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Feb 11 2010

The Placebo Effect

This post originally appeared on Facebook on January 27th, 2010.

Those of you who are not scientists may not be familiar with the term “placebo.” It is often equated in common language with “sugar pills”, or some sort of fake drug that doesn’t do anything. This is a reasonable proxy for what a placebo actually is. In a nutshell, a placebo is something that mimics the outward characteristic of an actual entity while having no real effect. This definition is imprecise, as placebos do have an effect, which is the whole point. The so-called “placebo effect” occurs when someone, believing that the placebo is actually the entity it is mimicking, undergoes some change that is attributed to the placebo, but is actually no more than their own psychosomatism (or naturally-occurring events). The key to this effect is that the person believes that what they are receiving is genuine.
Placebos are most commonly associated with clinical trials for medicines. One group, the experimental group, is given a new drug while the other, the control group, is given a placebo (often either a sugar pill, aspirin, or in the case of intravenous drugs, a saline solution). Once again, it is important to note that the patients (and in high-quality studies, the physicians) are not aware whether they are receiving the medicine or the placebo. Nowadays, placebo trials are less common, since medical ethics require that all patients receive at least the standard treatment that would be available if they weren’t in the trial.

There is a very good reason for doing this. The human mind is incredibly powerful. Sometimes merely the act of believing you’ve been given something that will help causes you to feel better. Indeed, there is marked symptom improvement even in some cases of terminal or chronic painful disease simply due to believing that the “treatment” you’re getting is fixing the problem. Thus, in order to determine concretely what effect, if any, a new treatment has, it is necessary to control for the placebo effect – make sure all patients are experiencing it. Any significant difference seen after the placebo effect has been accounted for is, therefore, a result of the real effects of the treatment.

(I’ve used the word “real” a couple of times here, and I anticipate that the more new-agey of you reading this will object to my co-opting that word for science. When I say “real”, I am using it the metaphysical sense – the real/non-real dichotomy – which states that those things which can be directly observed, measured, etc. are “real” while all other things are non-real. Please note that, although linguistically similar in English, non-real is not the same as “not real”. “Not real” means fictional, imaginary, having no basis in reality; whereas “Non-real” simply means that the concept is not a measurable, physically-based. Admittedly, a lot of things that are “non-real” are also “not real”, but that’s the subject of a different discussion. Think of it this way: unicorn farts are “real” in a metaphysical sense, but “not real” in a “WTF, UNICORNS?” sense.)

What all this means is that the simple act of believing something to be true causes our minds to behave as though it is true, even in those cases when the object of belief has no actual effect. Belief is absolutely essential to this process – if I tell you “hey, eat this sugar pill”, you’re not going to feel any better (unless you had low blood sugar, but then it’s no longer a placebo, init?).

Anyway, I said all of this as a preamble to the statement that’s been rattling around in my brain for a couple of months. It seemed particularly important to me. Maybe I am vastly overestimating the impact that my ideas have on people – maybe nobody cares about my inane ramblings and will just say “c’mon Ian, get to the swearing!” Anyway, here’s my fucking thesis:

If you have to believe in it for it to work, it’s a placebo.

Nobody intelligent denies the existence of the placebo effect. It’s been observed countless times in many different guises. However, we seem to be happy with confining it to the field of pharmaceuticals, even though it’s much bigger than that. It’s not a scientific thing, present only in beakers and pills, it’s a psychological phenomenon that occurs in the larger world around us, not only in terms of health but in the way we see the world. We carry good-luck charms, we have little personal rituals and idiosyncrasies, we talk about “fate” and “destiny”, we read horoscopes, the list goes on. This is stuff we all do, not just the crazy superstitious bunch. Remember that Seinfeld episode where George eats the éclair from the garbage? It was sitting right on top, only one bite out of it. It’s not as though coming in contact with the garbage can infused the food with virulent disease, but we all identified with the idea. That’s just a modified version of the placebo effect – we believe it’s dirty even though, rationally, we know it’s not.

So why am I talking about this? Why is this important? A placebo is given in a clinical trial as a kind of benign deception on the part of the experimenters. However, a patient in a hospital would never be given a placebo instead of real medicine in a treatment setting – we wouldn’t accept allowing someone to suffer when we have the ability to help. Why, then, are we completely willing to accept placebos in other forms – in some cases clamoring for them? Faith healing, homeopathy, crystals, reiki, tarot cards, psychics, chakras, qi, “The Secret”, placebos, placebos, placebos all. These are all examples of things that don’t work unless you believe they work.

I have, many times, heard the argument that there are other “ways of knowing” or “ways of measuring” that “Western science” can’t account for. This little fallacy will perhaps be discussed in another post, as this one is already getting really long. I’ll boil down my argument as concisely as possible here. There’s no such thing as “Western science”, there’s just “science”. Science is the act of observing the causal chain of a phenomenon to identify the “real”. If you’re not doing that, you’re not doing science. While we can argue metaphysics, ontology, theology, and all those good things from an East/West perspective, there’s only one kind of science. Everything else is slight-of-hand and superstition, washed down with a big handful of placebos.

This is the part where I provide my full-throated defence of all of the things I just attacked. It may come across in the previous paragraphs as though I think that placebos are bad, or that the only stuff that matters is the “real”. Some might believe this to be true, but I don’t. As I said, the mind is incredibly powerful. Sometimes when you’re faced with an incredibly-difficult situation (such as terminal illness, a big speech, an first date), you need to believe that you can get through it. Belief in ourselves is crucial, as otherwise we’d be far too realistic about our limitations and never try anything new or difficult. However, when we throw ourselves into the brink, come out alive, and then give all the credit to our luck rabbit’s foot, we’re doing ourselves a great disservice. When you do something good, take a victory lap! You overcame the odds and prevailed!

And, if you try something and you fail, well you can always blame immigrants, I guess.

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