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29 July 2014

David Tredinnick’s right that alternative medicine could work – but that’s not reason to embrace it

Our understanding of placebo-based treatments suggests that alternative medicine could benefit patients. But the impact on medical ethics could lead to unintended consequences.

By George Gillett

David Tredinnick MP, a member of both the science and technology select committee and the health select committee, made headlines last week for suggesting that astrology should be incorporated into medicine. This isn’t the first time the member for Bosworth has caused controversy, however – he’s also expressed support for homoeopathy and other alternative therapies. The idea that the NHS should fund more alternative treatments is a controversial one, but the issue is a lot more complex than it may first appear.

Alternative medicine is, by definition, medical treatment which has no clinically-proven benefit. In other words, the treatments have been shown to be no more effective than a placebo drug in clinical trials.

However, this isn’t to say that placebos are entirely useless for alleviating pain. Studies have shown that “dummy drugs”, such as sugar pills, can elicit relief for patients suffering from a wide number of conditions, be they chronic and acute. This phenomenon arises because patients believe that their treatment will be effective, causing their brain to send impulses to the painful area, down-regulating the noxious sensation. The pain-killing abilities of the placebo effect are well-documented, and studies have even shown that some kinds of placebo are more effective than others. For example, taking a placebo works better by needle than by pill – most likely because patients trust an injection more.

It is important to note that this evidence is limited to alleviating pain, and that placebos are unlikely to be effective in treating many other medical conditions. Nonetheless, almost eight million people in the UK suffer from chronic pain, a condition which alternative therapies could help treat.

Scientists have even discovered the area of the brain which is involved in this pain regulation, the wonderfully-named Periaqueductal Grey. By electrically stimulating this area, a patient’s placebo effect can be strengthened or weakened. It is even possible to block the opiate neurotransmitters involved in the neural pathway, in order to reverse these analgesic effects.

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Given that the placebo effect is so well documented, many have called for it to be harnessed in the treatment of conditions such as chronic pain (as have those, like Tredinnick, who trust pseudoscience that acts as a placebo). Indeed, in cases where pain relief has failed to succeed, the choice might seem straightforward – after all, the side effects to such treatments are virtually minimal. Yet, in reality, the situation is much more complex.

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The nature of the placebo effect (and much of alternative medicine) relies on a patient’s belief that the treatment will work. Although a single (noteworty) study in 2010 did find that such an effect can be observed when patients know they are taking a placebo drug, the trial’s validity was questioned, with criticisms of its small sample size and its method of recruiting participants. In fact, it’s likely that just by reading this article you’ll be more resistant to any benefit from alternative medicine. Hence, for such treatments to work, doctors must either disseminate false information to their patients, or be purposefully ambiguous, as many of the GPs who refer their patients to alternative therapies are.

Herein lies the problem. Central to the practice of medicine is the concept of informed consent; that patients must agree, and fully understand their treatment options. This is of paramount importance – medical treatments can be complex and can result in large impacts on a patient’s quality of life. To fully benefit from alternative medicine, we’d have to return to a paternalistic model of medicine, where we forewent autonomy in our medical care.

The dangers of such an arcane healthcare system are widespread. Lessons from history, such as experiments conducted without seeking the permission of the participants, or the practice of lobotomy, an outdated treatment justified by fabricated evidence, illustrate the importance of transparency and accountability in healthcare. More recent scandals, such as the disaster at the Mid Staffordshire NHS Trust, further highlight the importance of such ethical standards. To surrender these principles would be foolish – it is crucial that patients are free to question their diagnosis and treatment. After all, it is only when we understand a treatment option that we can ever truly consent to it.

This is the paradox of alternative medicine; by understanding, we render the treatment ineffective. Yet by concealing medical knowledge, we return to a dangerous, medieval-like approach to healthcare. It is for this reason why alternative medicine is flawed. As tempting as it might be to embrace placebo-based treatments, the ethical standards we would have to sacrifice are infinitely more valuable.