In my series on Chinese Pseudoscience Most of the benefits are quite clearly ascribed to something we call the placebo effect. I point this out over and over again but this special effect has a bad reputation, and most people who feel violated by my skepticism seem to picture 'placebo' as 'fake and doesn't work'. But that's far from the case.

I think it's about time to actually set the record straight.

Positive Thinking

When simplified, people tend to boil the placebo effect down to 'positive thinking'. But try telling somebody suffering from depression to just stop thinking so negatively. Not quite how it works.

I'm not saying the treatment doesn't work, I'm just saying that the method is built on a false premise. If I go to acupuncture to burst a bunch of blisters on my back, I'd be fine with the explanation that the needles pierced the skin and burst them accordingly. But if you give me thousands of years of history of qi points and meridian pathways that are manipulated in specific locations around the body, thus releasing healing properties that burst the blisters, I'm going to walk away with a rather sarcastic smile.

Placebo is much more than positive thinking or fake medicine.

In short

You'll find a lot of alternative medicine revolves heavily around physical - and mental - pain relief. Back pain, leg pain, anxiety, headaches, constipation, and other psychological varieties such as stress, some medicinal side effects and so on. This is convenient because the placebo effect is very good at dealing with these.

Though it cannot heal cancer, make you lose weight or remove parasites, it can reduce the symptoms that these conditions produce. And that's what it's all about.

How it works

Well, nobody is 100% sure, but it's complicated. Consider it like this. You walk into a homeopathy department and are greeted with this:

Typically it seems you will see a warm, bright area, and you enter an office that is comfortable and filled with books, polished wood and a calming atmosphere. Here you will return routinely and be given a range of exotic medicine you couldn't begin to understand.

This process makes you very self aware and your brain starts to perceive the pain differently. In the same way those annoying types of people laugh at their own jokes and kind of force you to laugh along even though you hate everything about the person and their shitty joke, this environment with extended routine pushes your mind to a place far away from sitting at home concentrating on how bad the pain is, and closer to 'wow these people are looking after me and fixing me with a customized, personalized set of medication, and they even (maybe) gave me a discount!'.

Another example would be babies. You'll find that when they hurt themselves, if they're aware that they're alone, they kind of go about their business, walk it off, far more than if they are aware their mother is in screaming distance. In that case, suddenly the pain of a stubbed toe is a near death experience for them. It's not that they're lying per se, their brain just knows they can get immediate help.

Is this a scientific viewpoint?

Naturally! Who do you think I am, a musician??

A Harvard study by a somewhat hit-and-miss researcher, Ted J. Kaptchu, found that placebo, or sham acupuncture reduced asthma patients' feeling of shortness of breath, even though all the tests on the lungs showed nothing had actually physically improved.

This raised a concerning issue that I have raised before. Using alternative medicine can and has done more harm than good. By making people believe symptoms and the problems are gone, they are putting themselves at greater risk. By believing and perceiving wellness, one could put themselves in a fatal position, and has historically lead to many deaths indeed, though I'd expect less extremes in the modern world.

Physical Effects

What's most fascinating is that it's not just a psychological trick based upon a cultural trust of doctors and a belief that you're taking something real. There are real, physiological effects in response to the anticipation of a drug working, too.

The human body has its own natural painkiller called Endorphins; a group of hormones secreted within the brain that trigger and activate opioid receptors. These opioid receptors have a pain-relieving, or analgesic effect, and this is what many current painkillers activate to help with your headache and get you to bed on time.

_{This little worm gets released from your brain}

With the anticipation and belief of a medicine working, the brain activates the same response, releasing the same analgesic effect.

To back this up, another study looked at patients with advanced Alzheimer's.

...if prefrontal functioning is impaired, placebo responses are reduced or totally lacking, as occurs in dementia of the Alzheimer's type.

With the opioid receptors damaged, Alzheimer's patients fail to benefit from both real and placebo effects, because their ability to function is based on the very same thing. But it's not all about positive pain killing effects:

Nocebos

To further complicate things, the nocebo effect is basically the same as the placebo in style, but with negative outcomes. Studies that had doctors inform some patients of potential side effects - specifically erectile dysfunction - showed a significant increase of those side effects occurring in the patients told (44%), compared to those who were not told (Less than 15%). Rather than being a release of painkiller doing the work here, it was shown to instead be the anxiety in the bedroom and prejudice of the drug that caused these effects in patients.

In other studies, substantial numbers of patients choose to drop out because of perceived negative side effects of the medicine, even though the medicine itself was a benign placebo pill.

What does this mean for the placebo?

The above demonstrates that the Placebo effect is not just a psychological trick, but a physical, real process the body goes through. Whether or not it is equally as effective as actual medicine or not will depend on a range of factors in each individual circumstance, and this is only really one area of an otherwise very complicated field of study.

Ethically, it is up to individual doctors to decide whether or not they should be used, but as far as I know, a good doctor uses them sparingly, even though they are known to work even if the patient is told about them. In the right hands, I see their usage to be safe and a decent way to solve some issues without any risk of side effects.

In fact, in the US, federal law requires a double-blind placebo test to be used in any test of new drugs, making sure a drug outperforms the real effects of a placebo in at least two clinical trials (This is largely how many Chinese research papers come up with so many positive results, adding a simple footnote that they 'couldn't perform a double blind study' - something I've seen half a dozen times in my Chinese pseudoscience series).

On the other hand, I strongly condemn alternative medicine for abusing this phenomenon for their own financial gain and reputation.

Is alternative medicine really that bad, if it still has a positive effect?

It is easy to find examples of alternative medicine gone wrong, especially in earlier history as mentioned above. But it can have negative effects in so many more ways in the modern day, too.

Alternative medicine does not need to go through the same rigorous testing, risk management and approval that actual medicine does. This means they can potentially be dangerous by means of medicine with dangerous ingredients, or even damaging lungs and causing strokes, in the cases of acupuncture and chiropracty, respectively.

Aside from direct health risks, alternative medicine is expensive because, you know, it's a business and not much else. Ignoring the irony of the main target audience being critics of 'big pharma', this can legitimately cripple the savings and financial stability of desperate patients looking for non-scary solutions.

It's worrying that more alternative treatments are wanted for kids

There's a psychological set of issues too. Patients receiving A.Medicine are often blamed for screwing up if the medicine didn't work; perhaps they weren't trying hard enough or didn't wait long enough, or you weren't relaxing hard enough. This never happens in established medical practices - unless there's evidence to say so, anyway. Additionally, the constant chase of hope can be exasperating, leading them on and feeding their desperation. When it comes to terminal and Incurable issues, you shouldn't be making them pay a large sum to go chasing denial and bargaining against grief. There's something very ethically wrong there I won't bother going into here.

What does this all mean for alternative medicine?

It means that, regardless of the negatives, they're going to be around for a long time, unfortunately. As long as conditions are passive enough to only really address pain, alternative medicine can claim to fix this, no matter how many corners it's backed into by real science and medicine. As I said in a previous post, Alternative medicine is an ever-receding pocket of healing, that shuffles its way around to whatever is hip with dissatisfied mums at the time and place around the world. From Western detox to Eastern Qi, the simple process of releasing endorphins will be a multi-billion dollar industry, likely for generations to come.

To make matters worse, every time a study - legitimate, flawed or otherwise - shows that by chance, there does indeed appear to be an effect slightly better than placebo, the media jumps on it and spreads it around the world as proof that it's the new medicine. A quick look at any of these studies, from my experience, has written in detail the huge critical flaws in the research process, or has failed to be replicated, or the healing properties arise out of pure luck rather than the 'science' they claim is behind the process.

It is my hope that the risk to the patients with real problems is at least minimized as the decades go by, like the aforementioned asthma patients, as well as those suffering from IBS, chronic or terminal illnesses and more. But I won't hold my breath.

Image Sources:

Homeopathy room
Spending chart (more fascinating charts within)

Other images CC0 Licensed

_{Sources: Asthma Study | Alzheimer's Effect | Erectile Dysfunction Nocebo Effect | A deep look into Kaptchuk's often-flawed studies | Ways A.Medicine placebo harms patients}