If I misrepresented your opinion, I do apologize.
On the specific matter of EMDR, that will be something we in psychology have to sort out and ultimately disseminate to other professionals and non-professionals. I am sorry to have taken out some of my frustration on that topic on you.
Sorry, but I can’t leave this statement with a “nevermind”.
The proposed mechanism does matter when evaluating whether a therapeutic intervention has a chance of succeeding. Coming back to homeopathy, for example, the supposed mechanism involves a high (often extreme) level of water dilution of the alleged active substance to the point where there likely is not a single molecule of the drug left - but the water retains a “memory” of the drug* and has curative powers. To anyone with common sense and a rudimentary understanding of basic science, this is total bullshit**, and any perceived relief of symptoms or “cure” can be no more than the placebo effect. Which may be fine, if the problem DSeid’s patient has is chronic fatigue, but not fine if the patient has AIDS or cancer, which many homeopaths claim they can treat successfully. Once a physician has given the patient his blessing to try homeopathy for a “minor” condition, what’s the doc’s credibility when he later tries to dissuade the patient from using homeopathy in a useless attempt to treat life-threatening conditions?
For me, this remains one of the big challenges in utilizing placebos - how to avoid giving tacit support to dangerous quackery, along with other problems like maintaining patient trust and assuring safety*** and low cost of placebo therapy.
Sometimes you do need to take a stand against flagrant quackery (in as gentle a way as you deem effective) in the best interest of your patients - even if a few of them think you’re too “judgmental” and abandon you in favor of a quack who’ll tell them what they want to hear.
*what skeptics have trouble understanding is how homeopathic water can have a memory of a drug after a big series of dilutions, but does not have a memory of what animals have crapped into the water before its eventual bottling as a drug.
**see above.
***Placebos are not always inert when it comes to effects. Various side effects, some quite severe have been reported in use of placebos. The human mind is a powerful thing.
But the problem here is that placebos can’t work with informed consent. For a placebo to work, the patient must believe in it.
The best technique I’ve seen proposed is, “Some people find relief from this treatment and some don’t. We don’t know why it works, but it might work in your case. Would you like to try it?”
Works for any treatment with no known mechanism of action, or any treatment for which the success rate is less than 100% - which is all of them, “alternative” or not.
That could work with a treatment that is known to be safe, but whose efficacy has not yet been determined. But if it is something whose efficacy is known to be simply placebo level, then you are doing a disservice to our system of health care. Billions of dollars are being diverted into treatments that do not work. Insurance companies are forced to fund it, the NIH is forced to fund it, and it is most likely costing lives due to wasted resources, if nothing else.
The only thing I was responding to was your assertion that you can’t have informed consent and use the placebo effect to your advantage. I believe you can, without using the word placebo, adequately inform the patient of the risks and benefits of a placebo treatment, as well as the fact that it may not work for them.
Jackmanni, I will agree with you up to a point - as they say “extraordinary claims require extraordinary evidence” - but if something is shown to work by the evidence then it works. That observation does not mean that the mumbo jumbo explanation of why it works is correct, even if I cannot come up with an explanation of why it works that fits current scientific models. I can believe that acupuncture works for some very specific and limited indications without accepting qi as the reason why and without being able to offer another explanation with great confidence (even though I still suspect “gating” has something to do with it). Scientifically it just becomes a reason to expand our understanding to fit the unexpected observation. It is no surprise that our understanding, while much better than understanding of a few decades back, is incomplete and that we cannot explain everything that happens. (Being unable to explain how the moon comes between the sun and the earth did not mean either that the eclipse did not actually happen nor that it occurred because the gods were displeased with our sacrifices.) That why the scientific method keeps at it, to explain what we currently cannot.
I do not see how my telling people that acupuncture may work for their headaches if they want to avoid the medications that I have been talking about, undermines my credibility when I tell them that it would be a mistake to take homeopathy instead of chemotherapy for their cancer. I even do not see how my hearing from a patient that they are wanting to try homeopathy for their irritable bowel syndrome and responding to that fairly neutrally, only offering my opinion if asked, and then telling them that honestly I think that homeopathy is a crock but it won’t do any harm and I understand how they might want to try something else since what we have to offer is so limited, interferes with my later saying that doing it instead of some other proven care option for another condition at some later date is a bad idea.
Let’s face it, for many conditions the best thing to do is nothing at all. But doing nothing is hard work. Really. It is tough for people to wait something out even when it is clear that most of what there is to do will only cause more harm than good. Some people do need something benign to do while waiting and it is important that we make sure that what they do is at least benign.
Strassia my telling them that there is no evidence that the method works and that I do not believe it does; that doing this or that thing is harmless but that this other version has some real risks associated with it so I would strongly advise against it, will not prevent a placebo effect. If they are trying it anyway, even when I have told them that no evidence supports its claims, then they still believe enough that it might work that the placebo effect can still occur. The mindset is that well, it hasn’t been absolutely proven to never work … and I want to try something. I agree with Jackmanni to this degree: if I know that the evidence is that the intervention is ineffective, then I have an ethical obligation to inform patients of that. Again the difference is that I can still be supportive of their trying it anyway if it is harmless and not substituting for treatment that is proven to be effective.
Has anyone ever gone to a “woo” doctor and not been told they are allergic to wheat and dairy and to stay away from sugar?
And here I thought this thread would be about doctors getting hit on by hot marketers…
The placebo effect is a weird thing. The author of the book I mentioned above did the data analysis on a single blind acupuncture test. Part of the experiment was to ask the patients to rate their confidence in the treatment. There was an extremely strong correlation between belief in that they were getting (much stronger than any correlation with what type of treatment they were actually getting). I also recall a study from a few years ago that found that study participants reported more pain relief when they were told the placebo was 2.50 a pill than when they were told it was .10 a pill. If you are using a placebo for treatment, the more confidence you can instill in the patient that the treatment will work, the better the results will be. If a treatment is really a placebo, then misleading the patient is the best way to get it to work.
Hence the ethical dilemma inherent in using placebos. If you are counting on the placebo effect to for a treatment to work, you need to give the patient as much confidence in it as you can to get the best result. Would you want your doctor to mislead you if it meant pain relief?