In the current scientific context it is well established that a situation of initiative is health enhancing, while in adverse situations it is pathogenic to be in a state of submission when typically fighting or fleeing are impossible. Resorting to alternative medicine is to put oneself in a state of initiative. It is usually associated with the belief that the chosen modality of alternative medicine is valuable (belief that may be shared by the practitioner). It is therefore easy to explain how the combination of state of initiative and placebo effect can have positive effects undetectable via randomised controlled trials.

Competing interests: None declared