Correspondence (letter to the editor): Results Are Easily Manipulated

In recent years I have started following discussions on placebo effects. I have reached the conclusion that the placebo effect of a study is nothing other than an indicator for the regulatory abilities—or let’s call it self healing powers—of patients in any given study cohort. If different studies show placebo effects ranging from 7–49% this may not be exclusively due to regression to the mean and spontaneous resolution. Furthermore, it may indicate that different numbers of patients with normal regulatory capacities were included in the placebo groups.

The authors assume that placebo effects account for almost the totality of effects in alternative and complementary medicine and ask whether targeted administration of a placebo constitutes deception. Simultaneously they recommend that the placebo effect should be consciously exploited as an important ingredient in orthodox medicine where genuine medications are used. I wish to ask the authors why they advocate using placebos in orthodox medicine while dismissing their use in complementary medicine?

I believe that the intentional exploitation of a placebo effect entails a risk of laying trial results open to manipulation—for example, in a clinical phase III study. Similarly, the intentional use of placebos by alternative practitioners should not be approved. However, would they devote themselves to gain comprehensive additional qualifications and studying the ample literature if they suspected they were working with placebos? Thus far, no “curabo” [I will cure] effect has been shown. A substance is not a placebo simply because we don’t understand its mechanism of action.