Author: Virgil Seutter
Date: October 8, 1997
7.1 The Placebo Effect (7.1)
7.1.1. The outcome of any study that introduces a
effect is epiphenomenal. It is a nonsequator of known cause-effect
relationships. The contextual nature of placebo that describes an inert,
innocuous intervention into a scientific study serves the reductionist model
for inquiry. (7.1.1) Jennifer R. Jamison,
however, notes that while the mechanist/engineering paradigm views the placebo
effect as one that "...distorts evaluation of the patient's response to therapy;
from a holistic perspective, the placebo is a valued and valuable therapeutic
7.1.2. Manual therapy, and particularly chiropractic, is confronted with
a clinical experience that is often labeled as due to "nonspecific (placebo)
effects." (7.1.2) Much of this is due
to the inability to quantify the experience between the patient - practitioner
encounter. It claims an interaction that remains elusive to mechano-reductionist
examination. Jamison, however, has used the "infomedical" model that views
the relationships between the patient - practioner as a feedback loop of
interaction that is non reducible. It represents a psychobiologic relationship
that is, for the moment, beyond the ability to define in the reductionist
model of inquiry.
7.1.3. The treatment (placebo) outcome must be globally viewed in the holistic
perspective. The placebo outcome is part of an interrelationship that manifests
in three ways: 1) the symptom - centered effect is that combination of treatment
history coupled with previous experience that anticipates the positive outcome.
It is attributional in that previous treatment experience by the patient
conditions the patient to a learning experience that encourages an expectational
positive/negative outcome, 2) the expectation effect is one that is modulated
by the practitioner in response to the perception of symptoms by the patient.
It is probably better viewed as an information - expectation effect in that
it is dependent upon the patient's psychological expectation of the treatment
outcome. It deals with the imagery content of the patient's expectations
to a treatment, those preconceived notions about a treatment that can, in
itself, be positive or negative in determining the outcome to treatment.
In this sense, the outcome is dependent upon the practitioner's ability to
provide knowledge (information) about the mechanism of the treatment (placebo)
in relation to symptoms that determines the outcome, and 3) the attributional
placebo effect is inductive in that it centers around the patient's ability
to rationalize the treatment outcome. While the symptoms could be self -
limiting, the relief from symptoms are inclined to be attributed to the treatment
(placebo) itself. (7.1)
7.1.4. Identification of the placebo effect from a holistic perspective suggests
that the placebo can be a valuable therapeutic tool for the practitioner,
whether medical or chiropractic. The advantage for chiropractic, as a physical
contact system, encourages the use of touch, attitude, and tone of voice
to encourage this placebo effect. The holistic paradigm and the placebo effect
suggest a communication that "allows the patient an active, participatory
role in the patient - practitioner encounter."
(7.1) It is this clinical communication
that encourages a participatory role from the patient, that, for Jamison,
characterizes the essence of clinical legitimacy of the holistic paradigm.
HOW TO CITE THIS
Seutter, V. "Commentary: Holism, Alternative Medicine, and Why
Chiropractic Embraces It. The Placebo Effect" Chiropractic Resource Organization.
8 Oct 1997. ChiroZine
(c) 1997-2001 Chiro.org. All rights reserved.
(c) 1997 Chiropractic Resource
Organization. All Rights Reserved. Reprint by