Why you may think the scientifically unsound treatment is working

There are several perfectly sound reasons you may believe the therapy you are using is working for you when the treatment is in fact totally ineffective.

The Placebo Effect

There are many treatments erroneously believed to be effective by both practitioners and patients. In fact, many medical procedures well into the last century were just that (and some still are). Such treatments are called “placebos.” A placebo is “any therapy prescribed knowingly or unknowingly by a healer, or used by layman, for its therapeutic effect on a symptom or disease, but which actually is ineffective or not specifically effective for the symptom or disorder being treated. [T]he placebo effect [is] the nonspecific, psychological, or psychophysiologic therapeutic effect produced by a placebo, or the effect of spontaneous improvement attributed to the placebo.” [Shapiro and Shapiro, at 12] With the advent of clinical trials, which compare active interventions (e.g., a drug) to sham interventions (e.g., a “sugar pill”) science has been better able to sort out the truly effective procedure from the placebo effect, and interventions which are no better than placebo are discarded. In fact, this is one feature that distinguishes the science-based practitioner from the unscientific practitioner. Practitioners who do not based their therapies on sound science do not discard treatment methods even when clinical trials demonstrate they are ineffective.

The placebo effect is not fully understood, but two aspects of it bear on understanding why the placebo effect operates especially well in otherwise unscientific practice settings. First, “[p]lacebo effects are influenced by patient-healer interpersonal relationships and are increased in pleasant, nonthreatenting, efficient clinical settings with doctors who are perceived by patients as warm, likeable and interested in them.” [Shapiro and Shapiro at 30]. Some unscientific practitioners excel in this regard. Second, “[a] positive placebo effect occurs more frequently in patients who have minor illnesses, symptoms that spontaneously vary and remit over time, and primarily affect the reaction to distress.” [Shapiro and Shaprio, at 30] As more fully explained below, these are exactly the types of problems the unscientific practitioner is likely to treat.

Natural History of Disease

Unscientific practitioners who claim the body has a self-healing ability are absolutely right. What they don’t tell you – perhaps because they don’t know enough about human functioning to realize it – is that the body’s self-healing mechanisms work perfectly well without the interventions of their therapies. This is why a series of "alternative" treatments may appear to “work:” over time, the body will heal itself, but (perhaps with encouragement from the practitioner) the self-healing (in medical terms, “spontaneous remission”) will be attributed to the unscientifc therapy.

The Cyclical Nature of Pain

Untreated chronic pain (such as that from osteoarthritis) goes through a natural cycle. Over the period of, say, a month, on some days the pain won’t exist, on some days it will be tolerable, and on some practically unbearable, and then the cycle will repeat. Naturally, the patient is most likely to seek relief on those days when the pain is at its worst. However, just as the pain is at its peak, it begins to recede. Thus, treatment at the peak and subsequent improvement may be misinterpreted as cause and effect, when actually the treatment had nothing to do with the patient’s relief. [Bausell, at 47-51]

You are not really that sick (or sick at all) in the first place

Fortunately, as one study showed, few people seek "alternative" medical treatments for serious diseases, and those who do are almost always also receiving conventional medical care. [Bausell, at 110] Perhaps this reveals that, at some level, most people realize that these treatments are questionable, because at a theoretical level many alternative treatments claim to be effective for a host of diseases for which no one uses them. For example, if misaligned spinal vertebrae can cause actual visceral disease, and chiropractic treatments are the remedy, why don’t people visit chiropractors for pancreatitis, congestive heart disease, pulmonary fibrosis and gallstones? Second, some unscientific practitioners promote therapies for conditions you don’t have. For example, iridologists and acupuncturists prescribe supplements for non-existent conditions. Likewise, chiropractors recommend regular adjustments for subluxations, which only chiropractors believe exist. Naturally, if a patient has been told he has a made-up condition and the practitioner now tells him he is now free of that condition, he is likely to believe he has been “cured.”

References

Arthur Shapiro, Elaine Shapiro, “The Placebo Effect: Much Ado About Nothing?” in The Placebo Effect: An Interdisciplinary Exploration, Anne Harrington, editor (Cambridge, MA: Harvard University Press, 1997).

R. Barker Bausell, Snake Oil Science: The Truth About Complementary and Alternative Medicine (New York: Oxford University Press, 2007).