The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?” Annals of Internal Medicine 136(11): 817–25

In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient– physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect—patient, practitioner, patient–practitioner interaction, nature of the illness, and treat-ment and setting—are examined