At their heart all pseudo-medical therapies are unethical.

At least in the US the first rule of Medical ethics is autonomy: the patient is captain of their medical ship and has the right to make whatever decision they choose about their health care.

It is the opposite of the old school doctor-knows-best paternalism. Occasionally I see a patient from another country and the family is adamant that the patient not be told the truth about his diagnosis and treatment options. It is a very uncomfortable position to be placed in.


It is my job as physician to tell my patients the truth, the whole truth, and nothing but the truth. Only then can they make an informed decision.

All the pseudo-medicines covered by this Society are no better than placebo in well done trials. The usual rule with pseudo-medicine is that increasingly well done trials show decreasing effect until a trial with no potential for bias (double blind, placebo controlled) show no effect. When a therapy is no better than placebo, we say the therapy has no effect.

There are several ways to consider the placebo effect, but at best you can say is that it only marginally improves subjective outcomes with no real effect on objective outcomes. I call it the beer goggles of medicine; placebo does not change reality, only the perception of reality.

Key to a placebo effect, such as it is, is not knowing that it is a placebo. Fake acupuncture will have more subjective improvement if the patient thinks they are getting acupuncture than if they think they are not. If you believe in the placebo, you also more likely believe you are better.

So to use the placebo effect of pseudo-medicines clinically you have to lie to the patient. You have to tell them the placebo will be effective even when it is not and can not be effective. Placebo requires deception and deception in medicine is not allowed. If you deceive patients they cannot have autonomy.

There is a recent meme (as my kids like to say) that if an pseudo-medicine is equal to placebo, then it is effective, by harnessing the power of the placebo. That is nonsense. A recent example of calling cold actually hot were the numerous headlines following Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma in the NEJM. All the headlines had variations of Placebo Effect Powerful in Asthma when in fact placebo did nothing and does nothing.

The NewStatesman summed up the issue nicely today:

Hence, for such treatments to work, doctors must either disseminate false information to their patients, or be purposefully ambiguous, as many of the GPs who refer their patients to alternative therapies are... It is for this reason why alternative medicine is flawed. As tempting as it might be to embrace placebo-based treatments, the ethical standards we would have to sacrifice are infinitely more valuable.

Too bad the major medical institutions embracing pseudo-medicines lack the same moral-ethical understanding.