From Guy Inchbald
Edzard Ernst takes a refreshingly practical approach to alternative therapies (26 April, p 44). Teasing out the genuine benefits of a therapy from the placebo effect can be next to impossible, as the placebo effect itself can bring about a marked improvement to some conditions.
The placebo effect must work by somehow stimulating the body’s ability to heal itself. If we rephrase this as “stimulating the body’s powers of self-healing” then we have a popular catchphrase used by many alternative therapies; searching for web pages containing “stimulate” and “self-healing” but not “placebo” just returned 154,000 hits. Perhaps therapists are being more realistic about the way their methods work than they are usually given credit for.
An important part of the placebo effect is that the patient must not think that they are taking a placebo. This is hard to achieve in conventional medicine without lying to the patient. But alternative therapies offer an inexhaustible supply of marketing spin to confound the patient’s understanding and thus allow the placebo to have maximum effect.
False claims about a substance’s benefit should, of course, be rooted out. But where a claim is not falsifiable it should not be discouraged, as it could be a vital part of the marketing spin. Even if the only benefit brought by a therapy acts through its placebo effect, that is no reason to discourage practitioners or patients from using it. A responsible health professional should surely prescribe such therapies whenever appropriate, and with enthusiasm.
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From Malcolm Learmonth, British Association of Art Therapists
In his inaugural lecture as professor of complementary medicine at the University of Exeter in 1993, Edzard Ernst quoted the writer H. L. Mencken: “To every complex problem there is a simple solution, and it’s wrong.” Yet he now claims that “the discrepancy between experience and evidence” concerning complementary therapies “is easy to explain”: benefit comes from “the encounter with the practitioner”.
This explanation is an oversimplification. Human encounters are complex. Their results cannot be tested by the randomised controlled trials that will yield the kind of evidence demanded by the UK-based Cochrane Collaboration, or the National Institute for Health and Clinical Excellence, or Ernst himself, because they do not lend themselves to the “isolate a single variable” approach that such studies require.
Psychological treatments based on encounter and relationship are not the same as placebo, for all that Ernst confounds the two. Meanwhile, orthodox medicine continues to roll out mechanistic drug and cognitive treatments whose evidence base is every bit as suspect as that of complementary therapies – as your report that antidepressants are barely better than placebos clearly shows (23 July 2005, p 4).
London, UK
From David Taub
Feedback seems to have missed the most startling aspect of Jennifer Buettner’s new “standardised” placebo (26 April). As a person who is extremely allergic to cherries, I am anxious to learn her secret for creating a “natural cherry flavour” that is “guaranteed to be inert”. Better yet is her genius in creating an inert form of dextrose.
All the sweetness and none of the calories? Forget the placebo business, she should sell this to the diet food industry.
Karlstad, Sweden
Upton upon Severn, Worcestershire, UK
