health care professionals need to be able to deliver such cognitive and emotional care.
This is a critical element of patient-centredness.
Explaining placebo effects: neurobiological processes
In an interesting review, Finniss et al.(2010) point out that the physiological mech -
anisms underpinning placebo effects vary across conditions. So, for example, in pain
relief these involve activation of endogenous opioids and dopamine systems while in
depression they involve changes in electrical activity in parts of the brain. Thus placebo
effects are observed because particular psychological processes initiated by interactions
between health care professionals and patients activate particular physiological systems
that have healing effects. If health care professionals understood better how their
interactions with patients could initiate such activation they could, potentially, enhance
traditional medical care. Moreover, CAM effects may be best explained by specific
physiological activation effects. However, it is not clear how such effects can be reliably
activated and it seems likely that the degree of activation may vary across patients. In
addition, as Finniss et al.(2010) highlight, there are ethical issues about how such effects
may be activated without deception. Finniss et al.conclude that further research on
deliberate initiation of placebo effects in clinical practice is needed to fully understand
how psychological changes may initiate these physiological healing responses. Such
research could allow health care professionals to harness placebo effects to enhance
patient care.
Understanding and testing complementary therapies
The assumptions underpinning many complementary therapies are incompatible with
scientific findings. For example, some homeopathic treatments are diluted so many
times that not a single molecule of the original substance remains. While homeopaths
claim that water somehow ‘remembers’ the original active ingredient this makes no
sense in terms of our understanding of the chemistry of water (Murcott, 2006).
Similarly, as the UK NHS website explains, acupuncture is based on the assumption
(first made 2,000 years ago in China) that health depends on a life force called Qi,
which flows along 12 bodily meridians. Needles are inserted into the meridians to
restore health by unblocking Qi flow. Yet anatomical research has found no evidence
of these meridians.
Considerable effort has been devoted to evaluating the effectiveness of comple -
mentary therapies and acupuncture is especially well researched (see also Vickers and
Zollman, 1999, for a useful introduction to osteopathy and chiropractic). Vas et al.
(2004) found that combining acupuncture with pharmacological treatment for
osteoarthritis of the knee led to greater pain reduction and increased physical
functioning one week after treatment, controlling for placebo effects. However,
Foster et al. (2007) found that adding acupuncture to advice and exercise for
osteoarthritis of the knee did not enhance effectiveness. Interestingly, the acupuncture
placebo condition in this study involved use of blunt needles, which collapsed into
their handles to give the appearance of penetration, thereby controlling for some
contextual effects. The UK NHS website notes that the UK National Institute for
Health and Care Excellence (NICE) only recommends acupuncture as a treatment for
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