By Neal S. Meritz, MD

The Placebo Effect and Integrative Medicine

By Neal S. Meritz, MD

T

he placebo effect has been regarded as a potent yet mysterious force, an entity that can mimic powerful drugs, yet relies on tricking patients. If it makes a patient feel better, is it wrong to

deceive?

The medical literature is consistent over many decades in confirming decided improvement and therapeutic effectiveness of placebos in approximately one-third of all patients.

Physiologically inactive treatments have been utilized frequently throughout the history of medicine, and until only recently medical treatment has been primarily the history of the placebo effect. Placebos can be tablets, injections, surgeries, or procedures that themselves would not be expected to influence a patient’s condition, symptoms, illness, or pain. And yet, placebos are able to alter the patient’s perception of the disorder.

Any medical intervention or health care interaction can involve placebo effects. Placebos given by subcutaneous injection have significantly greater effectiveness than placebos given orally. A large pill works better than a small one. Placebos have a considerable effect on pain and on illnesses manifested by stress. The suggestion that a negative outcome will result from a placebo is called the nocebo effect. If a patient is told that a non-active placebo will cause a serious side effect, that patient is pretty likely to experience that adverse reaction.

Placebos and nocebos have frequently been utilized in routine medical practice by honorable practitioners. A placebo acts via a psychological mechanism as an aid to therapeutic suggestion, but the outcome it produces may be either psychological or physical.

The placebo effect in large part explains why Alternative, or Complementary, or Non-Traditional Medicine is thought to be beneficial. Integrative Medicine purportedly combines alternative and traditional therapies thus providing the best of both approaches. But this is merely a smokescreen behind which enthusiasts of dubious practices try to incorporate their unproven methods into routine health care. They use anecdotes and testimonials to provide placebo treatments and political maneuvering to keep regulatory agencies at bay.

Many proponents of Integrative Medicine advocate this without misleading intentions, but the damage may well be equivalent. The evidence for complementary therapies is often lacking but they continue to be sold as promising solutions to the problems of real medicine. When a patient feels better after having used a product or procedure, it is natural to credit whatever was done. The fact that the alternative method may exert a placebo effect that relieves symptoms is not sufficient reason to justify its use. Cause and effect is elusive.

The placebo effect remains an important way in which patient outcomes can be improved. Bedside manner and caring presence have long been promoted as important in health care. What sets Alternative Medicine apart is that it has not been scientifically tested and its advocates largely denies the need for such testing. The burden of proof must be

borne by those who make the claims. It is their responsibility to conduct suitable studies and to report them in sufficient detail. Usually, these studies are not performed because Big Pharma is unwilling to bear the cost. Drug companies refuse to pursue treatments that are low profit and generally available.

Alternative Medicine and Evidence-based Medicine are mutually exclusive. People who choose Integrative Medicine think that they are utilizing a safe effective treatment, but they are often deceived. The placebo effect may be an important factor in regular medicine, but it is the most important principle of Alternative Medicine. There exists a reasonable argument that there is no Integrative Medicine, only scientifically proven, evidence-based medicine.

References Peters, Sabine. Alternative Medicine and the Placebo Effect. Child snd Adolescent / Developmental Psychology 3/24/14 O’Mathuna, Donal P. The Placebo Effect and Alternative Therapies. Altern Med Alert 2003;6(6):61-69. 6/1/03 Gavura, Scott. So-Called Alternative Medicine. Science-Based Medicine. 6/14/18 Barrett, Stephen. Be Wary of “Alternative,” “Complementary,” and “Integrative” Healthy Methods. Quackwatch 4/17/22 Meritz, Neal. Integrative Medicine.

San Antonio Medicine August, 2021 Vol 74 No 8 Jarry, Jonathan. Beware the Trojan horse of Integrative Medicine. McGill University Office for Science and Society Newsletter. 10/29/20 McCartney, Margaret. The Scam of Integrative Medicine. BMJ 2011;343:d4446

Neal S. Meritz is a retired Family Practice Physician, Graduated from the University of Texas Medical School at San Antonio in 1972. He is a member of the Bexar County Medical Society.