I like to pretend I practice evidence-based medicine. Pretend in the sense that I make a big fuss about how EBM I am when what I already do accords with a recent meta-analysis. But when it doesn’t, I make a point of rubbishing the research, on account of it being rubbish, or quietly carrying on as I am and hoping that no one will notice.
Thankfully, slabs of evidence which crush my pre-conceived notions of good practice come along fairly rarely. That said, I have only just recovered from that shocker in the college rag that concluded patients who believe they’re suffering from cardiac pain really are more likely to be suffering from cardiac pain. That is just so counter-intuitive on every level that I am still demanding a recount.
Anyway, now there’s this: ‘Can honestly prescribed placebos evoke meaningful therapeutic benefits?’ .
I’ll lead you gently through this, and those of a nervous disposition should look away now. So, you know about the placebo effect, yeah? Good. And you know they only ‘work’ because patients are lured into thinking they might genuinely benefit – the psyche therefore tricking the soma into feeling better, right? Wrong.
Because, apparently, even if you tell the patient that the treatment being administered is a placebo – in essence, that this is fresh air in tablet form that I’m giving you, but, hey, let’s give it a go – the patient still gets better. That’s right: fessing up that you’re giving them nothing, and therefore not building in a psycho-tickling expectation of improvement, does not stop them from improving.
The only rational conclusion to draw from this is, WTF?
I have always steered clear of placebos on the basis of the deceit required. Now it seems the supposed sleight-of-prescribing was real magic all along: you can adopt a policy of complete honesty and still cure all those migraines, IBSs and TATTs.
I don’t know whether to laugh or cry. But I do know that I’m thoroughly confused. Would someone who knows about research kindly take a look at this paper with a view to finding enough flaws to allow me to reconvene back in my comfort zone?
In the meantime I will console myself with the fact that, at last, homeopaths have no reason not to practice in an honest way. Because, now, they can dish out their various versions of water without having to dress it up in pseudoscientific claptrap. And it will remain as effective as it ever was.
Dr Tony Copperfield is a GP in Essex
