Changing Expectations

Changing Expectations

There is always the question as to whether a particular pseudo-medicine works. What ever 'works' means. Sometimes it feels like determining what the meaning of 'is' is.

When I say a pseudo-medicine doesn’t work, I mean is has no effect on the underlying disease pathophysiology. But that is different than having an effect, as pseudo-medicines do have an effect on illness if not disease.

Being ill is more than having a diseases: acute and chronic pain, not being able to work or function normally, sleep disruption etc all play into the response to having an illness. In residency we used to referred to all the extra complications as the supratentorial component of the illness, although not always in a complementary way.


I have snarkily referred to the effect of pseudo-medicines as beer goggles: they make the disease appear better than it actually is. Since the pseudo-medical intervention is fundamentally worthless, the treatment effect is not ethically based. The ends to not always justify the means.

However, it is interesting to see how people respond to pseudo-medicines. In A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies, they interviewed patients with chronic low pack pain before, during and after yoga, chiropractic, acupuncture or massage.

The results are interesting. Before the therapies the issue was whether not the treatment was going to be effective in helping their pain. After?

Participants seeking one of four CAM therapies focused most of their expectations and hopes during initial interviews on whether or not the treatment could lessen their pain. In later interviews, where self-care was included in the interview guide, emphasis tended to be broader, shifting from needing to be “fixed” to an emphasis on the body as a work in progress, in need of ongoing attention and care from both the patient and the CAM practitioner. This trend toward attention to management, self-care and wellness, and increased acceptance of pain as chronic, was reported by participants seeking all four therapies.

That is an interesting result from using different CAM modalities. The chronic back pain was not necessarily improved but the patients developed a more realistic approach, changed their expectations about their pain and took more ownership for a problem that required management rather than a cure.  A long term placebo effect.

They conclude that

These findings suggest the value of further research into the potential of the CAM therapeutic process to assist patients in taking control of their health management and wellness.

I don’t think so. I could argue that at least chiropractic and acupuncture are based in fantasy. Massage and yoga can have that taint; it depends on how they are sold.

We don’t the pseudo-science of CAM for this. It is, however, a worthy goal for reality-based base medicine.

Weaponized acupuncturists stake claim in Wyoming
Points of Interest 02/07/2015

Related Posts