Book review

UNDERSTANDING THE PLACEBOEFFECT IN COMPLEMENTARYMEDICINE

By D. Peters. Churchill Livingstone, July 2001.

ISBN 0-443-06031-2, Softback, 235 pages, £14.95

This book examines the theory, practice and

research behind placebos and the placebo effect in

complementary medicine. It is written by a variety

of practitioners from both conventional and

complementary medicine and gives a very

thought-provoking perspective in these days

where medicine is dominated by the all-prevailing

requirement to be ‘evidence-based’. The book is

both interesting and clearly presented with a

summary of each chapter’s content at the begin-

ning of each section and a note from the editor

giving some background on both the chapter’s

author and their theme. The book makes inter-

esting use of quotes, diagrams and case histories.

Each chapter ends with a conclusion summarizing

the key points from that section, a comprehensive

reference list and sources of further information,

including websites.

The first four chapters set the scene giving

definitions and summarizing the evidence that

the placebo effect is a research-based phenom-

enon. In addition, they correct a number of

‘myths’ about placebo effects and examine factors

that may elicit this response. It was interesting to

note that the status of the professional, their

confidence and rapport with the patient seems to

play a significant role in creating the placebo

effect. This is expanded upon in the following

chapters and, in my view, Chapter 5 stood out in

terms of its potential interest to dieticians as it

examined how practitioners ‘can optimize non-

specific effects’. It notes the importance of taking

time to listen to the patient showing real interest,

empathy and caring, arguing that the therapeutic

relationship is the most powerful trigger for a

self-healing response. The theme is further

developed in Chapter 6 which comprises a tran-

script from a lecture entitled ‘Some reflections on

creating therapeutic consultations’ and could be

of interest to all dieticians who have one-to-one

relationships with patients, particularly those

with chronic illnesses. It is followed by questions

from the floor and the speaker’s response. There

is also a chapter on the ‘therapeutic touch’, which

left me reflecting on how we as dieticians with

little in the way of a hands-on therapeutic role,

have an obvious gap in our ability to deliver

placebo effects via this route. There is, however, a

very interesting section on developing empathy

and ‘listening to the patient’s story’ – something

most dieticians are familiar with and are experts

at. This was reassuring and interesting to read

which stressed the value of allowing the patient

to describe their illness, symptoms and ‘take’ on

their illness as a cathartic process which may

benefit the patient over and above any thera-

peutic effects from any intervention that follows.

In these days of efficiency, staff shortages and

cost-containment this was an interesting thought

as time constraints may influence the practi-

tioner’s determination to deliver a diet education

message rather than listen to the patient. The

need to hear the ‘patient’s story’ would seem to

� The British Dietetic Association Ltd 2002 J Hum Nutr Dietet, 15, pp. 217–218 217

be particularly important when the history of

their illness is prolonged and complex.

In summary, this appears at first a very

specialist book but it would be of interest to

practising dieticians working with chronic condi-

tions who have an interest in the role of the

practitioner per se in eliciting a therapeutic

response. It is also clearly of interest to those

practitioners interested in holistic health and to

researchers involved in placebo-controlled trials.

Claire Wright

Senior Lecturer

Chester College

UK

Book review218

� The British Dietetic Association Ltd 2002 J Hum Nutr Dietet, 15, pp. 217–218