Correspondence (letter to the editor): Statistical Methods Are Inadequate

I would agree that, when administering pharmacologically effective medications, the mechanisms that underlie the administration of a placebo should be consciously exploited. I would, however, argue that such mechanisms cannot be achieved with very little effort. To influence positively the conditional reflexes and expectations of a patient is not possible without a greater effort being involved—much in the same way as a suitable personal charisma on the doctor’s part and of the atmosphere where the treatment is being given. Doctors are not trained for this, and neither does the medical system expect this of them in everyday clinical practice.

The placebo effect is still being confused with the phenomenon of prescribing a “sham medication.” However, placebo effects as I would describe them are so much more. No surgery, no irradiation treatment, no drug administration, no patient between doctor and patient, no expectation on the doctor’s part or the patient’s part are ever devoid of placebo or nocebo effects, even if this has not been (and probably cannot be) statistically proved in the individual case. These phenomena touch on sociological, philosophical, or even spiritual questions that statistical methods famously cannot capture. Doctors are prone to underestimating the placebo effect and often totally ignore the phenomenon, except when it is essential in drug experiments. Guideline based medicine, which is increasingly based on statistical proof of efficacy, is an obstacle to the access to and inclusion of placebo effects in everyday medical practice.