The placebo response. Who cares?

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The ‘gold standard’ method for testing the effectiveness of a treatment is the ‘randomised, placebo-controlled’ trial. Here, a group of individuals are randomly allocated to received an active treatment (e.g. a drug) or placebo (inactive pill). If the drug leads to benefits that are statistically more significant than any achieved with the placebo, the drug is generally deemed effective. If there’s no statistically significant difference, the treatment is generally deemed ineffective.

The placebo response, though, is not imagined improvement, but often objective and tangible improvement in someone’s condition. We perhaps don’t understand what drives the placebo response, but there’s no denying it’s real. It can also be very powerful.

In general terms, though, the placebo response is viewed negatively by many scientists and doctors. For example, many doctors will refer to any benefits natural medicine appears to have as ‘just the placebo response’. Well, often we have no idea whether it’s placebo or not, because often the approach has not been subjected to rigorous and study. Even if any improvement is down solely to the placebo response, would that be such a bad thing?

I was thinking about this recently while talking to a colleague about a piece of research regarding a light-emitting device (see here). Basically, this piece of kit shines light into the ears and this might have the ability to alleviate low mood and anxiety states, particularly where this is related to low light exposure (such as the winter months). A piece of research supports its effectiveness, though as I pointed out in the original post, the research was hampered by the lack of a placebo group. I mentioned this to my colleague, who responded: “So what?”

Now my colleague is a clinical psychologist, and holds a PhD. He reads and assimilates lots of research. He’s just the sort of person who might be expected to seize on the lack of a placebo group in the study as a fatal flaw. But actually, his reaction was one of not caring. Why not? Well, my colleague is a clinical psychologist, and sees individuals with psychological issues. His focus, ultimately, is to help his clients think and function more effectively. He does not care so much how the benefits might be achieved: He’s results-driven.

So, in the absence of a placebo group in the study I linked to, what are my colleague’s beliefs? Well, the study showed that a simple and easy intervention led to a significant improvement in the mood state of the great majority of people who used it. To my colleague, this is what matters. It does not matter to him (nor does it to I) that the benefits may have been as the result of light exposure, the placebo response, or a bit of both. In essence, all he cares about is that a person feels better.

I have seen thousands of people over the years and tried lots of different approaches in the hope that they can reduce or even rid themselves of symptoms such as fatigue, irritable bowel syndrome, low mood, skin complaints and arthritis. The great majority of the approaches I use (just as much of conventional medicine) have not been subjected to systematic study. However, I would not advocate the approaches if I’d not found them to be generally effective in practice.

Now, a lot of the clients I’ve seen over the years are informed individuals who are only to aware of the placebo response, and the fact that any benefit they see might be driven by this rather than the dietary or other approach they have taken. However, not once has a patient who has seen significant improvement in their condition abandoned it because it might have been due to the placebo response. On many occasions I have even had discussions about this. Invariably, even when individuals are well aware that we have no idea whether their improvement was down to the placebo response or not, they simply don’t care. All they care about is that they’re better.

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