Every good skeptic knows about the so-called “Placebo Effect,” right? It’s the scientifically proven principle that people can be healed of various ailments simply by believing that they are receiving an effective treatment. And the Placebo Effect is a boon for us skeptics who need a way to explain why some people are "cured’ by quack treatments such as psychic surgery, faith healing, aromatherapy, homeopathic medicine, acupuncture, chiropractic medicine, etc., etc., etc.
But what if the Placebo Effect were just a myth and people couldn’t really be cured simply by believing in the power of the treatment? How then would we, as good skeptics, respond to the wealth of anecdotal evidence from people who claim to have been cured by all manner of quackery? Would we simply have to say that we don’t know how the person was cured, but it sure as hell wasn’t because of the magic crystals? Or are there other tools in our skeptical arsenal that could take the place of our cherished Placebo Effect?
And, lest people think this is a wholly hypothetical question:
What’s more interesting is that Hrobjartsson and Grotszch’s study (and and earlier one by Keinle and Kiele (“The Powerful Placebo Effect: Fact or Fiction?” Journal of Clinical Epidemiology 1997) have been virtually ignored by the medical and research professions DESPITE having seriously challenged the original findings by Beecher.
Beecher’s original studies have been discredited due to methodological inconsistencies, poor (or non-existent controls) and outright shonkyism, yet the placebo is still standard practice in clinical and pharm. trials. Why? If there is no such thing as the ‘placebo effect’ (or at least if its power is dramatically less than the 35% oft quoted) why is it still claimed to have therapeutic validity???
A case of science behaving unscientifically perhaps??
Look at the results of double-blind studies which show that placebos cause headaches, tremors, diarrhea, constipation, itching, nausea, etc. And i’ve always been of the opinion that antidepressants (prozac, paxil, etc) all work solely on the placebo effect. An FDA-approved placebo is quite a powerful thing. And anyway, whose to say the patient wouldn’t end up being cured eventually, anyway? If you had a cold and I gave you a sugar pill, saying it cures colds, and a week later your cold were totally gone, would it be a miracle? Hardly.
Well, not according the the two men who did the study cited above.
The point is that the Placebo Effect has long been a handy tool for skeptics who want to debunk quackery. Why are some people apparently cured by aromatherapy, crystals, faith healing, etc? Why, because of the well-known Placebo Effect, of course. There’s no need to look any deeper – the Placebo Effect explains it all, and the suspect treatment can therefore be safely ignored in spite of anecdotal evidence that the treatment actually works in some cases.
But what if there really is no such thing as the Placebo Effect? What if belief and wishing cannot affect somebody’s health? How, then, do we explain away the anecdotal evidence of quack treatments? Is it always that “the person would have gotten better anyway”? Do we have to start calling people liars?
But the thing is Kalt, that these later studies show that there is probably NO SUCH THING as the ‘placebo effect’.
Your post shows how thoroughly the notion of the PE has entered our conciousness. At this stage, the PE is a serious contender for pseudoscience status, yet we all still refer to it as scientific ‘truth’.
And this is because (note to Godzilla about why I think it is more important :D) the scientific community still endorses it. Until they collectively refuse to subscribe to it, it will remain in our heads and our language as an unquestionable fact.
Now, as to ‘why’ the sci. community won’t dump the PE, I’m not exactly sure. But I suspect it is something to do with wanting to medicalize our lives. Perhaps it is difficult for them to acknowledge that people DO just get better (or experience vague symptoms (side effects) like insomnia and digestive upsets when double-blind trials are happening). Maybe the medicos like to think that THEY are causing such effects (by administering a placebo) and thereby retain a monopoly over the health of a community.
Y’see, if they refute the placebo effect, they are left with the prospect that 35% of sick people will get better off their own accord, regardless of medical intervention. And that can’t be good for the confidence of the medical profession.
Presuming for the moment that the “placebo effect” they discredit in the linked article truly doesn’t exist – what makes you think that some random “treatment” would fare any better?
Indeed, their study seemed to look at actual improvement, not perceived improvement, although I’d have to reread it to check. What evidence do we have that so-called quack treatments are any more effective than placebos in producing actual improvements instead of merely perceived ones?
Think you need to read the cited article again. The placebos in clinical trials are not used to elicit a placebo effect – they are used to facilitate double-blind testing. You have to give the patients * something * or both they and the experimenters will know who is getting the actual medicine.
Even if the placebo effect is a myth, I have to point out that anecdotal evidence is largely regarded by scientists of all types as the weakest type of ‘evidence’ there is. So, for most scientists, anecdotal evidence is not enough to make any scientifically valid claims about anything. For example, Freudian theory is based almost totally on anecdotal evidence (albeit by scientists such as Freud himself) and has now through more thorough research largely been debunked. Anecdotal evidence is not enough to prove that something works. Skeptics, rejoice!
As for the placebo effect, from what I learned in my college psychology class, many placebo effects are ‘caused’ by merely asking the patient if they have them. For example, if you interview a patient weekly and ask if they have had blurry vision or headaches, they are more likely to say yes, especially later in the study, simply because the idea has been placed in their head. Many studies have this flaw built right into them. A straight interview could eliminate this flaw, but since the studies need to get hard data on effectiveness and specific side effects, it is nearly impossible to get this info from free-form interviews without prompting the subject. Thus the “side effects similar to sugar pill” disclaimer you see quite often these days. In other words, the placebo effect comes not from the sugar pill, but from just asking the question. A medical “Schrodinger’s box”?
What if the placebo effect has different levels of effectiveness depending on the malady? Then, any universal meta-analysis to debunk the placebo effect is flawed.
Assuming the article is correct, and it may well be, it doesn’t do anything to the real arguments against bizarre courses of treatment.
Experimentation shows that these treatments perform like placebos, regardless of why placebos seem to have a performance if something isn’t better than bullshit it is for all intents and purposes bullshit. The fact that some people just get better is just that a fact. It will happen when bullshit cures are used, it will happen when cures that are based in current medical theories are used even if those cures aren’t really all that effective.
People who have gotten better using acupuncture, homopathy and the like would have gotten better anyway. They aren’t liars for saying “Well I used X and got better.” they just happen to be wrong that X caused the getting better. This applies to new medical techniques as well. Just because it looks like by theory a new treatment should work real research is needed to prove that it does work.
So the placebo effect really shouldn’t have ever been the basis of skeptical refuting of pseudoscience.
Heck, I’m as skeptical as all-get-out, but even I see a place for the placebo effect. For starters, a great many maladies are not caused by some purely organic reason, but because of mental stresses, i.e. a lot of our problems are created by ourselves, whether we know it or not. Heck, even thinking about a truly awful chocolate bar I ate about 20 years ago is enough to bring on a slight feeling of nausea, even though there is currently no chocolate in my system. It’s plausible to me that there are plenty of people who suffer nausea, headaches, double-vision and other minor transient ailments (with largely subjective symptoms) for purely psychological reasons. Offer these people a placebo and the placebo uses a fake cure on an ailment that was never real in the first place. In that sense, the placebo effect is perfectly valid, though I’d consider it a tool of psychology more then medicine.
As for miraculous placebo cures of ailments that are known to be physical, there are four basic challenges:
[ul][li]Are you sure the diagnosis was correct in the first place?[/li][li]Medical science not being exact, is it possible that even dramatic or supposedly terminal ailments go away on their own?[/li][li]Did the placebo help dispel the patient’s depression, which may have prevented them from taking care of themselves and exercising, etc. which contributed mightily to the recovery?[/li][li]When psychic surgery and faith healing and other methods are used for which no apparant mechanism exists, the “successes” are trumpeted while the failures (the patient continued suffering or died) are downplayed, thus making them appear more effective than they really are.[/ul][/li]
Cures that have no organic mechanism give me reasons to suspect a placebo effect, but nothing has ever proven to me the effect doesn’t exist.
A note that the article neglects to mention: We generally go about our lives with less intellectual rigor than is demanded in scientific studies. We might think we are free from headaches because of that superpotent homeopathic remedy, and simply don’t notice or don’t remember headaches.
Look at stereo equipment. People’s anecdotal evidence on what sounds better is worthless. Half the companies in the sector are founded on that principle. Controlled blind A-B tests are the only way to tell anything about relative merit. It may not be the placebo affect, but it is a closely related concept, and it definitely exists.
I’m not sure if I get the problem. The article linked seemed to debunk the placebo effect'' by pointing out several reasons why people taking the placebos might get better, even without invoking a mystical psycho-somatic effect of believing you will get better. So if those factors can explain’’ away the placebo effect, they can also explain away the effects of whatever quakery you feel like debunking, no?
