This page concerns the idea that Placebo effect mostly a myth.
If it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. -- Tweedledee, in Lewis Carroll's Through the Looking Glass
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It came as somewhat of a surprise to me to hear recently (on about 25 May 01) in an interview with a researcher at the University of Copenhagen that the placebo effect was, in effect, hardly any effect at all! The results of research have just been published in the latest issue of The New England Journal of Medicine; see Special Article -- NEJM below.
I have always been somewhat skeptical of at least some forms of the placebo effect, but how could I deny its existence inasmuch as it seemed to be so well established in the medical literature? I had been willing to accept that the effect could be real in the case of the power of suggestion and belief in overcoming psychosomatic distress, on the basis that the mind-body interaction might very well be effective in cases where the source of the distress was primarily psychological. However, I have been skeptical of how there could be any such effect in more organically based cases, such as, for example, decreasing the size of tumors by mere power of the will or by "mental imaging". For a discussion of various kinds of placebo effects, see CSICOP - Skeptical Inquirer below. Apart from supporting the traditional idea that the placebo effect is valid, it raises the real possibility that it can be seriously harmful.
In fact, the thought occurred to me that, in the case where one was trying to get rid of a tumor by mental imaging, why would one expect the result to be positive? Why not, instead, fear that kind, gentle thoughts, or thoughts of some monster to be fought, might, instead, lead to a worsening of the situation? If one gets a bit theological about it, one might smile to know that I saw a book in the Religion section of Chapters entitled Be careful what you pray for.
A few years ago, New Scientist magazine in the UK published an article which called into question the efficacy of a wellness clinic which counseled women recovering from breast-cancer treatments and surgery. The clinic claimed that its program of using gentle thoughts, mental imagery, positive attitudes, and spiritual ideas was beneficial to its clients. The clinic threatened to sue the magazine for some form of disparagement. In a form of dispute arbitration, the clinic allowed the magazine to examine its records. New Scientist found that the success rate for women treated at the clinic was significantly worse than for those who had obtained no follow-up treatment or counseling whatever. Could it be that positive thoughts could lead to results that are negative, instead of positive? In other words, if prayer works, could you cause more harm than good by praying the wrong way? Without any explanatory paradigm for such imaging or prayer, I could not see any reason to choose one kind of outcome over another. Maybe it's all "just" black magic?
See also some of my skepticism in relation to the closely related topic of faith healing, at No evidence for faith healing, and for similar forms of irrational belief, at Junk-science placebos. The latter reference provides an amusing explanation as to why the once-popular and "wonderful" product Vitamin O is no longer on the market. It was described on its label as “stabilized oxygen molecules in a solution of distilled water and sodium chloride.” Now, doesn't that sound impressive! (I find that to be sad, in a way. We already have vitamins A and E. If we just had also vitamins I, O, and U, we could have a new chemical grouping -- the vowel vitamins, A, E, I, O, and U. That would have seemed to be appropriately consonant with junk science!)
Warning: excursional diatribe ahead!
Excursional diatribe:
Junk punctuation: American system (mis)usage of quotation marks
It (see preceding two paragraphs above) also provides another irritating example of the misguided standard American system (which includes Canadian, but not British, usage) of including within quotation marks punctuation that belongs to the sentence within which the quoted term appears, and not to the object of the quote itself. Here is the sentence in question:
A more amusing example is “Vitamin O,” a wonder supplement advertised to “maximize your nutrients, purify your blood stream, and eliminate toxins and poisons — in other words, [to supply] all the processes necessary to prevent disease and promote health.”
Whereas I was referring to something that I prefer to denote "Vitamin "O"", the article seems to refer to something called "Vitamin "O,"". Does that little squiggle that looks like a comma denote some new form of chemical bond of which I am not aware -- maybe a non-covalent comma bond? The quoted sentence above also follows the standard American system of having, as the second-last symbol in the sentence, the period which terminates the sentence. Have you ever heard of anything more ridiculous? This American usage of quotation marks -- dubbed by H.W. Fowler (Fowler's Modern English Usage) the "common", as opposed to the "logical" technique -- defeats the very purpose of quotation marks, namely to quote exactly a string of characters. The American system leaves one to sort out whether the misplaced commas and periods within quotations belong to the quoted terms or to the sentence carrying the quote. Oddly enough -- but appropriately illogical, I suppose -- the American system does not provide for misplacement of the remaining punctuation marks! I like to term it junk punctuation.
Lest I be accused of unfairly disparaging the Americans, the Brits are also not always totally logical. In referring to a newspaper called The Times, Americans (and I) would use the pronoun it -- on the basis that it is a singular corporate entity. The Brits, oddly enough, would refer to it as they -- on the basis, presumably, that it is a company of entrepreneurial adventurers (Oh, those glorious days of Empire!). You might note, with some glee, that I have been too timid to use quotation marks in the preceding sentence! Valor has its limits!
There is even a field of study involving a Social placebo effect.
There are several discussions of ethical issues at the sites linked to below.
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Special Article -- NEJM 2001; 344 1594-1602: http://www.nejm.org/content/2001/0344/0021/1594.asp Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment. The New England Journal of Medicine -- May 24, 2001 -- Vol. 344, No. 21. . . . Placebo treatments have been reported to help patients with many diseases, but the quality of the evidence supporting this finding has not been rigorously evaluated. . . . We conducted a systematic review of clinical trials . . . We identified 130 trials that met our inclusion criteria . . .
Conclusions. We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.
From the Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, and the Nordic Cochrane Centre, Rigshospitalet -- both in Copenhagen, Denmark.
CSICOP - Skeptical Inquirer - Jan 97 - The Mysterious Placebo: http://www.csicop.org/si/9701/placebo.html The Mysterious Placebo. . . . Research shows that the placebo effect can be greater and is far more ubiquitous than commonly thought. . . .
Spontaneous remission and the placebo effect, which are known as nonspecific effects, are significant phenomena that have great impact on consumers and health-care professionals. Recovery from illness, whether it follows self-medication, legitimate treatment, or avant-garde therapies, may lead one to conclude that the treatment received was the cause of the return to good health. . . .
H. K. Beecher's seminal paper "The Powerful Placebo" (Beecher 1955) is among the most frequently cited and was undoubtedly responsible for the double-blind study design having been adopted as the universal standard. Beecher reported on twenty-six studies and arrived at an average placebo response rate of 32.5 percent. From this figure comes the often cited statement that a fixed fraction (one-third) of the population responds to placebos. But this is a myth. A recent paper (Roberts et al. 1993) concluded that "under conditions of heightened expectations, the power of nonspecific effects (placebos) far exceeds that commonly reported in the literature."
The paper, "The Power of Nonspecific Effects in Healing," is fascinating . . .
A number of other myths are associated with placebos. Try to answer the following questions:
The answer to all three questions is no . . .
Contrary to popular belief, placebos can be harmful. Placebo responses can "teach" chronic illness by confirming and/or reinforcing the delusion of imagined disease . . .
The use of placebos can undermine the doctor-patient relationship by requiring deception on the part of the caregiver. Consumer advocate Stephen Barrett has explicit reservations concerning overreliance on the placebo effect in clinical practice: "I am against people being misled. The quack who relies on a placebo effect is also pretending he knows what he is doing -- that he can tell what is wrong with you and that he has effective treatment for just about everything . . . he is encouraging people to form lifelong habits of using things they don't need" (Barrett 1977).
Harvard University Press-The Placebo Effect-Reviews: http://www.hup.harvard.edu/reviews/HARPLA_R.html . . . "To understand the placebo effect is to grasp simultaneously the success and the failure of medicine. This yin-yang comes through clearly in The Placebo Effect, which is based on the proceedings of a conference at Harvard University in late 1994. . . . The power and the prevalence of placebo effects should interest any healer, and so should this book. From it one will learn that ultimately the placebo effect cannot be understood, for once we discover some detail of its mechanism, that knowledge will no longer be considered a placebo effect." -- The Lancet [UK]
PLACEBO PRO & CON: http://www.ncehr-cnerh.org/english/communique2/Placebo.html The debate on the use of placebo in human experimentation is still very much alive. As we await the latest version of the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans, which will include some provisions on the use of placebo in research, we present the state-of-the-art opposing positions. . . .
MediChart - Project Placebo and Nocebo effects and phenomena in general practice: http://www.symposion.com/MediChart/englisch/ An interim statement after a meeting of placebo specialists at Eggeland-Hospital Bad Driburg, Germany; Fri 13.6 - Sun 15.6.1997. "The Problem of Placebo and therapeutic effectiveness" or the "Hunger for healing – enigma"10 Hypotheses.
The Scientist - Ethical Debate on Placebo Use May Prompt New Trial Designs: http://www.the-scientist.com/yr1998/sept/bunk_p1_980914.html . . . A debate erupted over whether it was proper to give people placebo when an effective therapy was available, even though the new studies were attempts to develop treatments that would be affordable in these developing countries . . .
Also contributing to current interest in placebos is the popularity of alternative medicine, mind-body concepts, and behavioral treatments for various disorders, which may involve psychological responses similar to those induced by placebo use. However, Anne Harrington, a Harvard University professor of the history of science, notes, "Alternative medicine is just as reluctant as any other form of medicine to say their results belong to the placebo effect, because it has been seen as nothing.". . .
Office.com The Placebo Approach An Unethical Trick or Smart Medicine: http://www.office.com/global/0,2724,61-21718,FF.html Practitioners seek ways to mobilize the mind against disease. . . . "We no longer can exclude the mind and look at only at what the body does," says Dr. Howard Brody, M.D., a professor of family practice at Michigan State University in East Lansing, Mich., and author of a new book entitled The Placebo Response ( http://shop.barnesandnoble.com/booksearch/isbnInquiry.asp?userid=22KFCYU0YV&mscssid=DN1CF8XUA1EG8NH81P78N88XA842B2U0&isbn=0060194936). "There's an interconnection there that, if not recognized, would be akin to a doctor working with a heart patient but ignoring the kidneys. They work together."
So Doc what did you really do Part 6: http://lists.netlojix.com/pipermail/chirolist/Week-of-Mon-20000110/000078.html . . . In 1980, The New England Journal of Medicine published an eloquent essay by its former editor Franz Ingelfinger, in which he argued that though arrogance was usually a pejorative word, doctors could exercise it in a way that was humane and salutary. If arrogance meant "insolence, vanity, arbitrariness or lack of empathy," it was worthless or worse to a patient. But if it meant the confidence some physicians conveyed in their own advice, then it was a gift to the sick, who are often frightened and, in their fear, a little childlike. . . .
Sham surgery may put patients at risk: http://www.studentbmj.com/back_issues/0300/news/52a.html Researchers in the United States have sparked off debate by using a controversial form of placebo surgery during clinical trials for patients suffering from Parkinson's disease.
Imprint Online Science - Placebo power as godd medicine: http://imprint.uwaterloo.ca/issues/012398/3Science/science01.shtml Debating whether the power of a non-drug is true healing or deception.
Scientific Studies that Show a Positive Effect of Religion on Health: http://www.godandscience.org/apologetics/religionhealth.html Many, if not all, of these studies are based on faulty methadologies interpreted by religious optimists. See No evidence for faith healing.
ECChap5: http://www.worldtheory.org/html/ecchap5.html CHAPTER FIVE: EDUCATION AND THE PRIMARY HISTORY OF MANKIND.
With this background, we can formulate the primary history of mankind. This is the history of the development of the four unique human traits: Language; Reason; Understanding; and, Emotional control imposed by the first three. . . .
The four stages in the evolution of the RULE traits are associated with four successive intellectual (or anti-intellectual) cultures: Religious; Literary; Specialist (Science); and, Generalist (Science). . . .
The social analog of the medical placebo effect - the social placebo effect - occurs in suggestible individuals upon the misrepresentation of myth as fact by social authority figures. This social form of the placebo response has an addictive quality, because the afflicted suffer from chronic anxiety concerning life and death. Consequently, the social placebo reactor requires constant doses of his endorphins supplied by 'worry beads' or by his myth 'pushers', whether priest or political authority.
The social placebo reactor group is ready at a moment's notice to go to the barricades with their charismatic leaders, from Mohammed and Jesus to Attila the Hun, Hitler, Marx and Stalin. Otherwise they suffer withdrawal anxiety. This biochemistry of belief explains the behavior of Orwell's proles, who have a high ratio of emotion to intellect.
Conversely, the far smaller leadership group has an inverse ratio - high intellect to emotion. Indeed, they have such low socializing emotions they are egoistic and merge slide into criminal behavior. The leader must have his group to achieve his intellectual goals uninhibited by emotion. The follower must have his leaders to supply anxiety relief from the fears of life and death - and enemies, real or imagined. . . .
This is a link from:
Corebooks, Inc: http://www.worldtheory.org/index.html Core Books publishes unified science, theory, education, and history.
Core Books is the first publisher of scientific philosophy. This is new philosophy. It is based on the first scientific theory of the world system. A world program - the ultimate 'killer app' - has produced it. It unifies all knowledge under a General Theory of Everything also called the General Theory of Evolution. . . .
The killer app predicts great detail such as the elementary particle zoo and how animal life and human sentiency emerge from chemistry. It develops proper theories of conflict, society, language, democracy, Communism, Deming's business plan, universal story structure, explanation, humor and even how to innovate systematically.
The great science-religion conflict is shown to end in a standoff. Deus Indeterminatus. Above all, the world program puts everything in standard format, from relativity to language. Learn one, learn 'em all. . . .
Teaching Junk Science! - Schools Section - Clovis Free Press: http://www.clovisnews.com/schools/junk_science.html Real Science uses a procedure called the scientific method.
A more amusing example is “Vitamin O,” a wonder supplement advertised to “maximize your nutrients, purify your blood stream, and eliminate toxins and poisons — in other words, [to supply] all the processes necessary to prevent disease and promote health.”
It was described on its label
as “stabilized oxygen molecules in a solution of distilled
water and sodium chloride.” In other words, the 60,000 consumers purchasing
“Vitamin O” — to the tune of $20 a month —
were taking salt water! Although this product was legally
exempted from certain FDA requirements by virtue of its status as
a “natural” diet supplement, the FTC was able to file a
complaint against it in 1999, based on false claims by its
promoters that it was being used by NASA astronauts.
Otherwise “Vitamin O” would
still be one of the world’s best-selling placebos. The
potential lasting power of “junk science”
is demonstrated by the story of German physician Samuel
Hahnemann,
who took quinine back in 1776 to investigate its use against malaria.
After taking the quinine
he experienced chills and fever, which are the symptoms of
malaria. From this he concluded, wrongly, that “likes cure
likes,” i.e., that diseases should be treated with medicines
that produce similar symptoms to the diseases.
In the course of testing this
theory with other herbal remedies, Hahnemann discovered that many
“natural” herbs are toxic and made his patients worse.
To reduce the toxic effects, he diluted the remedies until they
seemed to be working.
On that basis he formulated a “law
of infinitesimals” stating that higher dilutions of herbal
cures increase their medicinal benefits. To be fair, Hahnemann
conducted these experiments more than 70 years before scientists
understood that a dilution weaker than one part in 6.02 x 1023
may not contain even a single molecule of the dissolved
substance.
Thus he did not realize that upon
administering to his patients 30x preparations — dilutions
of one part herb to 1030 parts water — the placebo effect
was all that was really left to measure. Incredibly, homeopathic
medicine today still relies on Hahnemann’s theories.
Not only does it often come in 30x
preparations, it comes in 200c dilutions — solutions of one
part herb to 100 parts of water 200 times, resulting in one
molecule of the herb per 10400 molecules of water!
Modern homeopathists obviously can’t deny that
such preparations are beyond the dilution limit, but they insist
that the dilutions still work because their water or
alcohol/water mixtures somehow “remember” the herbs.
Despite this preposterous
claim, the market for these remedies is enormous. Just as many homeopathic
preparations are diluted to the point that they are nothing but
water, many “natural” herbs on the market contain drugs
and chemicals which interact with the human body like
prescription drugs.
For example, Echinacea stimulates the immune system, which
could prove harmful to people with type 1 diabetes,
rheumatoid arthritis,
or other autoimmune diseases. It
is therefore unwise — to put it gently — to take herbal
remedies or supplements of any kind without consulting a doctor
and/or the Physician’s Desk Reference for
Herbal Medicines. But many
Americans do so, equating
“natural” with “harmless” and
“good.” .
. .
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You can e-mail me at waynerp@sympatico.ca