Snake oil Science: the truth about alternative medicine

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Author equates alternative treatments with placebo effefct

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HEALTH
Author equates alternative treatments with placebo effect
Millions of patients seek treatment with unorthodox, unproven therapies, and many find relief.
By SUSAN J. LANDERS, amednews staff. May 12, 2008.
Washington — Doctors may not realize it, but they are familiar with the reason for the apparent success of alternative and complementary treatments; they just call it the placebo effect, said R. Barker Bausell, PhD, a biostatistician and professor at the University of Maryland School of Nursing.
Dr. Bausell, author of the book, Snake Oil Science: The Truth About Complementary and Alternative Medicine, which was released last year to favorable reviews, searched for the scientific evidence to support the claimed benefits of various unconventional treatments. But he came up short.
He conveyed those findings as well as his concern about the increasing amounts of research dollars being directed toward these treatments at an April 23 Capitol Hill briefing held by the Congressional Biomedical Research Caucus in Washington, D.C.
Dr. Bausell also served as research director for the University of Maryland’s alternative medicine center but has left that post for reasons that had nothing to do with his research findings, he said.
Dr. Bausell defined alternative medicines as any of a host of techniques, such as acupuncture, herbs, or yoga for pain management, used to cure a medical condition.
He is concerned that such treatments have moved from the far reaches of healing, where they were practiced by a few believers, to the heart of mainstream medicine, where they are incorporated with traditional treatments in “integrative medicine” centers at elite medical schools and hospitals. The National Institutes of Health’s National Center for Complementary and Alternative Medicine now has an annual budget of more than $121 million.
“Doctors no longer feel comfortable saying these therapies are shams,” Dr. Bausell said.
Many physicians are major players in integrative medicine centers. For example, Harvey Zarren, MD, a cardiologist and president of the board of the Integrative Medicine Alliance, a group of physicians and others in the Boston area, taps into many alternative techniques, including hypnosis, to help his patients lower their blood pressure. There is good evidence that such treatments work, he said. “Why not use all appropriate tools.”
One technique employed by therapists who use complementary and alternative techniques — but one that runs short for conventional medicine — is time, he said. “Give people time, give people respect. Look at the whole person.”
But questions remain about how and why these approaches work, and the need for more study exists.
NCCAM Director Josephine P. Briggs, MD, acknowledged recently in congressional testimony that, although millions of people use alternative treatments, very little is known about the potential of such treatments to improve health and well-being or preempt disease. “We also need to understand how [these] practices interact with other therapies and whether they are safe.”
Figuring out the “why”
But Dr. Bausell sees the central question differently.
Getting at the heart of why so many people believe in the benefit of these techniques means puzzling through “a family of artifacts, both psychological and biological, that conspire to confound us and make fools of us all,” he said.
Everyone makes inferences. A patient seeking relief from pain in an arthritic knee may go to a primary care physician, a rheumatologist and a homeopath and also turn to herbs, megavitamins, prayer and acupuncture, he said. But if the pain subsides while they are involved in acupuncture, “you will never convince that person [it] didn’t heal them.” What is not considered when weighing that success, though, is the waxing and waning nature of such pain, Dr. Bausell said. The easing may have occurred even without an intervention.
Therapists who practice these techniques also fail to keep records, and patients may, out of politeness, say they feel better after treatment even if they don’t, he added.
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Author equates alternative treatments with placebo effect – am…    3/28/12 5:00 PM    http://www.ama-assn.org/amednews/2008/05/12/hlsb0512.htm
The placebo effect — defined as a pharmaceutically inactive substance or procedure that can have a therapeutic effect if administered to a patient who believes he or she is receiving an effective treatment — also enters the picture. Dr. Bausell believes the placebo effect has convinced patients a treatment actually works, even when unsupported by research.
The AMA favors the evaluation of alternative treatments using well-designed studies and urges physicians to ask patients routinely whether they use any of these therapies.

Alternative Medicine: Think yourself better

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Alternative medicine

Think yourself better

Alternative medical treatments rarely work. But the placebo effect they induce sometimes does

May 19th 2011 | from the print edition

ON MAY 29th Edzard Ernst, the world’s first professor of complementary medicine, will step down after 18 years in his post at the Peninsula Medical School, in south-west England. Despite his job title (and the initial hopes of some purveyors of non-mainstream treatments), Dr Ernst is no breathless promoter of snake oil. Instead, he and his research group have pioneered the rigorous study of everything from acupuncture and crystal healing to Reiki channelling and herbal remedies.

Alternative medicine is big business. Since it is largely unregulated, reliable statistics are hard to come by. The market in Britain alone, however, is believed to be worth around £210m ($340m), with one in five adults thought to be consumers, and some treatments (particularly homeopathy) available from the National Health Service. Around the world, according to an estimate made in 2008, the industry’s value is about $60 billion.

Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies. (Meta-analysis is a statistical technique for extracting information from lots of small trials that are not, by themselves, statistically reliable.) His findings are stark. According to his “Guide to Complementary and Alternative Medicine”, around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically indistinguishable from placebo treatments. In only 5% of cases was there either a clear benefit above and beyond a placebo (there is, for instance, evidence suggesting that St John’s Wort, a herbal remedy, can help with mild depression), or even just a hint that something interesting was happening to suggest that further research might be warranted.

It was, at times, a lonely experience. Money was hard to come by. Practitioners of alternative medicine became increasingly reluctant to co-operate as the negative results piled up (a row in 2005 with an alternative-medicine lobby group founded by Prince Charles did not help), while traditional medical-research bodies saw investigations into things like Ayurvedic healing as a waste of time.

Yet Dr Ernst believes his work helps address a serious public-health problem. He points out that conventional medicines must be shown to be both safe and efficacious before they can be licensed for sale. That is rarely true of alternative treatments, which rely on a mixture of appeals to tradition and to the “natural” wholesomeness of their products to reassure consumers. That explains why, for instance, some homeopaths can market treatments for malaria, despite a lack of evidence to suggest that such treatments work, or why some chiropractors can claim to cure infertility.

Despite this lack of evidence, and despite the possibility that some alternative practitioners may be harming their patients (either directly, or by convincing them to forgo more conventional treatments for their ailments), Dr Ernst also believes there is something that conventional doctors can usefully learn from the chiropractors, homeopaths and Ascended Masters. This is the therapeutic value of the placebo effect, one of the strangest and slipperiest phenomena in medicine.

Mind and body

A placebo is a sham medical treatment—a pharmacologically inert sugar pill, perhaps, or a piece of pretend surgery. Its main scientific use at the moment is in clinical trials as a baseline for comparison with another treatment. But just because the medicine is not real does not mean it doesn’t work. That is precisely the point of using it in trials: researchers have known for years that comparing treatment against no treatment at all will give a misleading result.

Giving pretend painkillers, for instance, can reduce the amount of pain a patient experiences. A study carried out in 2002 suggested that fake surgery for arthritis in the knee provides similar benefits to the real thing. And the effects can be harmful as well as helpful. Patients taking fake opiates after having been prescribed the real thing may experience the shallow breathing that is a side-effect of the real drugs.

Besides being benchmarks, placebos are a topic of research in their own right. On May 16th the Royal Society, the world’s oldest scientific academy, published a volume of its Philosophical Transactions devoted to the field.

One conclusion emerging from the research, says Irving Kirsch, a professor at Harvard Medical School who wrote the preface to the volume, is that the effect is strongest for those disorders that are predominantly mental and subjective, a conclusion backed by a meta-analysis of placebo studies that was carried out in 2010 by researchers at the Cochrane Collaboration, an organisation that reviews evidence for medical treatments. In the case of depression, says Dr Kirsch, giving patients placebo pills can produce very nearly the same effect as dosing them with the latest antidepressant medicines.

Pain is another nerve-related symptom susceptible to treatment by placebo. Here, patients’ expectations influence the potency of the effect. Telling someone that you are giving him morphine provides more pain relief than saying you are dosing him with aspirin—even when both pills actually contain nothing more than sugar. Neuro-imaging shows that this deception stimulates the production of naturally occurring painkilling chemicals in the brain. A paper in Philosophical Transactions by Karin Meissner of Ludwig-Maximilians University in Munich concludes that placebo treatments are also able to affect the autonomic nervous system, which controls unconscious functions such as heartbeat, blood pressure, digestion and the like. Drama is important, too. Placebo injections are more effective than placebo pills, and neither is as potent as sham surgery. And the more positive a doctor is when telling a patient about the placebo he is prescribing, the more likely it is to do that patient good.

Despite the power of placebos, many conventional doctors are leery of prescribing them. They worry that to do so is to deceive their patients. Yet perhaps the most fascinating results in placebo research—most recently examined by Ted Kaptchuk and his colleagues at Harvard Medical School, in the context of irritable-bowel syndrome—is that the effect may persist even if patients are told that they are getting placebo treatments.

Unlike their conventional counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect, says Dr Ernst. They offer long, relaxed consultations with their customers (exactly the sort of “good bedside manner” that harried modern doctors struggle to provide). And they believe passionately in their treatments, which are often delivered with great and reassuring ceremony. That alone can be enough to do good, even though the magnets, crystals and ultra-dilute solutions applied to the patients are, by themselves, completely useless.

Hospitals using alternative healing methods

News » Health & Behavior    Fitness & Nutrition    Your Health: Kim Painter    Medical Resources    Health Information
More hospitals offer alternative therapies for mind, body, spirit
Updated 9/15/2008 11:25 AM | Comments    42 | Recommend    21    E-mail | Print | By Lisa Gill, Special for USA TODAY
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When nurses tried to insert an IV into patient Linda Aron’s hand, she was so anxious over the impending operation to fix her acid reflux that they simply had to stop.
Instead of continuing to poke and prod Aron, nurses at Grinnell (Iowa) Regional Medical Center called in a massage therapist to rub her shoulders and arms to help her relax. Within 10 minutes, Aron had an IV in place.
To meet patient demand and enhance the hospital experience, more hospitals like Grinnell offer patients complementary and alternative treatments. The American Hospital Association says today that 37% of hospitals around the USA make complementary and alternative treatments available — including acupuncture, touch therapy, and music and art therapy.
A similar survey by the hospital group in 2005 found that one in four hospitals offered such services.
MUSIC THERAPY: A healing grace note for patients BETTER LIFE: Rounding up alternative medicine news
By Doug Wells for USA TODAY
Patients such as Aron, 56, of Grinnell (population: 9,100), say they are surprised at how some of these therapies make a difference in their hospital experience.
“It was wonderful to have someone take your mind off of what was going on,” Aron says. “Having the human touch and knowing that someone is paying very personal attention to you helps. It keeps everything from being so medical.”
And, to help speed her recovery and relieve pain from the surgery, Aron currently receives weekly acupuncture from the hospital in Grinnell as an outpatient. She pays the $55 fee out of her own pocket.
“This is a movement toward ‘patient-centered’ care,” says Sita Ananth, director of knowledge services for the Samueli Institute, an Alexandria, Va.-based non-profit that studies alternative therapies. “Many hospital mission statements are to serve the mind, body and spiritual needs of their patients.”
Success measured in patient satisfaction
Ananth also points to the lucrative market potential of these types of therapies for hospitals, although most hospitals have yet to see a profit. According to the National Center for Complementary and Alternative Medicine, up to $19 billion a year is spent on alternative treatments. And the AHA’s survey showed that much of that is paid out of pocket for patients — 71% of them pay cash.
While these types of therapies have a useful place in the hospital, more data are needed to understand how they work, says Andrew Schafer, chief physician at New York-Presbyterian Hospital/Weill Cornell Medical Center. “Complementary and alternative therapies must be scrutinized in terms of their risk-to-benefit ratio and be subjected to placebo-controlled studies.
“If it turns out that the placebo effect is at work, that is not necessarily a bad thing,” he adds, “but today’s complementary and alternative therapies could be tomorrow’s medical breakthroughs.”
The majority of hospitals say that patient satisfaction is the No. 1 way they determine if an alternative treatment is beneficial, closely followed by clinical data on a treatment. Cleveland Clinic just completed a complementary and alternative therapy pilot program for patients undergoing heart surgery. Half of the patients — more than 1,700 — opted for spiritual care, counseling, art, music, touch therapy or guided imagery, and 93% of patients surveyed said the services were helpful.
Guidance from doctor groups for patients with chronic pain has helped bolster doctors’ acceptance of complementary treatments, says Richard Nahin, senior adviser for scientific coordination and outreach at the National Center for Complementary and Alternative Medicine. He cites new guidelines for treating lower back pain issued jointly last year by the American College of Physicians and the American Pain Society, which suggest many alternative therapies as potential treatments. “As doctors become more aware, hospitals will also follow,” Nahin says.
Not all doctors are on board
Yet the picture is not so rosy at certain centers. According to the AHA, 44% of hospitals that offer such therapies say that their programs have a mediocre or poor relationship with staff physicians.
Betty Carlson, 79, of Fenton, Mich., doesn’t need to be sold on the benefits. She received regular sessions with a Reiki therapist, a form of spiritual healing, and a spiritual adviser during her month-long stay at Cleveland Clinic after open heart surgery. As a retired nursing home administrator, Carlson says she was skeptical when first introduced to Reiki by a friend, but she quickly discovered how it helped relieve pain.
“It was very relaxing, and a gift toward my healing.”
READERS: If you found yourself in one of these hospitals, would you make use of their alternative therapies? Share your view or experiences below:

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MEDICINENET.COM DEFINES PLACEBO EFFECT


Placebo effect: Also called the placebo response. A remarkable phenomenon in which a placebo — a fake treatment, an inactive substance like sugar, distilled water, or saline solution — can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful. Expectation to plays a potent role in the placebo effect. The more a person believes they are going to benefit from a treatment, the more likely it is that they will experience a benefit.

To separate out this power of positive thinking and some other variables from a drug’s true medical benefits, companies seeking governmental approval of a new treatment often use placebo-controlled drug studies. If patients on the new drug fare significantly better than those taking placebo, the study helps support the conclusion that the medicine is effective.

The power of positive thinking is not a new subject. The Talmud, the ancient compendium of rabbinical thought, states that: “Where there is hope, there is life.” And hope is positive expectation, by another name. The scientific study of the placebo effect is usually dated to the pioneering paper published in 1955 on “The Powerful Placebo” by the anesthesiologist Henry K. Beecher (1904-1976). Beecher concluded that, across the 26 studies he analyzed, an average of 32% of patients responded to placebo.

It has been shown that placebos have measurable physiological effects. They tend to speed up pulse rate, increase blood pressure, and improve reaction speeds, for example, when participants are told they have taken a stimulant. Placebos have the opposite physiological effects when participants are told they have taken a sleep-producing drug.

The placebo effect is part of the human potential to react positively to a healer. A patient’s distress may be relieved by something for which there is no medical basis. A familiar example is Band-Aid put on a child. It can make the child feel better by its soothing effect, though there is no medical reason it should make the child feel better.

People who receive a placebo may also experience negative effects. They are like side effects with a medication and may include, for example, nausea, diarrhea and constipation. A negative placebo effect has been called the nocebo effect.


What Is the Placebo Effect?

By , About.com Guide
Updated February 01, 2010

About.com Health’s Disease and Condition content is reviewed by the Medical Review Board


Definition: A placebo, as used in research, is an inactive substance or procedure used as a control in an experiment. The placebo effect is the measurable, observable, or felt improvement in health not attributable to an actual treatment.When a treatment is based on a known inactive substance like a sugar pill, distilled water, or saline solution rather than having real medical value, a patient may still improve merely because their expectation to do so is so strong. To eliminate the effect of positive thinking on clinical trials, researchers often run double-blind, placebo-controlled studies.

Fast Facts About the Placebo Effect:

  • The word placebo literally means “I will please” in Latin.
  • The first known double-blind placebo-controlled trial was done in 1907.
  • The FDA doesn’t require that a drug study include a placebo control group, however, the placebo-controlled trial has long been the standard.
  • The NIH is funding several studies related to the placebo effect.

Sources: Placebo Effect, Robert Todd Carroll, The Skeptic’s Dictionary, Skepdic.com, The Mysterious Placebo Effect, by Carol Hart, American Chemical Society, Modern Drug Discovery, July/August 1999: The Healing Power of Placebos, by Tamar Nordenberg, FDA Consumer magazine January-February 2000

Also Known As: placebo, placebo response, power of suggestion
Common Misspellings: plasebo, placeboo, placebo affect

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Mynd ArtMynd Art ‏ @Mynd_Art

Your body is like a mirror of your belief system, #placebo effectbeing a prime example. What you think, your body makes happen.#secret

 


Kakilangit Kencana™Kakilangit Kencana™ ‏ @KakilangitKCNA

“If a placebo has an effect, is it any less real than the real thing?” ~Nathaniel LeTonnerre

 

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