The Holistic Nurse: What’s So Awful About the Placebo Effect?

I recently came across this post by Dr. Simpson, a plastic surgeon/medical blogger who had some choice words about complementary and alternative medicine (CAM). I will admit that there may have been steam coming out of my ears by the end, but here is the gist: Complementary and alternative modalities as a whole are bad/unethical medicine and should not be utilized by medical providers nor sanctioned by state boards. 

As you can probably predict, I object. Vehemently.

It is true that many CAM options don’t have high levels of scientific evidence to back them up. But perhaps we need a new way of looking at evidence. RCTs may be the “gold standard” of science, but many CAM modalities logistically can’t be tested using these methods. The reason is that many CAM practices rely on a give and take between provider and patient, a deep therapeutic relationship without which these practices indeed may not be as effective. When I climbed onto the table at my energy healer’s practice, my participation in the process was required. Were I to be randomized in a study to a “sham” energy medicine group, chances are I would feel and experience nothing. Does that mean my experience wasn’t valid? It sure as hell was to me. When I see my acupuncturist once a month to help me with stress management, can I prove that the needles provoked a physiological response that in turn directly caused me to relax? Probably not. But does the experience help me relax in ways that no other experience has? Yes, yes it does.

Which brings me to my main point. Perhaps we will never be able to prove the scientific efficacy of certain practices. But so what? If they help us heal in a holistic sense, do they need to be “proven”? If our bodies feel refreshed and our minds are renewed when we leave our provider’s office, is this “placebo effect” such a problem? If the danger is negligible and the potential for healing unlimited, what’s the big deal?

I understand the role of evidence in recommending health care decisions. I’m going to be a Clinical Nurse Leader, for crying out loud. CNLs are all about evidence-based practice. I also recognize that nurses need to embrace research and encourage best practices. If you want science, go check out the National Center for Complementary and Alternative Medicine. You’ll get more evidence than you could ever want. Some of it might surprise you.

There is also something to be said for qualitative research. There is something to be said for creating theoretical frameworks and interviewing patients about their experiences with CAM in order to explore themes that may come in handy when designing person-centered interventions. There is something to be said for the psychosocial and physical wellbeing that can and does result from interactions with holistic health care.

RCTs and systematic reviews certainly have their place in advancing the science behind Western medicine.¬†But there are equally valuable research methods and equally important priorities when we are talking about helping our patients heal. We don’t just need to know which blood pressure medication is going to be most effective. We also need to know what brings a person’s blood pressure up, and how we can help them lower it through learning to deep breathe. Will it be effective with every single patient? No. But neither will a drug. Is it beneficial to teach sustainable, person-centered, non-pharmaceutical¬†methods of self-care? You bet.

As health care providers, we need to broaden our minds about the definitions of “health” and “healing”. In the mind of Dr. Simpson, “healing” means freeing oneself of illness. But I think we all know better than that. I think we are all on a journey. Some people with illness might even say they are healthy (gasp!), because they can get up every morning and do what they need/want to do each day.

If biomedical providers are this close-minded to holistic options, it’s no wonder their patients don’t tell them when they want to try acupuncture, or see a chiropractor. It’s the lack of conversation between and among providers of all types that leads to dangerous outcomes. Don’t blame the homeopath for prescribing those herbs. Blame the silence that wedges “us” versus “them”, that makes patients reluctant to reveal whom they’re seeing, and why. Blame the superiority complex that we in Western medicine claim over modalities that have been around for thousands of years.

We should be talking to each other. It’s for the good of our patients.

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