To a large extent, the placebo plays an important part in both science-based and alternative therapies. It is necessary therefore, to consider it in some detail.
 
Placebos have been used for centuries by both physicians and quacks. According to the Shorter Oxford Dictionary, the word placebo has been used since 1811 to mean a medicine given more to please than to benefit the patient.

We are conditioned from an early age to expect simple remedies for almost any minor hurt. As an infant, the words "Mummy kiss it better" is an effective placebo. Later in life we learn that there is always a pill for something in the medicine cabinet. Regardless of whether the medication was intended for the purpose, the mere act of swallowing it becomes a palliative. So exactly what is a placebo, how does it work and to what magnitude?
 
Usually taking the form of a tablet, pill, capsule or intravenous injection, a placebo is a pharmacologically inert substance such as lactose, saline solution or starch.
 
Its principal use is for the purpose of comparison in an experiment, as in the double-blind study design. In this technique, neither the subject, nor the observer is aware of what agent was used or indeed when it was used. "It works, but we don't know how it works" is the usual response by "alternative" healing practitioners when asked to explain the mechanisms of their treatment. So if it works, and there are thousands of patients who will testify that it does work, to what can the cure be attributed when there is no scientific basis for that treatment? To answer the question, we must first consider the nature of illness.
 
The human body, within certain limits, has an innate ability to self-heal. A cut finger will bleed, the blood will coagulate and the severed tissue will eventually rejoin. This healing process can be assisted by cleaning the cut with antiseptic to prevent infection, the application of a Band-aid, or in the case of a more extensive wound, a suture or two. Likewise, a broken bone will knit together of its own accord, albeit possibly resulting in a deformity. The healing process can be accelerated by having the bone reset and the limb immobilised for a period of time.
 
Sundry aches, pains and infections come and go for no apparent reason, and their passage can be hastened or the pain ameliorated with drugs until such time as they disappear. Many of these half-perceived discomforts that cannot be defined as illnesses or diseases are elevated to that status and treated by alternative practitioners — with predictable results.
 
Also to be taken into consideration is the average duration of minor conditions such as a cold and some fevers, and the natural variability of disease.
 
Many disease have ups and downs ... periods of remission (a "high") and depression (a "low"). Therefore, if a treatment — regardless of what that treatment may be, is applied during a "low" period, improvement will follow. If it is applied as the patient is descending from a "high" and getting worse, one of two probabilities arise. Natural variability could ensure an improvement or the disease remains stable. If the latter, it could be argued that the treatment has not been applied long enough or that the application of a higher dose is required.
 
So it can be seen that given the body's self-healing ability, the nature of illness and the variability of disease, in many cases, a perceived helpful intervention, during that period, whether it be a pill a potion or a prayer, could be believed by some to be the cause of a cure. Where such an intervention, such as an inert medication is used for its psychological effect, it is called a placebo. It is important to note also, that there is a tendency in all of us to ascribe cause and effect where none exists.

While not suggesting that placebo is a standard treatment, some of the reasons for using it include a psychological instrument in the therapy of certain ailments arising out of mental illness; as a resource of the harassed doctor in dealing with the neurotic patient; to determine the true effect of drugs apart from suggestion in experimental work; as a device for eliminating bias not only on the part of the patient but also, when used as an unknown, of the observer, and as a tool of importance in the study of the mechanisms of drug action.
 
Double blind studies testify to the effectiveness of placebos in the order of 35%. (Beecher 1955). That they can relieve symptoms has been proven in a variety of conditions including the relief of pain arising from physiological causes such as severe postoperative wound pain, psychosomatic and stress related problems. As with all therapeutic agents, there can be associated subjective side-effects, usually in the order of about 10%. These include dry mouth, sensation of heaviness, headache, nausea, difficulty in concentrating, palpitation and allergic-type reactions. (Wolf & Pinsky, 1954.) There is also the danger that "alternative" therapists may use placebos as palliatives in an ad hoc and in a non-science based manner. Contrary to popular belief, placebos can be harmful.
 
John F. Dodes, president of the New York chapter of the National Council of Health Fraud cites Jarvis in "The Mysterious Placebo", (Skeptical Inquirer, Jan/Feb. 1997).

 
Consumer advocate Stephen Barrett also has explicit reservations concerning over-reliance on the placebo effect in clinical practice:

 
A curious placebo effect was discovered during a Canadian study involving 613 patients, and reported at a meeting of the American Urological Association at New Orleans on April 18, 1997. Over a period of two years, patients were given either the Merck & Co. drug finasteride, or a placebo (white flour in a capsule.) The subjects were tested by measuring the sizes of their prostate glands and by having them urinate into a metered device that determined the rate and volume of flow. The finasteride patients experienced a 21% decrease in prostate-size, while the placebo group experienced an 8.4% increase in prostate-size. Nevertheless, a significant number of the 303 men in the placebo group felt much better, and demonstrated improved urinary flow — even though their prostates grew in size.
 
As the report of the study did not indicate whether it included people who received no treatment at all, there
may have been some spontaneous physical changes other than those attributed to a placebo effect.

The urologist who headed the study is now willing to prescribe placebo therapy for benign prostatic hypertrophy rather than to fully discourage medication and do watchful waiting. However, the placebo he has in mind is Saw Palmetto, a herbal remedy yet to be demonstrated as trustworthy by the herbal industry. The study seems to show that there is an important psychological component to the urinary performance of men with prostate problems. As a consequence, there is an increased likelihood that a quack remedy can generate a substantial number of satisfied customers who will attest to a remedy's efficacy when in fact their condition is worsening. Placebos are not harmless if they mislead patients in this manner.

A Saw Palmetto Complex (a formula consisting of the herb, zinc, Pumpkin seed, Lycopene and Epilobium) is advertised by Bio-Organics and claims to "...help reduce fluid retention". The advertisement continues, "If fluid retention persists seek medical attention" — the implication that the product may not work hardly inspires confidence.


REFERENCES

Barrett, Dr. Stephen. 1977. Health Frauds and Quackery. FDA Consumer 11:12-17.

Beecher, Dr. Henry K. 1955. The Powerful Placebo, J.A.M.A. Dec. 24, 159:1602-1606.

Bogduk, Dr. Nik. 1988. Romance, Magic, the Dollar and Truth, the Skeptic, Vol.8, No.2, p.23-26. Australian Skeptics, NSW.

Dodes, John E. 1997. The Mysterious Placebo. Skeptical Inquirer, January/February. 44-45.

Gordon, Dr. Richard. 1988. Quackery, the Skeptic, Vol.8, No.2, p. 27-28. Australian Skeptics Inc., NSW.

Houston Chronicle, April 18, 1997. p. 20A.
 
Jarvis, Prof. W.T. 1990. Dubious dentistry: A dental continuing education course. Loma Linda University, California.

Wolf, Drs. S. and Pinsky, R.H. Effects of Placebo Administration and Occurrence of Toxic Reactions. J.A.M.A. 155:339-341. May 22, 1954.