Author equates alternative treatments with placebo effect

Washington -- Doctors may not realize it, but they are familiar with the reason for the apparent success of alternative and complementary treatments; they just call it the placebo effect, said R. Barker Bausell, PhD, a biostatistician and professor at the University of Maryland School of Nursing.

Dr. Bausell, author of the book, Snake Oil Science: The Truth About Complementary and Alternative Medicine, which was released last year to favorable reviews, searched for the scientific evidence to support the claimed benefits of various unconventional treatments. But he came up short.

He conveyed those findings as well as his concern about the increasing amounts of research dollars being directed toward these treatments at an April 23 Capitol Hill briefing held by the Congressional Biomedical Research Caucus in Washington, D.C.

Dr. Bausell also served as research director for the University of Maryland's alternative medicine center but has left that post for reasons that had nothing to do with his research findings, he said.

Dr. Bausell defined alternative medicines as any of a host of techniques, such as acupuncture, herbs, or yoga for pain management, used to cure a medical condition.

He is concerned that such treatments have moved from the far reaches of healing, where they were practiced by a few believers, to the heart of mainstream medicine, where they are incorporated with traditional treatments in "integrative medicine" centers at elite medical schools and hospitals. The National Institutes of Health's National Center for Complementary and Alternative Medicine now has an annual budget of more than $121 million.

"Doctors no longer feel comfortable saying these therapies are shams," Dr. Bausell said.

Many physicians are major players in integrative medicine centers. For example, Harvey Zarren, MD, a cardiologist and president of the board of the Integrative Medicine Alliance, a group of physicians and others in the Boston area, taps into many alternative techniques, including hypnosis, to help his patients lower their blood pressure. There is good evidence that such treatments work, he said. "Why not use all appropriate tools."

One technique employed by therapists who use complementary and alternative techniques -- but one that runs short for conventional medicine -- is time, he said. "Give people time, give people respect. Look at the whole person."

But questions remain about how and why these approaches work, and the need for more study exists.

NCCAM Director Josephine P. Briggs, MD, acknowledged recently in congressional testimony that, although millions of people use alternative treatments, very little is known about the potential of such treatments to improve health and well-being or preempt disease. "We also need to understand how [these] practices interact with other therapies and whether they are safe."

Figuring out the "why"

But Dr. Bausell sees the central question differently.

Getting at the heart of why so many people believe in the benefit of these techniques means puzzling through "a family of artifacts, both psychological and biological, that conspire to confound us and make fools of us all," he said.

Everyone makes inferences. A patient seeking relief from pain in an arthritic knee may go to a primary care physician, a rheumatologist and a homeopath and also turn to herbs, megavitamins, prayer and acupuncture, he said. But if the pain subsides while they are involved in acupuncture, "you will never convince that person [it] didn't heal them." What is not considered when weighing that success, though, is the waxing and waning nature of such pain, Dr. Bausell said. The easing may have occurred even without an intervention.

Therapists who practice these techniques also fail to keep records, and patients may, out of politeness, say they feel better after treatment even if they don't, he added.

The placebo effect -- defined as a pharmaceutically inactive substance or procedure that can have a therapeutic effect if administered to a patient who believes he or she is receiving an effective treatment -- also enters the picture. Dr. Bausell believes the placebo effect has convinced patients a treatment actually works, even when unsupported by research.

The AMA favors the evaluation of alternative treatments using well-designed studies and urges physicians to ask patients routinely whether they use any of these therapies.