Author: Virgil Seutter
Date:     October 8, 1997
Parent Node:

7.1  The Placebo Effect (7.1)

7.1.1. The outcome of any study that introduces a placebo 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 tool." (7.1)

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.

Seutter, V. "Commentary: Holism, Alternative Medicine, and Why Chiropractic Embraces It. The Placebo Effect" Chiropractic Resource Organization. 8 Oct 1997. ChiroZine ISSN1525-4550
(c) 1997-2001 All rights reserved.

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(c) 1997 Chiropractic Resource Organization. All Rights Reserved. Reprint by permission.

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