Newsletter sign up
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
NICE should recognise 'placebo effect' of complementary therapies
10 Aug 09
NICE should include benefits from the ‘placebo effect’ of complementary therapies such as homeopathy when they assess them for use on the NHS, according to leading think-tank the King's Fund.
Complementary therapies - such as homeopathy - are often criticised as being 'nothing more than placebo', but a King's Fund report now says these effects are important and should be considered during the NICE appraisal process.
Calling for a 'holistic approach' from NICE, the report says complementary therapists often spend longer with patients and ‘maximise the benefits of the setting’, and the effect of this is overlooked by the NHS.
‘As long as findings from research can provide confidence in the positive effect of the physical intervention at the heart of the treatment, then any added benefit brought by the therapeutic relationship and the context for treatment should count as part of the treatment effect,' the report says.
‘For complementary therapies such a holistic approach to effectiveness should be adopted by bodies such as NICE, when comparing cost-effectiveness across a range of treatments.'
The controversial proposals come from a heavy-weight panel of independent experts – including former president of the Royal College of Physicians, Dame Carol Black – but have already been criticised as ‘double standards’ by one critic.
The report also says new research is needed into complementary therapies, but ‘these do not need to be placebo-controlled as long as they control for the possibility of the patient getting better over time.’
Professor Stephen Holgate, professor of immunopharmacology at the University of Southhampton and one of the report’s authors said: ‘As scientists, we have often sneered at the placebo effect. But as doctors, we know it can have a real impact on the outcomes of treatment for our patients.’
But Professor Edzard Ernst, professor of complementary medicine at Peninsula Medical School in Exeter, said: ‘This is the introduction of double standards through the back door.'
‘In this case we might as well allow an ineffective medication on the market, because it too will have a placebo effect.'
Readers' comments
I wonder whether the esteemed professors Black and Holgate have heard of informed consent? Are they going to lie to their patients in order to get the placebo effect to work? I am avidly interested in the ground-breaking study designs that these experts will develop, which will somehow "control for the possibility of the patient getting better over time". Come on, do tell.
So how exactly is NICE going to assess the cost-efficacy of a placebo treatment?
What a load of BS. Non-complementary therapies produce placebo effects just as strongly as complementary therapies, yet we don't accept those treatments because they produce a placebo effect. We accept them because they are MORE effective than a placebo. Why should complementary treatments be treated in any other way? Clinicians who are empathetic and spend time with their patients are well demonstrated to have positive effects on outcome including improved adherence to treatments. If these effects are worth including then let's ensure are clinicians who provide effective treatments have the training, attitudes and resources (including the time) to provide patient-centred, empathetic care. And why call that approach to the treatment a placebo? Sounds more like an effective psychosocial intervention to me.
It may often be forgotten that the design of the usual RCT may have the effect of minimising the non-specific effects of treatment. Inclusion of a placebo arm in research enables the specific effects of the treatment arm to be evaluated but provides no information on the magnitude of the placebo effect nor any other non-specific effects. One requires both a no treatment arm and placebo arm to get this data. I understand that very few studies done in the past have provided both these so our knowledge of these important factors remains sadly very limited.