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Practitioners of “placebo enhancement”

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

In 2001, the infamous Philadelphia Panel on rehabilitation interventions showed that many popular treatments cannot beat a placebo, an evidence-based bummer of epic proportions. Physical therapist Carol Davis found this “shocking in many ways” and wrote a letter to the editors of Physical Therapy. Like so many others, before and since, her reaction was to blunt the bad science news by putting placebo on a pedestal and moving the goalposts of science, suggesting that controlled trials aren’t so great. The editors’ reply was excellent:

If Dr. Davis believes that our future as a profession lies in our ability to produce placebo effects, perhaps she misses the point. Her view taken to its logical conclusion would not mean that we could, as she said, “reduce the musculoskeletal curriculum by two thirds,” but rather that we could possibly eliminate this aspect of the curriculum in its entirety as we become not physical therapists but rather practitioners of “placebo enhancement.” As a curriculum coordinator, Dr Davis should know that this role is not what sets us apart from other practitioners and is not seen as our raison d’être in any practice act or in any document that describes our practice. I believe Dr Davis’ views to be unwise and reckless and, most importantly, potentially injurious to those patients who expect us to have some basis in science for our practice.

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