Dr’s. lies & patient benefits?

Posted on May 31st, 2010 by O'DB in the Forest

acupuncture joke

A recent study published in Nature Neuroscience in mice suggests a physiological explanation for the pain-relieving effects of acupuncture. Adenosine, a neurotransmitter (a signalling compound around the body’s nervous system), is released in response to acupuncture & activate adenosine A1 receptors (proteins found in the membranes of pain conducting nerves) to elicit analgesia or pain relief. In Ed Yong’s brilliant blog Not Rocket Science he breaks the paper down & questions whether  the claims are over-stated – for instance stimulation of local areas, without acupuncture or needles per se, may also cause sufficient elevation of adenosine & resulting analgesia.

I left the following comment on Ed’s blog & thought it’d make an interesting topic here at GSTC:

‘On a broader sweep, it got me thinking about the placebo effect. I know this isn’t an original thought, but assuming that the placebo effect is significant in pain relief, then isn’t this a valid piece of a medical practitioner’s arsenal for treating patients? Or, in other words, is it right, ethically or Hippocratically, for a Dr. to knowingly defraud their patients with whatever works (yes, even homeopathy if the patient believes it works) to elicit a placebo effect? I’m not pro-alternative remedies, but if the placebo is a sufficiently strong effect isn’t it worth deliberately eliciting this response if it helps?’


10 Responses to “Dr’s. lies & patient benefits?”

  1. Gareth in Thailand says:

    Sounds plausible but wouldn’t a known placebo effect treatment then become ineffective as, once licensed, the patient would know its based on the placebo effect and therefore loose the very faith / belief in the treatment that made it effective in the first place.

    • O'DB says:

      yep, exactly. Which is why the medical establishment would have to push the effect as genuine, even if it meant defrauding the public, so that the placebo effect would be maintained.

      If it works, it works – but would be based on lies. Ethical dilemma or common sense?

      • Gareth in China says:

        I guess it depends on the percentage of patients who benefit from the placebo effect.
        If it is 100% then great get on with it, if its less than 50% then maybe that stat has to be quoted to the patient (just like some conventional medicines that aren’t 100% effective have their chances stated).
        However introducing that percentage doubt may well lessen the chances of it working and therefore lower the percentage in the first place and could lead into a spiral ending in zero effect – a classic feedback loop.
        I’m not sure I have anywhere near the knowledge and information to make a call on this but the above is my opinion with the data available.

    • O'DB says:

      Ed Halliwell in The Guardian has written a piece on the use of placebo in medicine:

      http://www.guardian.co.uk/commentisfree/belief/2010/jun/07/placebo-effect-alternative-treatments

    • PBScott says:

      I am quite confident acupuncture should work, I have never actually heard it didn’t work before, but I also believe some of the claims of its miraculous healing powers are probably overstated.

  2. O'DB says:

    If you’ve the time & inclination to follow the Nature Neuroscience adenosine/acupuncture story further a cpl more blogs have critiqued/commented on the study:

    Steve Novella’s Nurologica blog
    http://www.theness.com/neurologicablog/?p=2015

    & Orac at Respectful Insolence:
    http://scienceblogs.com/insolence/2010/06/when_what_an_acupuncture_study_shows_is.php#more

  3. Ethical dilemma…I have been faced with this issue in the past with my clients especially when it is determined that there is no real medical reason for the symptoms. A little colored water can go a long way. But, for everyday people like myself, I would want to know what the doctor really thinks as I’m going to look it up on the Internet anyway. I also ask questions about how it works and why until I understand in clinical terms.
    .-= Clinically Clueless´s last blog .. =-.

  4. Oh, I love the picture!!! The VW van is hilarious!!
    .-= Clinically Clueless´s last blog .. =-.

  5. O'DB says:

    Jim – yep the adenosine is released by the body as a result of stimulating a localised area – an inflammatory response, though piercing isn’t necessary since the same effects can be achieved with tooth-picks & faux-needles (needle with retractable needle head). Which is why the research was criticised: they make a link specifically to acupuncture, yet piercing the skin, acupuncture points & qi & meridians which are all fundamental to acupuncture weren’t fundamental to this adenosine effect – a localised (but not specific acupuncture points) stimulation (needles, tooth picks, even rubbing) may elicit this inflammatory response (increased adenosine release) & provide some analgesic relief. So, interesting finding, but not technically acupuncture.

    It was actually another criticism of the study – regarding the placebo effect & lack of control for it – that got me thinking about the broader implications of using the well known placebo effect & deliberately harnessing this to achieve cheap & relatively effective treatment (it’s not a panacea for pain but has measurable effects in certain pain states).

    As posted above Ed Halliwell in The Guardian has written a piece on the use of placebo in medicine, so developing this idea further:

    http://www.guardian.co.uk/commentisfree/belief/2010/jun/07/placebo-effect-alternative-treatments

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