As far as the popularity of Alt Med, it does appear to be growing but it is far smaller than proponents would make it. The surveys that purport to show widespread use often include non-medical things like massage, yoga, relaxatin, and such that really aren’t intended to treat disease but to help patients cope. Here are a couple of articles on the subject:
How Popular is Acupuncture?
CAM in Hospice Care
National Health Interview Survey 2007- CAM use in Adults
As for the placebo, this is a huge multifaceted and complex subject. The effects of belief and expectancy on reporting of subjective symptoms, which is what most people mean when they think of the word placebo, is certainly an improtant part of the perception of efficacy for some CAM therapies.
Acupuncture, for example, has indisputable effects on how people perceive their pain and nausea. But these effects are just as strong for “fake” acupuncture (needles in places not consider true acupuncture points, retractable needles that don’t penetrate the skin, and even poking people with tooothpickks), and they are elicited better by enthusiastic and empathetic acupuncturists than by business-like and matter-of-fact acupucbturists. The CAM folks try to spin studies like these to say that placebo effects are really min-over-matter effects, and that real healing is going on. But what they really show is that these interventions don’t change the physical disorder that causes symptoms, only the perception of those symptoms by the patient. There ay be some value in that, but as Doug’s citation from Dr. Novella above points out, this can just as easily be had with therapies that also really work.
Goldman, R.H., Stason, W.B., Park, S.K., Kim, R., Schnyer, R.N., Davis, R.B., Legedza, A.T., Kaptchuk, T.J. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial. Clin J. Pain, 24(3), 211-218.
Sjöling M, Rolleri M, Englund E.. .Auricular acupuncture versus sham acupuncture in the treatment of women who have insomnia. J Altern Complement Med. 2008 Jan-Feb;14(1):39-46
A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain (Arch Intern Med. 2009;169(9):858-866
White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G .Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2011 Dec 12. [Epub ahead of print]
Ernst, E. Soo Lee, Myeong. Choi, Tae-Young. Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011;152:7555-764. (mixed results but studies with sham, as opposed to placebo, have clarified)
However, the placebo efect also encompasses a number of biases, confounders, and outright errors that plague clinical trials. Many of the reasons for having a placebo comparison group in a trial have nothing to do with beleif or expectation, but with effects of participating in clinical trials that can create the inaccurate impression or a significant treatment effect. In any case, none of this has anything to do with the current spin that says even if CAM is not better than placebo, placebo is real therapy after all so CAM works. Sheesh!
Here are some more dtetailed articles on the issue.
Michael Specter on the Placebo Effect
Does Thinking Make it so? CAM placebo fantasy vs scientific reality