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

After all the experiments had been completed, the Royal Commission could see that patients had responded in a similar way regardless of whether the water was plain or magnetized. Therefore, they concluded that magnetized water was the same as plain water, which meant that the term magnetized water did not really mean anything. Moreover, the Commission stated that the effect of supposedly magnetized water was due to the expectation of patients; today we would say that it was due to the placebo effect. In short, the Commission accused Mesmer’s therapy of being fraudulent.

The Royal Commission did not, however, speculate about the widespread effects of placebo throughout medicine, which is why Haygarth’s research on tractors fourteen years later is credited with formally recognizing the role of the placebo effect in medical practice. On the other hand, the Royal Commission did make a major contribution to the history of medicine, because it had designed a new type of clinical trial. The key breakthrough in the Royal Commission’s experiment was that the patients were unaware of whether or not they were receiving the real or fake treatment, because the glasses of mesmerized water and plain water were identical. The patients were said to be blind.

The concept of blinding can be applied to entire trials, which are known as blinded clinical trials. For example, if a new pill is being tested then it is given to all the patients in the treatment group, while a pill that looks the same but without any active ingredient is given to the control group. Importantly, patients have no idea if they are in the treatment or control group, so they remain blind as to whether or not they are being treated. It is quite possible that both groups will show signs of improvement if both respond to the placebo effect caused by the possibility of receiving the real pill. However, the treatment group should show greater signs of improvement than the control group if the real pill has a genuine effect beyond placebo.

In a blinded trial, it is crucial that both the control group and the treatment group are treated in similar ways, because any variation can potentially affect the recovery of patients and bias the results of the trial. Therefore, as well as receiving pills that look the same, patients in both groups should also be treated in the same location, be given the same level of attention and so on. All these factors can contribute to so-called non-specific effects — namely effects resulting from the context of the treatment process, but which are not directly due to the treatment itself. Non-specific effects is the umbrella term that also covers the placebo effect.

It is even necessary to monitor patients in both groups in exactly the same way, because it has been shown that the act of close monitoring can lead to a generally positive change in a person’s health or performance. This is known as the Hawthorne effect, a term that was coined after researchers visited the Hawthorne Plant in Illinois, part of the Western Electric Company. The researchers wanted to see how the working environment affected the plant’s output, so between 1927 and 1932 they increased artificial illumination and then reduced it, they increased room temperature and then reduced it, and so on. The researchers were amazed to find that any change seemed to cause an improvement. This was partly because workers expected that the changes were supposed to bring about improvements, and partly because they knew they were being monitored by experts with clipboards. It is difficult to remove the Hawthorne effect in any medical trial, but at least the effect should be the same for both the treatment group and the control group so that a fair comparison can be made.

Creating identical conditions for the control and the treatment groups effectively blinds the patients to whether or not they are receiving the treatment or the placebo. Yet it is also important to blind whoever is administering the treatment or the placebo. In other words, even the doctors treating the patients should not be aware of whether they are giving a sugar pill or an active pill. This is because a doctor’s demeanour, enthusiasm and tone of voice can all be affected by knowing that he or she is administering a placebo, which means that the doctor might unconsciously give hints to patients that the medicine is merely a placebo. Such leaking of information, of course, can jeopardize the blinding of the patient and the overall reliability of the clinical trial. The consequence would be that patients in the placebo control group would suspect that they were receiving a placebo and would then fail to exhibit a placebo response. Perversely, patients receiving the real treatment would have no such qualms and would exhibit a placebo response. Hence, the trial would be unfair.