The Magazine

Doing Harm

The alternatives to medicine can be sickening.

Dec 2, 2013, Vol. 19, No. 12 • By TEMMA EHRENFELD
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The “sense” of alternative medicine comes down to the power of the placebo effect and the attractive idea that we can use it to our advantage. My mom’s tiny white homeopathic pills for “calm” did appear to make her calmer, and if you asked her why she took them, she didn’t invoke homeopathic theory. “They work,” she said. Homeopathic remedies, Offit says, are safe because they are actually sugar or water. One popular product (I’ll confess that I’ve used it) is oscillococcinum, for colds and flu. Offit argues that it’s a better choice than cough-and-cold preparations with pseudoephedrin, which, according to the Centers for Disease Control, can cause hallucinations, seizures, and heart problems in young children. 

The best news here is a paragraph on scientific research showing that people can be taught to suppress and enhance their immune responses. We also hear from Norman Cousins, the man who told us to laugh when we’re sick. Offit concludes with Cousins’s account of his meeting with Albert Schweitzer, whose clinic in West Africa brought, in 1912, quinine for malaria, digitalis for heart disease, and salvarsan (the first antibiotic) for syphilis. Schweitzer took Cousins to a jungle clearing to see an elderly witch doctor at work. The witch doctor gave some patients herbs; for others, he gave no herbs but filled the air with incantations. For a third group, he pointed to Schweitzer.

Later, Schweitzer interpreted for Cousins what had occured. The first group had problems that could be resolved without treatment, or couldn’t be treated. People in the second group were receiving “African psychotherapy,” according to Schweitzer. And the people in the third group, the witch doctor knew, had problems that Dr. Schweitzer could treat better than he could. 

Similarly, today’s mainstream and alternative healers both have their place, Offit writes. 

The problem comes when mainstream healers dismiss the placebo response as trivial or when alternative healers offer placebos instead of lifesaving medicines or charge an exorbitant price for their remedies or promote therapies as harmless when they’re not or encourage magical thinking and scientific denialism at a time when we can least afford it. 

I would like to have heard more from Offit on how our society can humanize medicine and make better use of the placebo effect. Although he doesn’t mention this, deception and denial of scientific evidence may not be necessary. In a 2010 pilot study, a Harvard team studying the placebo effect compared two groups of people suffering from irritable-bowel syndrome, a chronic gastrointestinal disorder accompanied by pain and constipation. One group received no treatment. The patients in the other group were told they’d be taking fake, inert drugs—delivered in bottles labeled “placebo pills”—but that placebos often have healing effects. 

The results surprised everyone: Patients who knew they were taking placebos reported twice as much relief as people in the no-treatment group.

But a later study, with asthma patients, found that although people perceived improvement while on a placebo, the benefit couldn’t be measured objectively. Seeing improvement that doesn’t exist is a problem if it leads someone to not take an effective treatment. So there’s help to be had in a harmless placebo, but only when there’s no better option. 

The witch doctor had it right.

Temma Ehrenfeld is a writer in New York.