Sunday, January 22, 2012

Is placebo like gravity?

So.. I'm thinking lately that manual therapy will never be able to eliminate placebo from its work. As a commenter (Natalie Shaw) pointed out today on Facebook, it's kinda like gravity. You barely notice it's there. Which made me think about the craziness of a culture demanding that you must take everything out into outer space to weigh it, so that gravity (placebo) is eliminated. How Balnibarian is that? How tooth-fairy supportive is that?

What's worse is a culture that says, OK, if you can't do that, then we accept all sorts of ideas that aren't even plausible. From Science-based Medicine blogpost by Harriet Hall,

Visceral Manipulation Embraced by the APTA

Placebo (in my own humble opinion) is a patient's attitude, readiness: it's in every awake person, every conscious human; it's there all the time, including for something as supposedly as objective as surgery (see comment by ErikMeira in the same SBM thread, Jan 20th).

Viewing it as a confound when building an evidence base for manual treatment (especially for manual treatment of live, conscious, hopeful people) is really counterproductive. I think placebo would be best framed as a match the *patient* might use to ignite his/her own recovery, regardless of treatment.

The corollary of this is that all manual therapy (regardless of kind), or maybe medical treatment too, assists, maybe blows on the flame a bit. Too much is counterproductive, might extinguish it.

Everything a patient needs for combatting nuisance pain is already right there inside their own nervous system. A good human primate social groomer will realize this (however instinctively, non-consciously); he or she will cheerfully step outside his/her own ego to help somebody build whatever fire they need to build to burn off their own pain problem.

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