What’s Wrong With the Placebo Effect?

In my years as a Physical Therapist, I have read many research articles and even submitted one for publication. I have read some articles lately that attributed the positive effects of Physical Therapy treatment of acute low back pain to the Placebo Effect. There are a lot of research articles that I have read over the years that, in a belittling manner, attribute positive effects that the authors or editors don't understand to the Placebo Effect. This brings up to issues. The first is that in the scientific literature, often positive results of studies that don't fit neatly into our version of how things should be are sneered at and ascribed to the Placebo Effect as if that makes them less valuable and less valid. The second thing is, what is wrong with the Placebo Effect anyway? I think that it is wonderful that the mere belief that something will help, makes it help. It is a testament to the power of an individual to heal.

In the studies of Physical Therapy, there was definitely statistical improvement in the condition of the patients receiving treatment. The studies were several years old and the authors and editors could not or chose not to give an explanation as to why the patients benefitted. They concluded that it must be the Placebo Effect. I could give a plausible explanation as to why they improved that fits into a mechanical model based on our current understanding of how things work. Others could probably give explanations that fit into models that they work within. But more disconcertingly, was the impression that the study gave that the benefits were not important or not real. This attitude can make people overlook the benefits of the treatment.

The other thing that I see frequently, is that a study might conclude that it is "merely" because someone is receiving attention that they improve. Attention, compassion, "Universal Love" are the intangibles that are inseparable from receiving good health care. These, in conjunction to high level technical expertise in one's field of practice make for a powerful combination. As good friends of mine often says, that people often go to a doctor or health practitioner to get some (universal) love and acceptance as much as to get a drug.

I was working with a patient the other day who came to me for help with her neck pain and nerve irritation causing numbness in her arm and hand and for knee pain and tightness. She came in with 60% of neck rotation right causing pain and numbness into her arm and unable to straighten out fully her right knee and stand on it without pain. During the treatment session I was mobilizing her neck joints, gently mobilizing her nerves in the arm to help the numbness, and mobilizing her knee to regain full extension. We were talking about the Placebo effect as she related a story to me of a doctor in the mountain country. Apparently the folks around there would come to him with various maladies complaining that someone had put a "hex" on them. Try as he might, he could not convince them that a "hex" could not make them ill. Finally he started giving them blue water in a vile to take, and it helped them to feel better. This is a common type of story which I think we brush off as being incidental.

When this woman got up off the treatment table, she had gained neck rotation to 80% which no longer caused numbness into her arm and had much less neck pain. She could fully extend her knee and stand on her leg without knee pain. I attribute these improvements to loosening up the tight fibrotic tissues that are affecting the joint mechanics and limiting to joint play or accessory motion glides and to restoring the natural ability of her nerves to slide, glide, and elongate and adapt to normal human motion. Someone else who didn't think in these terms might attribute the improvements to the Placebo Effect. I'm not sure why the mountain folks that this womans' story related to started to improve when they got something that they thought would help started to improve, but I wouldn't invalidate the results just because I don't understand them.

There is another study that I read, which was a nicely designed study where people with AIDS were randomly assigned to two groups. One group was prayed for, the other was not. The people did not know which group they were in. The people doing the praying were from all over the country and from many denominations and spiritual disciplines. The people who were being prayed for, statistically did better in the parameters of quality of life and longevity than the people in the group that was not prayed for. These results can not be attributed to the Placebo Effect since the people in the study did not know which group they were assigned to. This just illustrates that there are influences on our lives that don't fit into the nice little scientific paradigm that we like to try to fit into. So what is so bad about the Placebo Effect anyway?

Written by Krista J. Clark, PT

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