Whenever we feel sick, or have pain, we tend to go to the doctor or to a therapist of some kind. The thing is that most of us usually don´t like going to the doctor or therapist and we wait a long time before we finally decide to go. And then when we finally decided to go, the symptoms usually improve. This makes us think that the doctor we decided to go to or the therapy we decided to do worked. I mean it´s quite simple, A leads to B, or doesn´t it? Let´s take a closer look at that.
When we think that just because two things happen together, then one must have been the cause of the other is called a LOGICAL FALLACY and this is something we do a lot.
Let me give you an example: When the rooster crows, the sun rises. Therefore, the rooster causes the sun to rise.
We do this more than we can imagine, and especially in my field (physical therapy) I see it a lot, I have also done it. Patients would come to me, I would treat them and they would get better, so I would naturally think ¨I´m the best¨ and ¨he got better because of me and my new wonderful technique that I applied on him¨ . We tend to base clinical convictions on personal experience and this, my friends, is a mistake. We have to base our treatments on randomized, placebo-controlled trials. Any treatment that doesn´t base itself on that is ¨bogus¨. This is the foundation of modern healthcare.
And which treatments usually don´t base themselves on that……¨alternative medicine¨(https://sports-diet-pain.com/?s=acupuncture). But sometimes ¨alternative medicine¨ works, why is that? Well, here are just a couple of reasons why sometimes it ¨works¨.
- The natural history of a disease- Many diseases are self-limiting. If the condition is not chronic or fatal, the body´s own recuperative processes usually restores the sufferer to health.
- Regression to the mean- Many diseases are cyclical, meaning they get worse or better temporarily, but always move back to an average severity(1). Back pain, arthritis, allergies, and multiple sclerosis are cyclical, meaning sometimes they get worse and sometimes they get better. Usually, we go to the therapist or doctor when we have the most pain, so it´s bound to get better no matter what the therapist does to you.
- Placebo effect – ineffective treatment that can nevertheless be consoling. But the placebo effect is not restricted only to fake treatments, it also plays a role in the impact of real medicine. For example, although a patient will derive benefit from taking aspirin largely due to the pill´s biochemical effects, there can also be an added bonus as a result of the patient´s confidence in the aspirin itself or in the doctor who prescribes it (2). That is why sometimes the doctor´s reputation, the cost of the treatment, its novelty, a gentle touch, a nurse´s smile, a diploma-covered wall, could all increase the placebo effect(3-5). https://sports-diet-pain.com/2013/10/18/placebo/
- Confirmation bias- We desire treatment success because illness is unpleasant. Recently there was a study (6 ) that measured objectively and subjectively the effectiveness of active albuterol against placebo (the patients were given a fake active albuterol), sham acupuncture or no intervention. Active albuterol is used for those who have asthma, it’s a bronchodilator. Subjectively ALL experienced an improvement (they used a visual analog from 0 to 10, in which 0 means no improvement and 10 means complete resolution). With albuterol the subjective improvement was of 50%, with placebo it was 45%, sham acupuncture 46% and the no-intervention control group getting a 21%. So, all improved subjectively but there was a big difference between placebo-sham acupuncture and the no intervention group, even though all 3 were INEFFECTIVE for the disease, crazy right?! Well, objectively (which means we can measure it), they made each of the 4 groups blow to measure lung function. And not surprisingly, the albuterol group improved the best, in fact, the real albuterol did 3 times better than all the other three groups. But, what was amazing is that all 3 ¨fake¨ groups improved a little, even thought NOTHING was being done to them. And also, objectively there was a HUGE difference between the real treatment and the fake treatment although subjectively there was barely any difference!!!! I hope you all understood the importance of this.
Alternative medicine is called alternative because it really doesn´t work. If it worked it would be called MEDICINE. Physical therapists out there reading this, let´s try to base our treatments on randomized, placebo-controlled trials and not on our own clinical or personal experience.
Here is a nice video that talks about alternative medicine. It´s 45 minutes but very interesting.
- Streiner DL. Regression toward the mean: Its etiology, diagnosis, and treatment. Can J Psychiatry. 2001;46:72–76
- Ernst E, Simon S. Trick or Treatment ? Alternative medicine on trial. Transworld Publishers.London,UK.2008
- Benedetti F, Mayberg HS, Wager TD, Stohler CS, Zubieta JK. Neurobiological mechanisms of the placebo effect. J Neurosci. 2005;25:10390–10402.
- Ernst E, Resch KL. Concept of true and perceived placebo effects. BMJ . 1995;311:551–553.
- Evans D. Placebo: Mind over matter in modern medicine. Oxford University Press; 2004
- Michael E. Wechsler, John M. Kelley, Ingrid O.E. Boyd, Stefanie Dutile, Gautham Marigowda, Irving Kirsch, Elliot Israel, Ted J. Kaptchuk. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in AsthmaN Engl J Med. Author manuscript; available in PMC 2012 January 14.Published in final edited form as: N Engl J Med. 2011 July 14; 365(2): 119–126
- Osteopaths-Chiropractors: Cracking of the bones (sports-diet-pain.com)