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Letters to the Editor
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CAM (Complementary and alternative medicine)
Harnessing the “placebo effect”
From Professor B. L. Furman, FRPharmS
The question posed by Chris
Morris (PJ, 18/25 December 2004, p880) about “the
efficacy of prescribers spending more time with their patients and supplying
conventional medicines” is an interesting and challenging one,
not only in assessing the effectiveness of complementary and alternative
medicine but also when assessing conventional medicines themselves.
There is a large literature on the “placebo effect” which
perhaps started with Beecher’s classic paper in 1955.1 However,
it has been subsequently argued that the placebo effect may be part of
a spectrum of care and treatment2 and it has been suggested that there
is little evidence to support the assertion that placebos have powerful
clinical effects.3 The methodological problems in estimating placebo
effects have been reviewed.4 In an excellent and thought provoking review,
Papakostas and Daras5 argue the case that not only placebos but also
any feature of the non-specific elements of the physician-patient encounter
may engender the healing response and that one should speak of “the
response to the healing situation” rather than “the placebo
response”. Which of the many factors (including “spending
more time with their patients”, which itself probably comprises
several factors) of this physician-patient encounter contribute does
not appear to have been investigated. If the response to the healing
situation can be understood, then it could be harnessed and incorporated
into standard pharmacological and surgical treatments. This may reduce
patients’ dissatisfaction with conventional medicine, while concomitantly
increasing its effectiveness.5
Brian L. Furman
Dean of Science
University of Strathclyde, Glasgow
References
1. Beecher HK. The powerful placebo. JAMA 1955;159:1602–6.
2. Kienle GS, Kiene H. The powerful placebo effect: fact or fiction?
Journal of Clinical Epidemiology 1997;50:1311–8.
3. Hrobjartsson A, Gotzsche PC. Placebo interventions for all clinical
conditions. Cochrane Database Systematic Review 2004;3:CD003974.
4. Hrobjartsson A. What are the main methodological problems in the estimation
of placebo effects? Journal of Clinical Epidemiology 2002;55:430–5.
5. Papakostas YG, Daras MD. Placebos, placebo effect, and the response
to the healing situation: the evolution of a concept. Epilepsia 2001;42:1614–25. |
The
Pharmaceutical Journal