My placebo is bigger than yours

January 25, 2011
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Just read Richard’s post featuring Ben Goldacre, then followed Youtube links to interviews and reread “bad science”… I like him. The conclusion I came to is that Dr. G would have made a great homeopath… or chiropractor or GP for that matter. Thing is that there was one interview in which I think he made a very good point. He referred to it as the crucial problem with (at that point) the discussion about NHS funding for homeopathic treatment in the UK. It revolved around the fact that it was “no better than placebo” combined to the fact that it is (in Dr. G’s opinion) tantamount to “lying to the patients” i.e. you are saying you’re doing something which you aren’t. So, regardless of whether the fact that a therapeutic measure can elicit placebo-healing, it shouldn’t be shown support because it is based on the perpetuation of a fabrication. I might be making to many tangential leaps here but that interview statement reminded me of Dawkins’ (one of the) points in “The God Delusion”: that believing is idiotic, or to paraphrase him: an insult to the human mind. Mixed together in my slightly dyslexic mind these two comments made me realise what it is I take issue with in all this: I think it is in fact irrelevant whether a patient (or a religiously inclined person-as I believe the argument stands up against Dawkins’ point too) believes or not, the only thing that matters is what they do with it. The two are very different points and must at all times be discerned from one another.

I support that notion by saying that there are good religious people and there are bad religious people. There are good non-religious people and there are bad non-religious people. The fact that they are or are not religious is in fact irrelevant to whether they are good or not. One could argue that there is an ethical or moral code lain within religious scriptures and that those who subscribe to said scripture are more likely to behave in a  morally just manner. My argument is that it is not the scripture or religiousness that elicits the behaviour but the way it resonates with the reader’s mind. Guns don’t kill people, people do… and all that. On the same point I don’t think it is the patient’s “faith” which determines the ability to elicit the placebo effect but rather the way that the individual’s predispositions lead him/her to respond to the suggestion. Isn’t that the same as “faith” or “belief”? No, I am referring to the hard-wiring of the human mind. This distinction solves an issue many people bring to me when they are trying to argue that “it can’t be placebo because it doesn’t require the patient to believe in it”. Point is: it still can be, regardless of that, but it doesn’t require it because “faith” has nothing to do with it the way the individual mind resonates with the statments made/ the treatment given howevere does.

I may end up shot down over this but I thought that there was some research done into the placebo effect which concluded that it was largely irrelevant whether the patient is told whether what they are getting is sham or “the real stuff”. That could put an end to Dr. Goldacre’s argument that offering a placebo is tantamount to lying (assuming that it is fromheretoonforth publicly declared to be a sham treatment when known to be of course).

This, ultimately, puts placebo treatment along simlar lines as hypnosis or auto-suggestion training as it employs (in my opinion) the suggestability of an indiviudal to ellict desirable responses. Derren Brown, anyone?

Another point on placebo is that is has been defined as a “perceptual effect” or reinterpretation of condition without attributable change in physical condition. I think that is quite naive. Changes in perception will ellicit physical changes, even if it is just on a neuro-chemical level and the definition given on www.ukskeptics.com sets itself up for a dramatic fall (i.e. their definition  is demonstrably false if a physical response can be elicited with sham treatment-which it has been).

Why am I banging on about this? Because placebo is a valuable commodity, not some dirt-word of the nether regions of healthcare. Placebo is a part of life and should be embraced for what it is. The nonsense that revolves around it really does not help matters and just delays proper use of the placebo effect. And that would just end with more people taking drugs unnecessarily and costly surgery…

If, as “alternative” practitioner I am good at eliciting the placebo effect and delay the emergence of pain, dysfunction and injury AND I inform my patient of the fact that I am not doing a fat lot other than making the patient feel better about their condition then I cannot see what the objection(s) could be…. But: that’s a lot of “ifs” and I think anyway that there is a little more to it than just that.

Regards,

Stefaan

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  • http://www.chiropractorswarwick.co.uk Stefaan A.L.P. Vossen

    Absolutely, but the only point I am trying to raise here is just that I think it would be useful to think of placebo a bit more as a potential ally rather than just something “woo”. Analyize it, understand it, isolate it and use it to the benefit of the patient. Scientifize it so to speak.
    I don’t like liars at the best of times, bare-faced or otherwise, but the problem is one of self-delusion and motivated indoctrination. This is one of the reasons I have a giggle and pity chiropractors who are technique-obsessed and believe they have the answers to all questions. If life was only so simple…
    Stefaan

  • Matthew

    You raise an interesting point. I think however that the ethical problem for homeopathy (and other similar forms of treatment – crystal healing reiki etc etc.) is that the practitioner emphasizes a system of healing which has insufficient basis in evidence. Homeopathy is based upon unsound science, and the fact that some people get better due to the placebo effect does not excuse the fact that they are in effect being lied to about how the treatment works. I think that the cornerstone of ethical medicine is the opportunity for informed consent on treatment. If one were to advocate a system like homeopathy which is based entirely on magical thinking, and then use the fact that the body heals itself due to a placebo effect as evidence in support of said treatment, then this is at the very least disingenuous and at worst a bare-faced lie.

  • http://www.chiropracticlive.com Richard Lanigan

    It an interesting ethical question. If you act confidently have a good line in bullshit, then tell the patient you will cure them they are more likely to get better.

    Never been comfortable myself with the ends justifying the means argument.

  • Stefaan Vossen

    but thing is: are therapists open minded enough to acknowledge it in all fields of healthcare?

  • http://twitter.com/welshandgrumpy Colin Jenkins

    BG knows about overt placebo:-

    (2nd programme I think)

    http://www.bbc.co.uk//radio4/science/placebo.shtml

    (need real player download but worth it)

    But as I recall the idea was taking some serious hits recently.

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