The newest issue of Scientific American Mind has a pretty interesting article on placebos. Although CAM isn’t mentioned specifically, what the highlighted studies suggest has a lot to say about the power of alternative medicine and the overall abilities of the human mind.
The article looks at two different types of placebo; Conditioning placebos, in which real medicine is paired with a second stimulus and the medicine is removed, leaving a second stimulus that provides relief, and Expectation placebos, in which a sham stimulus works because it is similar to a previous effective medications (such as an injection followed by a similar saline injection) or because the patient believes that the sham treatment will work.
The gist of the article is that expectation placebos only seem to work on subjective symptoms, like pain. Conditioning placebos can actually have physiological effects, everything from immunosupression to, in one case, shrinking tumors.
Of course, none of this answers the question of whether placebo treatment is ethical. Consider alternative medicine, for example. Or alternative therapy. One alternative psychotherapy, the emotional freedom technique (EFT), involves tapping on acupressure points on the body while repeating statements that remind one of their problem. Proponents point to horribly-designed studies and argue efficacy. Most likely, the effects are the result of placebo, distraction, and cognitive reprogramming.
So if we can say that placebo is effective, is it ethical to use placebo to treat mental or physical disorders? I say no. First, because the placebo effect is not as reliable as standard treatment. If I were a therapist, I wouldn’t want to hang my success rate on whether someone believes that tapping can solve all of your problems. Second, placebo is unpredictable. If someone believes in the efficacy of a treatment, then becomes unconvinced, it could cause serious problems.
Of course, psychotherapy has its own issues with placebo. With research showing that the therapeutic alliance is more important than any particular therapeutic school of thought, belief plays as much of a role as anything else.