Originally a comment by latsot on Ask the rocks.
The placebo effect is real, no disputing that. It’s weird, it’s complicated and it’s wonderful. There’s no doubt that it’s helpful, sometimes.
But let’s be clear, it ain’t gonna cure your broken leg, your cancer or even that ache in your knee that everyone older than 40 gets on a Monday morning that makes them think about phoning in sick. That might just be me.
And let’s be doubly clear: many if not most of the advocates of things that are really placebos are trying to persuade vulnerable people that whatever horrible thing they are desperate to have cured can be cured by snakewater. Lots of people die because of it.
I’m sure you see the difference between a physician prescribing a placebo and a random person selling someone a placebo in the guise of special medicine that actual doctors refuse to acknowledge is real… lending it legitimacy to many people.
One of them is… dicey and I’m not generally in favour of it. The other is wrong in just about every possible sense.
I have no sympathy at all for the idea that since there’s a placebo effect we’re justified in bullshitting patients.
For one thing, there’s no need: Medical-sounding placebos are just as effective as bullshit-sounding placebos, pretty much by definition. Co-opting someone’s beliefs in nonsense isn’t necessary. A physician would do better to foster their patients’ critical thinking and their critical examination about whether the medicine worked, I think.
But more importantly, patients can also be tricked into feeling better when they’re actually not. That’s one of the many reasons that the use of placebos by actual medial people is really dubious and why their use by people who feel entitled to practice medicine without knowledge or license should be criminal.
I have to mount at least some defence of placebos as used by medical professionals – in conditions with real, chronic pain or other discomfort but unknown etiology (for example chronic back pain), providing symptomatic relief, even through the use of placebos, has value to the patient. Placebos work even when you tell someone it is a placebo. So, as long as you are upfront with a patient I don’t necessarily think using placebos is problematic. Are you being tricked into feeling better? Well, the truth is we don’t understand the placebo effect. So, we don’t know if the apparent effects a patient reports are real (but with unknown mechanism), or illusory. But when treatment options are limited or non-existent, I think there can be a place for placebos.
And of course, in controlled trials, you have to prescribe placebos (unless you’re comparing against a current treatment in a relative effects way), and not tell the patients whether they are getting the real drug or the placebo. Or the scientists studying the drug for that matter. Again, I think transparency and openness are key – and the basis of true informed consent to those trials.
On the other hand – homeopaths and other quacks who knowingly mislead their patients for personal gain (not their patients welfare), those people are pure evil, but I don’t realistically know how we can convince the many believers of that fact.
I have an old one for that…:
https://www.facebook.com/144310995587370/photos/a.271728576178944.71555.144310995587370/948964068455388/?l=3cb264d3c9
The placebo effect isn’t as real as people think, as evidenced by trials that use a third arm with no treatment whatsoever for comparison with placebo and with a treatment. See a meta-analysis of such trials here http://www.ncbi.nlm.nih.gov/pubmed/12535498.
Interestingly, some studies have also found a placebo effect for certain conditions. But most of the evidence people use to argue for the placebo effect is not as rigorous, it simply is based on the fact that some people in the placebo arm of a two-arm study experienced improvements. People feel that this is evidence of a placebo effect for some reason, but it isn’t, because it doesn’t control for spontaneous improvements.
In a few cases, suggestions by a doctor that a patient will get better can be helpful. If a patient is very focused on nausea, then he is going to continue to have nausea despite medications and ruling out other non-psychological causes. It is not too hard to make yourself feel nauseous. If the doctor suggests that nausea will get better with time, then for some patients it does. Sometimes a patient seeing a doctor regularly is helpful even if the doctor doesn’t prescribe anything. If there is something physically wrong, a patient may feel better but it won’t last long.
Well, the old tradition of giving penicillin as a placebo for colds and influenza has borne pretty dreadful fruit. All sorts of treatments, including surgeries, have been used because the patients (and the doctors) could not register that they weren’t really effective.
So, there’s no excuse for homeopathy, just because tonsillectomies used to be overdone etc. etc.