – is a myth. Any influence a sham treatment has over the variables can be reduced to psychological factors, with past studies falling foul of poor methods.
However, in the very least, it still leaves room for inactive treatments to make patients believe they’re feeling better. And, given western medicine primarily concerns itself with the individual patient ‘s sense of wellbeing, it might be argued that placebos could be used to placate a patient where no other treatment is available.
Ethically, such actions are highly questionable. Few physicians would feel comfortable duping a patient into thinking they’re receiving a treatment, when in fact they’re getting a fake pill or potion. Not to say this has stopped some from administering fake treatments without patient consent.
A new study now shows we might have the wrong end of the stick altogether – that any psychological bias towards placebos comes as a result of its superficial resemblance to treatment. Giving rationality too much credence, it was assumed that a patient needed to suspect that their treatment was legitimate. Instead, it seems the same effects might arise regardless of whether the patient knows the treatment has no bioactive components, putting lie to the claim that ‘it’ll work if you believe it will’.
Ed Yong has a great write-up on the study at his blog. While the study’s method left room for plenty of questions, if its results are legitimate it demonstrates that simply engaging in medical ritual might be enough to bias a patient’s disposition towards their wellbeing. The patient needn’t be led to accept there is a biophysical foundation to the ritual – just that there is a semblance of medical intervention.
The precise limits of the placebo effect and its cultural relationship remain fuzzy. Whether it will ever be an ethical approch to medication is hard to ascertain. However, knowing that a personal rationalisation might not be necessary for a patient to benefit from medical ritual is a positive step to better understanding how the way a patient is treated can be as important as the treatment itself.