When you are trying to determine if a drug or treatment is doing patients any good, one problem you have is the placebo effect. Many patients get better on their own, just healing themselves. Others will say they feel better to make the doctor happy. Others will honestly think they feel better, just because they expected the treatment to work. Many such patients go on to give glowing testimonials of the treatment they received, oblivious to the fact that it actually did little or no good.
So it is important to do a placebo trial. Half the patients you give the drug you are trying to test, and the other half are given placebos: pills that look just like the ones you are testing, but they have no medicine in them. Furthermore, it is important that you do the test double-blind: the patient must never come into contact with anyone who knows which of the two types of pills they are getting, so they have no way of figuring out. You then compare the improvement rates between the two groups. Normally both groups improve, at least a little bit, but the drug is only considered to work if the drug itself performs significantly better than the placebo.
Double-blind placebo trials didn’t become very common until well into the 20th century. Doctors were aware of the placebo effect for centuries before that, and often deliberately gave treatments they knew did no good, realizing that sometimes the patient would get better and be grateful for the “help”.
Double-blind placebo trials are now the normal standard for western medicine. Any prescription drug you can buy, and any new treatment an MD does to you, has to have been proven effective in a double-blind placebo trial. However, some old, obvious treatments like bandaging a scar or putting a cast on a broken bone probably never had to be placebo-tested.
Double-blind placebo trials take a lot of time, and are expensive. When a new drug is developed, they first spend years testing it on animals and people, not for effectiveness, but just for bad side effects. Then they spend years testing for effectiveness. Patents only last for 17 years, and the drug companies complain that it’s sometimes hard to get a drug to market very long before the patent expires, at which point other companies can compete to manufacture and sell the drug as a generic, driving the price down so the company that developed the drug has a hard time making enough off it to pay for their research.
It is illegal for an MD to give you alternative medicine. Alternative medicine, by definition, has not proven itself in double-blind placebo trials. There are two types of alternative medicine:
- That which has been shown not to work. When a substance or treatment is shown not to work, people can still write glowing testimonies of their “cures” by it in books, blogs, and magazine articles. It’s called freedom of speech. And in some cases, politicians allow special, non-MD practitioners to do the treatment, especially to appease traditional practices of ethnic minorities.
- That which has not been shown to work. When an alternative substance or treatment is shown to work, then regular MD’s start giving it out, and it is no longer “alternative”, it is just “medicine”.
I’m not sure how the government draws a line between drugs and “natural” remedies. “Natural” remedies don’t have to prove themselves, and can be bought without a prescription. “Drugs” cannot be bought at all unless they prove themselves, and then can only be obtained with a prescription.
There is some limitation on the “natural” stuff. Sellers of herbs and vitamins can’t make unproven medical claims on the label. Much as they would love to write “vitamin X prevents cancer” or “St John’s Wort cures depression” on the bottle itself, they can’t do that. But they can and do say anything they want in the alternative medicine press.
Well said and succinctly put, Bill. There is such a close link between physical health and psychological well-being, I’m sure that 20 years from now we will be astonished at how little attention early 21st doctors paid to it. Big fan of old-fashioned placebos in our house – when she was little, my daughter had endless sticking plasters on things that didn’t really need them, and minor bumps and bruises were kissed or rubbed better, just as my mother used to do for me. Just knowing someone cared was enough to make the pain disappear! Also, once I went to a homeopathy consultant for a problem I was having that conventional medicine couldn’t fix and I had to tell the guy my entire medical history. There followed a week or so when I seemed to go through a symptom of every illness I ever had – talk about the power of suggestion! The homeopathy didn’t fix the problem I consulted him for though! Still not sure how they explain homeopathy working in cattle, though – I guess they just use it to treat things that would otherwise go away of their own accord without treatment, then credit homeopathy with the cure!