From the desk of Dr Sam Shohet
BDS MGDS RCS(Eng) LiAc MBAcC ICAK
IN DEFENCE OF THE PLACEBO
Medicine’s Elite
It seems that Medicine’s decision makers, those who decide what is right and what is wrong, what is good therapy and what is not, what is science and what is quackery, what we should be spending our money on and how, have been at it in spades recently. But are they right and how do they arrive at their life affecting decisions? Are scientific tests all they are cracked up to be and how can we separate the wheat from the chaff and get the best of all worlds?
WHAT RATTLED MY CHAIN
Homoeopathy
During the last couple of weeks I was involved in a few radio talk programmes over two “hot” topics that were circulating in the media. One was about the suspension of payments for Homoeopathy by a number of Health Authorities on recommendations by an eminent medical professor who felt that the money would be better spent on drugs and therapies which are scientifically proven to work and not the result of a placebo effect. This was despite the fact that Homoeopathy has been shown to be effective in both children and animals.
Also a study published in the Journal of the American Medical Association, JAMA, into the effectiveness of Homoeopathy concluded that there was some proof that it worked, yet the editorial decided it was against all logic to accept that it could work and dismissed it as placebo!
Diet
The other topic under discussion was the effect of diet on health and disease. This followed revelations from studies that found a reduction of heart disease death of well over 70% in people who followed a Mediterranean type diet compared to those who followed a diet as recommended by the American Heart Association. Similar reductions were achieved in diabetes, obesity and cancer, and all without any side effects. The very best any drug can do in this respect is a 15% reduction and comes with a litany of side effects including death, yet these drugs enjoy annual revenues of billions of dollars.
The problem with any diet of course no matter how life saving and effective it may be, is change, and people in general do not like change preferring to take a pill instead, regardless of the odds.
Other Related Topics in the News
Apart from diet and Homoeopathy, the compulsory fluoridation of water supplies and the premature termination of the estrogen and progestin arm (EPT) of the Women’s Health Initiative (WHI) study by the National Heart, Lung and Blood Institute (NHLBI) in the US because “overall heath risks exceeded benefits…”, were other extremely important topics discussed in the media which serve as clear indications of the confusion we all find ourselves in. I shall get back to these two issues later.
FIRST THE SCIENCE
Health decisions are almost always backed by scientific research which uses the time honoured placebo controlled clinical trials, preferably double blinded where neither the researchers nor the patients are aware of what is being dispensed. These trials are mostly carried out for drugs where we need some statistical proof that a drug to treat a condition works better as compared to a neutral substance which we call a placebo.
And this is where it all begins to get messy.
DEFINITIONS
Science – “knowledge ascertained by observation and experiment, critically tested, systematized and brought under general principles, especially in relation to the physical world.”
Placebo - “a medicine given to humour or gratify a patient rather than to exercise any physically curative effect; a pharmacologically inactive substance administered as a drug in the treatment of psychological illness or in the course of drug trials”
Pharmacology – “the science of drugs”
Drug – “any substance used in the composition of medicine to cure, diagnose or prevent disease”
Psychology – “the science of the mind; the study of mind and behaviour”
ENERGY MEDICINE vs SCIENCE MEDICINE
Acupuncture, homoeopathy, healing, meditation, yoga etc., practised for thousands of years are considered ineffective and placebic since they are not evidence based not having been subjected to recognized scientific testing. The argument seems to be not whether they work but the way they work which does not stand up to scientific scrutiny. But are we really comparing like with like?
THE 5 SENSES
Science bases everything on principles which can be proved and give us results which are repeatable and must fall within criteria we can all understand and measure. This naturally limits us to things we can see, touch, hear, taste and smell. Anything that falls outside of the 5 senses is difficult if not impossible to measure and therefore ceases to be scientifically believable, becoming a figment of our imagination – hence the coined phrase ‘it does not make any sense’.
When is a Placebo not a Placebo?
I must admit that I was truly shocked to find out not very long ago that a placebo is not necessarily an innocuous substance but may actually contain some active ingredients.
You see, apparently it all depends on what we are testing. Let us take hay fever symptoms as an example. If we are only trying to prove that a drug which claims to reduce watery eyes and a runny nose is better than a placebo, we need to first cancel out the common side effect of all these types of drugs, a dry mouth, by adding an ingredient into the placebo which actually causes a dry mouth!
In reality, every time you give someone something which you claim will help them, drug or otherwise, there will always be the expectation that it will work. So in a way a drug is also working as a placebo.
In Search for The Inactive Placebo
If you look at the definition of a placebo as needing to be pharmacologically inactive it is clear that the definition of inactive is only relative to what we consider to be active. Is air inactive when without it we are dead within minutes? Or perhaps water when without it we are dead within days? Why even a thought is active since it causes the release of chemicals in our brain which in turn elicit a reaction.
DOUBLE STANDARDS
Medicine of the Mind
It always puzzles me when no-one challenges the validity of psychology and psychiatry as being a part of scientific medicine although both deal with the mind and its effects on the physical being of the body, much like the placebo. Neither discipline has ever undergone scientific trials to provide proof of effectiveness yet there they sit well ensconced within the core of scientific medicine.
Mind games
Then come the well established and accepted methods of the promotion of drugs once they have acquired their scientific credentials: advertising, using colour, shape, size, strap lines, jingles, posters and so on. This is all surely unscientific hype working mainly on the mind and very much within the definition of a placebo. Interestingly, none of the alternative therapies advertise their wares. In fact they are prevented by law from doing so.
WHEN SCIENCE NEEDS NO PROOF
Fluoride
This has to be one of the greatest recycling success stories of the modern era. Just think what a coup it was to use a waste product of the paper industry as a treatment for tooth decay. It is too toxic to dispose of ecologically so just dump it in our water supplies. No need for scientific testing here. Brilliant!
Hormone Replacement Therapy
This was touted as a great idea to help women retain their youth well into middle age and beyond. But as with every good idea we first have to find a need for it so we have to invent a disease. And hey presto The Menopause was born. What should be a natural seamless transition which takes place over a number of years became an illness overnight for which the remedy or cure was already waiting. Without any scientific testing the processing of urine from pregnant mares became a viable opportunity to print money.
Unfortunately, it was found recently that these did not live up to the claims and the risks of taking them far outweighed the touted benefits.
Others
There are many other similar instances where therapies or drugs take their place in standard medical practice without so much as a single test report only to be later exposed for the risks they pose. These include amalgam fillings, vaccinations, antibiotics against viruses, antacids for heartburn plus many more.
What about the side effects?
All drugs have side effects whether they have been tested or not and these side effects can sometimes be worse than the disease they are supposed to be treating and may be even death. Yet they are still regarded as preferable to other therapies which have been shown to work time and again and with fewer if any adverse side effects simply because they do not stand up to the testing criteria used to prove effectiveness. The fact that it is the testing procedure that is flawed and not the therapy holds little ground since natural therapies do not have the backing of the biggest money makers on the planet: Big Pharma.
Revelations
What we think and believe is happening is not necessarily what is actually taking place since the process of life and living goes far beyond anything that science can explain or comprehend.
So in reality, anything beyond a basic understanding of the way things work in science can be limiting to progress. The only way forward is to free the mind and reach the spirit and the soul, both intangible and at the same time as real as we want them to be.
Remember always, all dreams can become physical realities; we just have to believe that anything and everything is possible. After all, WE ARE ALL ONE.
With warm regards,
Sam Shohet