Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

Doctors who studied the research into, say, homeopathy would soon realize that it is bogus and that any benefit to the patient is due to the placebo effect. If a doctor nevertheless decided to prescribe homeopathy, then he or she would be forced to lie to the patient in order for the placebo to be effective. In short, the doctor would have to reinforce the patient’s misplaced faith in the extraordinary power of homeopathy or perhaps even instil such a false belief. The question is simple — do we want our healthcare to consist of honest, evidence-based treatments or do we want it built upon a foundation of lies and deceit?

In fact, the best way to exploit the placebo effect is to lie excessively in order to make the treatment seem extra special. A doctor could use statements such as ‘this remedy has been imported from Timbuktu’, ‘you’re receiving the last supplies’, ‘the remedy has had a 100 % success rate so far this year’, ‘this remedy neutralizes the most evil anti-matter in each of your cells’. Such statements will raise a patient’s expectations, thereby increasing the likelihood and extent of the placebo response. In short, for maximum-strength homeopathy, the doctor would need to tell the biggest pork pies imaginable.

Doctors regularly exploited placebos in the past, as they had little else to offer patients, but modern medicine now has real treatments that have been tested and shown to be effective. We strongly feel that there should be no return to a medical system that relies on placebos — a view shared by the doctor and journalist Ben Goldacre:

Whether mainstream medics would want to go back to the old ways and embrace the placebo-maximising wiles of the alternative therapists is an easy question: no thanks. The didactic, paternalistic, authoritative, mystifying mantle has passed to the alternative therapist, and to wear it requires one thing most doctors are uncomfortable with, dishonesty.

Our position — that the routine use of placebos is unacceptable because doctors should never lie to their patients — might seem draconian. Indeed, those who oppose our view would argue that the benefits of lying outweigh our ivory-tower ethical arguments. These opponents would feel that white lies are acceptable if they improve the health of patients. We would counter that routine peddling of placebos would lead to a widespread culture of deception in medicine, which would in turn result in a series of corrosive consequences for the medical profession. Imagine what healthcare would be like if doctors routinely prescribed placebo-based treatments, such as homeopathy:

Doctors would have to establish a conspiracy of silence and agree not to reveal the bogus nature of homeopathy. None of them would be allowed to point out the truth about the Emperor’s New Clothes, as this would undermine homeopathy’s placebo effect.

Medical researchers would not sign up to this pact, as their mission is to understand disease, its causes and its cures. In the name of progress, they would be honour bound to point out that existing research fails to support homeopathy. This would lead to scientists and doctors giving conflicting messages.

Homeopathic prescriptions would act as a gateway drug, encouraging patients to experiment with other irrational treatments. Professor David Colquhoun has neatly summarized the insidious dangers of homeopathic remedies: ‘Their sugar pills contain nothing and they won’t poison your body. The greater danger is that they poison your mind.’

Parents might ignore scientists who promote life-saving interventions such as vaccination, and instead they might listen to homeopaths promoting alternative (and ineffective) ways to protect children. After two centuries of progress since the beginnings of the Age of Enlightenment, a decision to move away from evidence-based medicine could usher in a New Age of Endarkenment.

Pharmaceutical companies would be in a strong position to argue that they too could promote placebo remedies. Why should they bother with the expensive process of proper drug development when they could make bigger profits by marketing a placebo sugar pill and pretending that it was a panacea?

Finally, there is one more reason why placebo treatments should be avoided. In fact, this particular reason is so powerful that it will soon become obvious that it is completely unnecessary and unjustifiable to use placebos routinely to treat patients. Everyone agrees that the placebo effect can be very beneficial, but the truth is that we do not need a placebo in order to evoke a placebo effect. Although this sounds paradoxical at first, it actually makes perfect sense if we explain what we mean in more detail.