11 January 2008

“If there’s little risk, why not exploit the therapy?”


“U.S. News‘s Avery Comarow has been editor of the America’s Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.”

In his personal blog he reflects on recently reporting on alternative medicine:

“Academic medical centers all over the country—venerable altars of clinical research and practice like Mayo and Duke, top-ranked cancer centers, and even children’s hospitals—are scrambling to roll out therapies that five or 10 years ago most regarded as dubious at best, crackpot at worst. Acupuncture, homeopathy, herbs, traditional Chinese medicine.

When I began my reporting, one of the first things that struck me was that not a single researcher or clinician bothered arguing that the evidence for any of the alternative therapies they were testing and using on patients was persuasive. To the contrary, all agreed that almost none of the studies that show positive results have been designed or run very well.

If I wanted an evidence base, I was out of luck. But absence of evidence, as the late astronomer Carl Sagan said, is not evidence of absence. And if we lack an understanding of or explanation for how something works (as was the case for decades for how an airplane could stay airborne), that doesn’t give us the ammunition to state that it doesn’t work. In philosophy, that kind of reasoning is called argument by ignorance.

The patients I spoke with told me how acupuncture had made their allergies go away, how they were able to avoid painkillers after major surgery because of hypnosis or visualization or other mind-body techniques, how a homeopathic remedy that science would regard simply as water reduced swelling and pain within hours after an injury. I heard many such anecdotes, along with candid appraisals of treatments that seemed to be effective only for a short time or not at all. These people were not all true believers.

It may be that the placebo effect is behind most of the successes claimed for alternative therapies. I suspect it probably is—it can be quite powerful. Suppose we could tap into that power. Maybe we’d need to redefine our thinking about a therapy’s ability to work. What does “work” mean, anyway?

I wrestled with the story for weeks, because those patients made a considerable impact on me. Yes, I’m still an evidence guy. I still want well-done clinical trials to be the foundation for care. I still want researchers to set high standards and to meet them before claiming success. But we’ve been learning some amazing things in recent years about the way the mind affects the body and the body affects the mind, discovering a relationship far more dynamic and interlocked than anyone previously believed. It seems as though many alternative therapies may exploit this relationship. If there’s little risk, why not exploit the therapy?”



  1. Because it costs a bloody fortune.

    Comment by hairnet — 11 January 2008 @ 10:38 am

  2. Evidence?

    Comment by homeopathy4health — 11 January 2008 @ 10:41 am

  3. I do find the notion that some ailments can be alleviated by ritual and suggestion that affect their mental state fascinating, however that notion is not certain and no credible scientist would make the claim that the placebo effect can heal serious diseases such as cancer. In fact a persons mental state has no bearing on survival rates from cancer. I am curious as to why you are promoting this story? After all it undermines homeopaths claims that the remedies actually do anything and supports sceptics claims that a sympathetic chat and a cup of tea are responsible. I applaud your open mindedness in giving this issue an airing and hope you take on board its conclusions.

    Comment by gimpy — 11 January 2008 @ 11:23 am

  4. I support this story:

    a) because people get better.

    b) because it supports alternative medicine even though there is currently a lack of scientific understanding.

    Comment by homeopathy4health — 11 January 2008 @ 1:12 pm

  5. I support this story as well, even though I disagree with the “probably placebo” conclusion. But I understand the attitude. I said the same thing once upon a time. The idea that it’s not just a “mind thing” can be profoundly disturbing. It opens the door to a lot of strange, woo-woo ideas that I was not and in some cases am still not comfortable with. However, a true scientist does not dismiss inconvenient evidence.

    I applaude Avery Comarow for having the courage of honesty and for putting patients above idealogy.

    Comment by John (Woo-Woo Science) — 11 January 2008 @ 8:49 pm

  6. I find it disturbing that so many people are happy to claim that the placebo effect works, when they are totally unable to explain HOW it works, yet they are not prepared to accept that any other equally inexplicable method of treatment works.

    Not quite a level playing field, is it?

    Comment by Ohreally — 12 January 2008 @ 12:37 am

  7. ohreally, the placebo effect has been ‘proven’ in tests. there is a wealth of replicable experiments showing this.

    As for costs, please consider the cost per patient of running the homeopathic hospital in tunbridge wells.

    Comment by hairnet — 12 January 2008 @ 11:52 am

  8. which tests?

    the cost per patient.. which is what exactly?

    Comment by homeopathy4health — 12 January 2008 @ 1:29 pm

  9. The placebo effect is a name for an UNEXPLAINED effect of giving a medicine (or other therapeutic intervention). It has not been proven, only demonstrated to occur, and it is the result of an UNKNOWN number of factors. The theory of the placebo effect is less well founded than homeopathy by a huge margin. Also, homeopaths have a much better and stricter definition than orthodox medicine, since they can recognise and evaluate a much greater range of responses to treatment.

    About cost: a GP costs about 4 times what the average homeopath charges, and specialists even more, and that is before the charges for drugs … and more drugs to deal with the problems of the first lot … and yet more drugs to deal with the new problems … and so on.

    Comment by Ohreally — 12 January 2008 @ 1:52 pm

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