November 20, 2013

Alternative Medicine and the “The Remarkably Powerful, Highly Underrated Placebo Response”

The quote is a chapter title in Do you Believe in Magic? The Sense and Nonsense of Alternative Medicine, the excellent new book by Dr. Paul Offit, and the best I've read on this topic. Offit is the author of other books like Autism’s False Prophets and Deadly Choices.

Much of the book details how alternative medicine – an unregulated industry under no legal obligation to prove its claims or acknowledge its risks – can actually be harmful to our health. He explains how:
  • Megavitamins increase the risk of cancer and heart disease.
  • Dietary supplements have caused uncontrolled bleeding, heart failure, hallucinations, arrhythmia, seizures, coma and death.
  • Acupuncture needles have transmitted viruses and pierced hearts, lungs and livers.
  • Chiropractic manipulations have torn arteries.
Offit also takes on my bêtes noires: the media celebrity doctors -- like Oz and Mercola -- who promote alternative medicine.

But Some Alternative Therapies Work . . .
. . . thanks to the placebo response. Dr. Offit writes:
There’s no such thing as conventional or alternative medicine or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t. And the best way to sort it out is by carefully evaluating scientific studies -- not by visiting Internet chat rooms, reading magazine articles, or talking to friends.

Despite the lack of scientific evidence, many popular therapies do work, Dr. Offit notes. In the past, when people found relief using unsubstantiated therapies, critics suggested the improvement was "all in their heads.” But in the 1970s, scientists discovered that the body -- in response to pain -- produced chemicals that acted like morphine. Thsse chemicals -- endorphins -- created a placebo pain relief that was physiological and real. It wasn’t all in their heads.

Acupuncture as an Example of the Placebo Response at Work
Researchers have spent lots of time and money studying acupuncture in people who claim it works. First, they compared outcomes when needles were inserted into correct and incorrect acupuncture points. No difference. They used standard and retractable needles; patients felt the sting of the needle but didn’t know whether it had punctured the skin. Again, no difference. The patients experienced pain relief.

Psychologists have argued that this placebo effect is simply an exercise in conflict resolution. To allay their concern that acupuncture is unconventional and expensive ($65-$120 per session), recipients simply "believe" it works. BINGO. Conflict resolved.

Here's a thought: what's wrong if real pain relief results from a patient's body creating its own endorphins? Isn't that process preferable to using drugs, with their often negative, unintended consequences?

Offit notes that those who dismiss acupuncture make three arguments:
  1. Acupuncture is a deception. If acupuncturists were honest, they would tell their clients: “The reason it works is that you think it works. And thinking alone might be enough to release endorphins.” Of course, such comments short-circuit the placebo response.
  2. Acupuncture is expensive. But it may well be that the more expensive, the better. MIT researchers administered two different sugar pills for pain. One group was told their pill cost ten cents; the other, $2.50. Participants who got the costlier pill actually experienced less pain.
  3. Acupuncture needles are risky. They have punctured hearts, lungs, and livers and transmitted viruses like HIV, hepatitis B and hepatitis C.
Other Possible Benefits of the Placebo Response
In research findings even more remarkable than those involving endorphins, scientists discovered that people could suppress or enhance their own immune systems. In one study, patients who suffered itching, sneezing, and watery eyes when exposed to pollen on flowers experienced the same reaction when exposed to pollen-free artificial flowers. They had learned the allergic response and released their own histamine.

Studies also found that healthy men could "learn" to release their own cortisol, a "stress" hormone produced by the adrenal gland. In another study, a teenage boy with lupus had his medicine combined with a distinct taste (cod liver oil) and smell (rose perfume). Then he received a placebo with the same taste and smell. The boy learned to suppress his immune response, and -- as a result -- needed less frequent doses of his regular lupus medicine.

"If people can learn to stimulate or suppress their own immune responses," Offit says, "it’s not a leap to believe that placebos can impact a variety of diseases. Even though most alternative medicines don’t work better than placebos, some placebos work. So why not use them.”

That’s the positive take on alternative medicine and placebos.

Offit’s next chapter is: “When Alternative Medicine Becomes Quackery.” That's our topic for tomorrow.

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