Designer's Corner - Alternative Therapies and Placebos: Conceptual Clarification and Methodologic Implications

Abstract

The past decade has witnessed increased public awareness and use of alternative therapies for the management of diseases and symptoms (Schwartz, Chesney, Irvine, & Keefe, 1997). Spiro (1997) relates the increased use of alternative therapies to the need for personal connection, belonging, and comfort. A variety of biochemical, psychophysiological, and psychological therapies are available, including homeopathic preparations such as sulphur for dermatoses (Linde et al, 1997), acupuncture, reflexology, massage therapy, therapeutic touch, and self-help approaches. Margo (1999) reports that alternative therapies are used by 20% to 50% of persons in industrialized countries, with some $14 billion being spent on such therapies in the United States. A large number of publications have been devoted to alternative therapies (e.g., Journal of the American Medical Association, 280, 1998); medical and nursing schools are offering courses in alternative therapies; and funding has been made available to systematically investigate the effects of alternative therapies (e.g., National Institutes of Health) (Kwekkeboom, 1997). Despite the interest in alternative therapies and the accumulating empirical evidence supporting their effectiveness, some scholars view these therapies with scepticism. Many consider them as placebos (Linde et al., 1997; Shapiro & Shapiro, 1997). The arguments for or against considering alternative therapies as placebos are based on differences in professional paradigms and perspectives on what constitutes a placebo