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To the Editor:

I was very much engaged by Dr. Bonchek’s review of research involving Tai Chi as a treatment for Fibromyalgia.¹ I agree with his premise, that much of the improvement ascribed to Tai Chi could in fact result from the placebo effect. But what most engaged me was fibromyalgia as a perfect vehicle to study the placebo effect itself.

In Wired Magazine, Steve Silberman discussed the efforts of William Potter and others to not only study the placebo effect, but to convince Big Pharm to dedicate research dollars to that study.² Could the placebo effect be more than an impediment to new drugs being produced and approved? Could the placebo effect be harnessed to heal patients without the need for chemical or invasive interventions? Currently, the placebo effect is cast as the tare against which treatment effectiveness is measured. But could a placebo be the treatment itself, measured against, who knows, maybe doing nothing?

But how could one study such a thing? Doing nothing means allowing a patient to come to further harm. But perhaps not in the case of fibromyalgia.

Dr. Bonchek states “Provided that a patient’s condition will not worsen while a possibly ineffective therapy is tried, what harm is done, as long as the therapy is harmless and inexpensive?” He’s referring to fibromyalgia, for which lack of treatment provides no further risks to the patient. And this is the essential quality that makes fibromyalgia an ideal subject for placebo studies. No harm will come to patients even if the placebo effect doesn’t help. And no harm will come to patient who are put into a control group and thereby receive no treatment at all.

What’s more, fibromyalgia currently has no treatment which has been proven effective. The condition’s “very existence has been questioned,” according to Dr. Bonchek. So doing nothing will not only fail to harm the patient, but doesn’t even have an opportunity cost. The patient isn’t cheated out of a more effective treatment that may have helped.

So I agree that the effectiveness of Tai Chi on fibromyalgia patients needs further study. I agree that the media’s report of the study is flawed, failing to show to necessary caveats. But I believe a more important and effective study could be designed using fibromyalgia patients. And a study on the placebo effect itself could reverberate far beyond any one condition, and provide a new tool for the practice of health care.

Erich Goldstein, MS
Math Faculty
Lancaster General College of Nursing & Health Sciences

References
 

1. Bonchek, L. (2010). Faint Praise, Imperfect Studies, and the Placebo Effect. The Journal of Lancaster General Hospital, 5, 65-67

2. Silberman S. (2009, August 24). Placebos are Getting More Effective. Drugmakers are Desperate to Know Why. Wired, 17.09