Wait a minute..

[Diane]

This article (http://www.guardian.co.uk/commentisfree/2008/mar/24/medicalresearch.pseudoscience) is about a woman in the UK, who is studying aspects of CAM, and trying to fathom why the public seems to be so stubbornly drawn to it. She's taking a second look at placebo in particular. Good on her I say - the more people are out there making better sense out of things, the better.

I put it here in the decontamination room, a place where looking at something like this can be done in safety. We have tyvek suits, hoods, showers... the whole schmoo. :D

[Diane]

The reason I brought this article here is because large chunks of it have already been covered, if people would take the time to read up on pain science. Someone in the UK needs to point this woman who is doing this series of TV shows, toward Wall's work, and send her a set of Topical Issues in Pain, where she would learn how the "science" of placebo and of treating pain is being thought about and applied. Seriously, this series as described sounds like it never heard of pain science. UK pain division, you should get around more, do more public education, write more letters to more TV producers, to people like Kathy Skyles. Excerpts:
it takes a brave scientist to launch into this territory and risk getting attacked from both camps by daring to ask a simple question: is there anything science can learn from complementary medicine? That is precisely what Kathy Sykes is doing in her current television series, Alternative Therapies (the second programme is on BBC2 tonight). As Bristol University's professor of public engagement in science and the director of the Cheltenham Festival of Science, no one can challenge her credentials as a scientist, yet her scrutiny of particular therapies throws up serious challenges to conventional medicine.

Sykes is too good a scientist to give complementary medicine an easy run. Tonight she examines reflexology, and gives it pretty short shrift. There are 30,000 reflexologists working on a million British feet a year. They base their work on a theory that parts of the sole of the foot correlate to organs in the body. The only problem is that Sykes could find no one, reflexologist or scientist, who could explain how these correlations might work. Furthermore, it turned out that this "ancient" healing system seems to have originated with an imaginative American woman in the 1930s. ... Sykes presses on and it takes her into two areas of scientific research. First, she digs up new research on the importance of touch, which can have a profound impact on the brain. Even the hand of a stranger reduces anxiety and that of someone with whom one has a close relationship is even more significant. In fact, Sykes finds some scientific underpinning which goes beyond placebo in many of the therapies she looks at. But it is placebo which emerges as a recurrent and crucially important thread in her quest, and it leads her to the work of several American scientists who are trying to identify what placebo is, who it works for, and why it works.

This is one of the most common charges made against complementary medicine - that most of it is no better than placebo. But there is a way of turning that accusation around: perhaps complementary medicine is an effective way to harness placebo as one of the most powerful - and cheapest - of healing processes. Rather than being derogatory about the phenomenon as "just" placebo, perhaps we should see it as one of the most remarkable and little understood aspects of the human body. Wall certainly did.

That line of inquiry has taken Sykes to the US several times over the course of the two series she has made. There placebo has become a new frontier in medicine. In a range of studies with startling results - even sham knee surgery can be as effective as the real thing - many factors contribute to placebo: the confidence of the doctor; the social, cultural expectations around the procedure; the empathy and warmth of the patient-doctor relationship; the patient's degree of faith. Get all these right, and the outcome can be remarkable. Harvard professor Ted Kaptchuk is publishing a study this week which shows that placebo is as good as any conventional treatment available for irritable bowel syndrome. Given that the eight most industrialised nations spend $40bn a year on medication for this condition, that's revolutionary stuff.

This kind of research into placebo gives some insight into why complementary medicine has boomed and why there are so many people who cite their own experience to passionately defend it. The average consultation with a GP is 4.6 minutes, while the complementary therapist can devote an hour to taking detailed personal histories. That time and relationship provide a context and an opportunity for the ritual and recasting of personal experience which Kaptchuk believes are the crucial elements of placebo.

Complementary medicine is most popular where conventional medicine fails, such as with musculoskeletal conditions and mental health - stress, depression, anxiety (the recent revelations about the inefficacy of Prozac were another reminder of how shaky the science is in a large area of conventional medicine). Several complementary therapies are particularly effective at pain relief - you had to see Sykes's footage of hypnotism helping a woman to have teeth extracted without anaesthetic to believe it. Kaptchuk argues that pain is not a static given but can be experienced dramatically differently.

I put this article into the "decontamination room" here on somasimple, because it irritates me that it was written in such a way as to suggest that pain is not already being studied and treated scientifically. :thumbs_do
Instead, it is highlighted as an important problem that only CAM seems able to address. This is an insult to conventional medicine and to PT in general. In PT, at least a few of us are taking on pain and its treatment (and the whole nervous system and its functional quirks in general) as an entire field well worthy of study.