But that is not all. Recently, I have been involved in an on-going re-evaluation of the therapeutic process, especially in homeopathy, in terms of a complex interaction between the patient, the practitioner, and the remedy called PPR entanglement. This is based around what meaning one should attach to the results of double-blind randomised-controlled trials (DBRCTs), which are currently the 'gold-standard by which most therapeutic procedures are tested and judged.
When double-blind randomised controlled trials (DBRCTs) of homeopathy are conducted, the results are at best equivocal, though there are more trials showing homeopathy is better than placebo. However, sceptics of homeopathy take negative results obtained from DBRCTs as indisputable 'facts', while the positive results are rejected out of hand. Never once is the possibility entertained that the DBRCT might itself be fundamentally flawed or perhaps totally inappropriate, not only for testing homeopathy/CAMs but also conventional medicine.
For example, the DBRCT makes the implicit assumption that blinding and randomisation ensure the observed specific effects of a therapy and the non-specific effects of the therapeutic context are separable into discreet quantifiable elements. This assumption is necessary because only then can results obtained from DBRCTs havestatistical 'significance', making it possible, it is thought, to 'get at' what the therapy itself is actually doing, free of any 'complicating' contextual factors. Thus in homeopathy, the remedy is considered an agent of therapeutic effect, completely separate from case-taking, which provides context.
But what if there is no justification for separating therapy from context? What if in fact they are so deeply and intimately intertwined and correlated with each other, any attempt at separation so disturbs the therapeutic effect, it makes the results of such trials meaningless? After all, in 'real life' no therapeutic procedure, including conventional medicine, is ever practiced according to this separation of therapy and context required by the DBRCT protocol. What is increasingly apparent, is that this implicit separation fundamentally interferes with the therapeutic process under investigation.
It has been argued that without the implicit separation of therapy and context on which the DBRCT protocol depends, the placebo concept could evolve into something altogether more complex than the mere pejorative connotations currently ascribed to it. Apart from pharmacological efficacy, this new concept would need to include less quantifiable (and therefore from a 'hard' evidence perspective, more contentious) 'observables' such as belief, e.g., of the patient in the practitioner and the therapy, and the practitioner in his/her own abilities, etc. Such a collection of semi-quantitative and qualitative observables would constitute the 'therapeutic state', generated by an 'entangled' correlation of patient, practitioner, and therapeutic modality. Though difficult, concrete steps towards theoretically (link to my paper) and experimentally (link to Harald's paper) ascertaining this state have recently been taken, warranting further investigations in the future - and perhaps injection of a tiny fraction of the funds currently being spent on expensive drugs with toxic side-effects.
