Understanding the Placebo Effect in Complementary Medicine: Theory, Practice, and Research

By David Peters | Go to book overview

Preface

Complementary practitioners promote the idea that their methods somehow 'switch on' self-organising processes. One of complementary and alternative medicine's most intriguing implications for mainstream health care is that doctors should re-integrate this aspect of the healing task; that we must not only confront established pathology but also learn how better to catalyse the process of healing. As practitioners we prefer to think we are effective: why else would we be practitioners? But therein lie several potential problems: firstly, because we might be less effective than we like to think; and secondly, that therefore it will be difficult to reflect honestly on our effectiveness. In the search to become more effective some practitioners aim for ever more technical expertise, but to what extent is our therapeutic effectiveness determined by our humanity and presence rather than technical knowledge and our skill as a therapist? How much of a treatment's effect is due the patients own response and resilience? Would it be demeaning if we as practitioners had to accept that a great deal of recovery depends on responses we trigger and, that as practitioners we have to persuade, rather than force recovery?

In everyday speech, a placebo is a fake treatment, something given to please the patient. How strange then that placebo effects should be so strong; so consistent that experimental studies must be intricately designed to avoid them, so great is their influence on treatment outcomes. Modern clinical trials aim to bracket off all human variables and bias by using randomisation and blinding, for only when they achieve this, can small differences in outcome between experimental group and control group be attributed to the treatment alone. Yet the fact that around 60% of control groups tend to improve forces us to ask what the personal and inter‐ personal factors that so profoundly affect outcomes might be; and how we should make better use of them. There are important issues here: why are 'fake' treatments so effective and so hard to distinguish from 'real' ones; what ought we to make of the insidious implication that personal and inter-personal elements are not part of proper practice? Since they include resilience, natural remission and the effect of a good practitioner-client relationship — all desirable aspects of good medicine — these 'human factors'

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