https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539455/
A whole chapter is devoted to the power of belief and its effects on
physiology, highlighting the possible differences between individuals, however
well matched they are in statistical terms. What the book does not discuss is
the conflict between such personal characteristics and evidence-based medicine
(EBM), which depends on observations in groups rather than
individuals.4 Evans'
analysis suggests that there are ‘complex ways in which people come to
believe their treatment will be effective, sometimes putting the evidence of
their senses above the voice of authority, while at other times doing
completely the opposite’. Many within the medical profession continue to
be guided by similar instincts, describing their thought processes as clinical
judgment. It is issues of this sort that have made EBM so hard to implement.
As discussed in chapter 5, a dampening effect of placebo on the acute phase
response could be interpreted as reflecting the uniquely human social
expectation of care from
others.5 Perhaps the
most intriguing part of the book, coming from this former psychotherapist, is
the exploration of the role of psychotherapy. His conclusion is that, even if
psychotherapy proves to be no more than placebo, this does not necessarily
detract from its usefulness; and, if it is better than placebo, our failure to
understand how it acts on the brain may be analogous to our ignorance of
exactly why certain drugs are effective. Evans is at his best when writing
from personal experience. Whatever the reader's conclusions about the
scientific arguments, his examples and delivery provide a thoroughly engaging
way into this debate.
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