Interesting post.  I will have a look at the BMJ paper.  Interesting study.  If this can be replicated and confirmed it can be put to use.

One point though- the idea of "thoughts affecting the body" is very well known and broadly accepted in modern biological science.  It is common knowledge that subjective feeling of stress and anxiety, if chronic can affect the risk of cardiovascular disease.  This is due to stress affecting the circulating hormones such as cortisone, adrenaline etc.  

There is very good epidemiological evidence for this, most recently demonstrated by the likes of Sir Michael Marmot and the Whitehall studies, but many others have confirmed these links.

Also, chronic stress, (which arises in the brain due to environmental stimuli, affects release of hormones from the anterior pituitary gland, thus in turn affecting the  circulating hormones) also has a surpressive effect on the immune system.  This is why people who suffer extreme chronic stress can have such trouble healing, which is well documented in the home carers of patients with alzheimers disease for example, since being a carer of such patients can be such a stressful experience over years.

Also, thoughts such as fear and even very mild stress can affect the conductance of the skin.  You can measure this quite easily, the skin is a very responsive organ to external stimular that cause stress.  This might explain the link between stress and problems of the epidermis such as eczema and other allergies but as yet this has proven very complex and hard to understand fully.

The positive effects of social support are also well documented on reducing the insidence of mental health problems and cardiovascular dieases, all via the brain and its interaction with the environment, the hormonal systems, the cardiovascular system and in fact, the entire body.

In fact, when you actually know something of modern science, it is littered with examples of how our physiology, psychology and basic functions are all totally interconnected and responsive to the environment.  The idea has been around for a very long time, the basic idea of homeostasis, the works of Claude Bernard, Hans Selye, etc.  

Just thought you should know that the idea of thoughts affecting the body is something established loing ago in medical science and a proper understanding of human physiology makes it clear how this would be.  Ideas of man as an energy system are redundant however, unless you mean in some metaphorical sense, which is great for poetry but doesn't add anything to our understand and in fact moves it backwards.

That the body works as a fully intergrated, highly complex system with the aim of achieving and maintianing homeostasis both internally and in more complexs ways behaviourally is well know and derived from scientific study.  

The idea that modern science reduces the system of the body to isolated units and views them as functioning in isolation is not based on any model to be found within the life sciences today.

Regards

H

Dear Bryan,

The term 'placebo' appears to imply that an affect could have what could be considered as 'supernatural origins' i.e. beyond that which can be explained by conventional science and medicine, however as we all know science and medicine are only as good as the prevailing level of knowledge.

Can a scientific explanation can be ascribed to such a phenomena.  I believe that this can be so.  Let me take the case of homeopathy where there is huge debate over how the technique works and the regular supply of sceptical articles to the scientific press and the national press. In Russia they have isolated the antibodies produced by homeopathy and have statrted to manufacture them. They have been used in pharmaceutical products licensed in Russia for the last 10 years. More: these class of antibodies are now being researched by GSK and other pharmaceutical companies.  

So let us keep our brains working and open.

Most CAM technologies are based upon the body's natural interaction with its environment through the senses, temperature, electromagnetic effects, etc.  The body recognises such sensory input in various levels: (1) as a sense which we use to orient ourselves in our environment (2) as a stress event i.e. which exceeds our natural tolerance limits (3) as a pain i.e. identified by the endocannabinoid response, adapted by acupuncture, and by hypnosis, and (4) as a response to physiological damage.   These are, in various ways, recognised by medicine.

The term placebo 'should' lead us to acknowledge that the human body has a mechanism able to stimulate the body's natural healing response.  The challenge is to find the methods which enable us to use this natural healing mechanism.

Graham Ewing

I fell some years ago and dislocated my shoulder. It was put back at the hospital, but I couldn't move it for weeks. I reluctantly tried accupuncture after Physio failed, and pain killers weren't working. That night after treatment I was in so much pain I cried most of the night, eventually drifting off to sleep at about 5 am. When I got up I still couldn't move the arm properly. I didn't believe in accupuncture at all then. The day after that I got up and was able to dress without assistance.

I'm not surprised that Prof.Edzard Ernst tried to dismiss the findings as the "Placebo Effect". However that doesn't explain why accupuncture worked on my daughter's lame stallion when the vets had written him off. He certainly had no expectations of accupuncture working at all, and tried to bite and kick when the first needle went in. The lady practitioner just waited a few minutes, and he quietened down, and allowed her to put the other 6 in without so much as a twitch. 2 days after treatment he was able to walk down to the paddock. He had a second course 10 days later and a few days after that showed no signs of lameness at all.

Dogs and cats respond well to accupuncture.  But then I very much doubt the learned Prof. has ever seen the animals being treated successfully. If it works on animals and people who don't believe in it, the Placebo Effect can be largely discounted.

Hi Beryl.

I'm afriad you misunderstand what placebo means.  The placebo effect is not entirely accounted for by the expectations of the patient.  This does make up part of many placebo responses, but not all.  Very often complaints can be self writing and recovery can have nothing to do with either the treatment or the percerption of it.  

That's why the only convincing way one can discount placebo effects is to do trials comparing treatments with placebo.  The fact that a treatment works in animals, sceptical humans or children is not sufficent to discount placebo effects by any means.

The junk medical profession and its academic barking dogs thrive on publicly funded grants to keeping asking 'Why?' It's a fruitless task. As I write it's Grant Application time in the Antipodese and the boffins in the sheltered workshops for the academically gifted are busy thinking up more inane questions to answer - and keep bread on the table for another year.

It's nothing new that women and their partners who are exceptionally healthy don't have a great deal of trouble conceiving. Like wise it's been known for thousands of years that traditional Chinese medicine and accupuncture are highly effective in restoring poor body system function to good.

The debate is over. Pens down!

Edzard Ernst and his colleagues show just how shallow and selective their research is when they bag traditional treatments.

Ignore them. They know not what they say.

I keep hearing the term placebo effect being used by those who support the allopathic paradigm in whatever manner seems to suit them at the moment.  If they feel that they can demean the results of a study or anecdotal reports, then the term becomes pejorative.  If they're in a position in which results from CAM studies demonstrate efficacy, then they use the term placebo in a positive manner, suggesting  that it's simply an issue of the mind affecting the body, thus making their allopathic treatments more effective.  

It seems to me that trying to have it both ways is not legitimate.  Either use the term placebo in a "pejorative or positive manner, but stop trying to have it both ways.

Definitions of placebo (from Answers.com):

"   1. A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well.

"   2. An inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug.

"Something of no intrinsic remedial value that is used to appease or reassure another."

I have also looked for definitions of placebo effect, and nowhere do the complexities brought up by harradine come into play.  A placebo effect is associated with the patient's, and only the patient's, belief in whether something will affect symptoms.

In any case, The New England Journal of Medicine included a metastudy of placebo against no treatment (http://content.nejm.org/cgi/content/abstract/344/21/1594), with very interesting results.  The conclusion stated in its abstract is:

"We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos."  In reading the article, it's made clear that only trials that rely on subjective results can show any effect from placebo, and that the larger the trial, the less likely that any placebo effect can be noted.

In other words, the placebo effect is, according to a metastudy done by allopathic doctors, nonexistent, other than in results that are subjective only.

Spider woman.

I certainly would not wish to use the word placebo in a perjorative sense.  In reality, perjorative uses of any words have no place in determining whether a treatment words.  There never need be any judgement of emotional laden use of language.  Just evidence.

Placebo responses of course do not have "powerful clinical effects".  That is why it is considered unethical to use placebo effects as a form of medical treatment.  

The reason why placebo controlled trials are conducted is because, ultimately, when performing a trial the goal is to determine cause and effect.  You are aiming to establish whether the response you say in a patient, or group of patients, whas causes by the treatment that you used.  Only once this is established can you say "treatment X causes this response in patients".  

How do you go about determinoing cause and effect?  Well, that is where the methods of science are by far the best means.  This is where science comes into its own.  man kind has not yet devised any better means to determine cause and effect that the scientfic method.  There simply is no better way that the objective experiment and observation to determine these kinds of relationships.

But it is not easy.  it can be very difficult indeed to determine cuase and effect.  The most common ,mistake that is made is mistaking two events which are associated with one another as one causing the other.  This happens so often in science, medicine and pretty much every aspect of life that is seems to be our defulat setting as it were.  it actually takes some thought and careful analysis to be able to prevent out instincts to find connections that simply are not real.

Lets look at an example.  Two events that are associated, but one does not cause the other.  Wearing sunglasses and skin cancer.  If we looked carefully, (and this is pourely hypothetical, for illustration_ we could probably find an associated between wearing sunglasses and developing skin cancer.  i.e. people who have worn sunglasses for the greatest number of days in their lives carry a greater risk of skin cancer than those who have never worn sunglasses in the same population.  Obviously, one can easily see how this might come about and we would not jump to the conclusion than wearing sunglasses causes cancer.

However, this sort of mistake can be much more subtle, even very difficult to spot by professional scientists and this leads to very common erroneous interprations of data and false conclusions being drawn.  To get around this problem , scientists and philosophers developed experimental methods than would tease out the nature of associations and tell us whether these are cuasative or not.  One of these methods is the controlled experiment and for medicines, this take the form of the placebo controlled experiment (or trial).

We could just take a group of people who are ill and give them a treatment.  Some will get better and some will not.  How can we then be sure that the treatment actually helped the people who got better?  Perhaps they simply got better all for some other reason that we don't know about, especially likely since many other people didn't get better at all.   We really want to avoid giving people treatments that don't work because this will either prevent them from using something else, or cause them harm if there are side effects.

What could we do to tell if the treatment actually caused people to get better?  Well, we could keep repeating the treatment over and over again with every new patient we see.  If they get better soon afterwards, then we could conclude that our treatment works.  

But we do know that, when tested people can very often report that they feel much better and that their symptoms have improved even when no active treatment was given, but placebo instead (just as your definitions describe it).  This is not just about how they perceive their illness.  Often illnesses genuinely do improve over time and the clinical course often changes from day to day, week to week, month to month.  How do we differentiate between the effects of out treatment and these other effects than apply?  

Placebo controlled testing can tell us whether the effect of our treatment is due to something actually to be found within the treatment itself, or some other factor, something we haven’t been able to identify, but which nonetheless is real and is unrelated to the ingredients of our treatment.  Do these effects account for all of the effects to be found with our treatment (i.e., out treatment is basically a placebo itself), or can it not fully account for them (i.e., there is a therapeutically window, out treatment has an effect above and beyond placebo and seems to do some good, telling us than what we are using may be worthwhile?

This sort of testing is difficult to perform, if not conducted properly open to distortion and bad science and often performed terribly as little more than a marketing exercise for one treatment or another.  But when performed as it should be, it is the best way to establish whether a medicine is active and works.  

Homeopaths (and drug companies) are both very troubled with placebo controlled trials for a reason- they are powerful and there is no getting around them without cheating. Often drug companies can try to cheat this system and hide negative data.  Homeopaths try to cheat this system also by claiming that it does not apply to them, or that their methods are incompatible with this approach (Which is nonsense.  Just as the laws of gravity apply to us all, so do the rules of logic and reason.  This is a very weak and ignorant argument that “reason does not apply to me”.

As an independent, I see the tricks employed by both drug companies and homeopaths to try and deceive or evade the evidence based approach.  This is itself is proof of the power of these methods, an inherent endorsement of the scientific method itself.