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Double standards from the King's Fund

In Complementary and Alternative Medicine, many people seem to believe strange things: if a treatment, say homeopathy or spiritual healing, has powerful non-specific effects (and no specific effects), it can nevertheless be deemed to be a good therapy.

In Complementary and Alternative Medicine, many people seem to believe strange things: if a treatment, say homeopathy or spiritual healing, has powerful non-specific effects (and no specific effects), it can nevertheless be deemed to be a good therapy.

The most important thing, proponents of this argument say, is to help the patient, no matter by what mechanism!

True, the placebo effect helps patients and, in the end, that's what all clinicians want to do. But come on, think again! We don't need a placebo for generating a placebo effect! If you prescribe a treatment with specific effects (a 'non-placebo') with empathy, care and sympathy - if, in other words, you manage to establish a good therapeutic relationship with your patient - she will benefit from a placebo effect plus from the specific effect of the prescribed treatment.

To turn this argument around, if a clinician prescribes a placebo, he prevents his patient from benefiting as much as she ought to: she would be helped by the placebo-effect but obviously not by any specific effect. I would have thought that such considerations are fairly elementary and that we have all understood them during our basic training. Well, I was wrong!

The King's Fund recently published a report 'Assessing Complementary Practice' which tries to bang in the point over and over again that CAM differs from the rest of medicine in respect to non-specific effects: '…research into the clinical effectiveness of complementary practice should control for temporal and regression effects but not necessarily seek to control for the positive aspects of the context in which the practice is delivered or the therapeutic relationship that the practice seeks to create.'

Elsewhere, the report states that 'it may be appropriate…not to control for placebo effects' when testing complementary therapies. Anything else? Yes, you probably guessed it: 'payment by…the NHS may be appropriate' for such a placebo therapy.

Those who wrote this report seem to have a firm grasp of the wrong end of the stick!

Professor Edzard Ernst Professor Edzard Ernst

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