An atypical side-note

I don’t talk about my job on this blog, and today will be no exception. However, I am (as reported on the sidebar) a scientist who works in the medical field (kinda). As such, I feel it appropriate to comment on this story I saw in the news:

Doctors have sharply cut some financial ties to drug companies, thanks to increased scrutiny about relationships that critics allege improperly influence medical treatment, a survey suggests. The biggest change occurred in the number of doctors who accept drug company money for attending medical meetings, including covering travel to sometimes exotic locations. That fell from 35 per cent in 2004 to 18 per cent in last year, the survey found.

There is a near-constant din that comes from advocates of alt-med that medical doctors are “in the pocket of Big Pharma”, and that anyone who advocates science and opposes superstitious nonsense must be getting paid for their position. Anyone who has been to my apartment or seen the way I dress will be able to attest that if I get money from Big Pharma, it’s not enough (full disclosure: my employer does receive research money from pharmaceutical companies, under contracts that strictly bar those companies from interfering with our research in any way. I have not personally received a cent from any corporate interest).

I will give the alt-med crowd one accolade to hang their hat on – they changed the conversation. It used to be the case that doctors were very much in bed with the pharmaceutical companies, and it was repeated and consistent criticism of this practice that led to findings like the one above. It was a legitimate criticism of a shady practice, and it forced regulators to police the kinds of remuneration that physicians were allowed to (or felt entitled to) accept. This didn’t happen spontaneously; many doctors initially denied that the gifts exerted any influence over them whatsoever. Of course the evidence suggested otherwise.

It’s good to see when a small group of people can raise public consciousness about a serious ethical issue and see meaningful results. I applaud the alt-med crowd for a job well done, and look forward to the day when my merry band of skeptics can return the favour and stop the egregious abuses of trust that alt-med practitioners are allowed to get away with every day.

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Religious thinking used for good

I try to be an honest broker. While I am staunchly anti-religion, I am perfectly willing to recognize when it does something I think is good. This is one of those rare examples where I can’t really spin this as anything other than a positive:

“Today I will start with a three-part sermon on: Jesus was HIV-positive,” South African Pastor Xola Skosana recently said in a Sunday church service. The words initially stunned his congregation in Cape Town’s Khayelitsha township into silence, and then set tongues wagging in churches across the country.

However, as Pastor Skosana told those gathered in the modest Luhlaza High School hall for his weekly services, in many parts of the Bible Jesus put himself in the position of the destitute, the sick and the marginalised. “Wherever you open the scriptures Jesus puts himself in the shoes of people who experience brokenness. Isaiah 53, for example, clearly paints a picture of Jesus who takes upon himself the infirmities and the brokenness of humanity,” he told the BBC.

He is also quick to emphasise that he is using the metaphor to highlight the danger of the HIV/Aids pandemic, which still carries a stigma in South Africa’s townships.

When I was young, I had a book of Aesop’s fables. For those of you too lazy to click, Aesop was a slave and story-teller from about 2600 years ago. His fables are among the most famous of all time, and still persist in our common lexicon (“sour grapes”, “crying wolf”, “dog in the manger”, “lion’s share”, “tortoise and hare”). The great things about the fables is that they didn’t require verisimilitude to teach a lesson – a talking fox that wants to eat some grapes is a stupid idea, but we can still apply the lesson. Oftentimes complex moral lessons could be drawn from the childish stories. It didn’t matter if Aesop actually wrote them, or if he even existed.

In the same way, Pastor Skosana is using the tale of Jesus of Nazareth to teach a complex moral lesson about compassion and empathy. As a non-religious person, I certainly doubt that Jesus of Nazareth was the son of Yahweh. There is some historical doubt as to whether Aesop actually existed, or whether (like Homer of The Iliad) he was in fact a non-corporeal “author” for a number of stories that were spread by word of mouth. There is equal doubt as to whether Jesus of Nazareth actually existed, or whether his story is an amalgamation of several messianic leaders that was hodge-podged into the story of one person. For the religious, it is vitally important for Jesus to have been a real person who actually lived; who did and said the things attributed to him. For the rest of us, it’s a relatively unimportant detail if Aesop, Homer, or Jesus were real.

There is a device of literary interpretation that is singularly well-used by the religious – that is, the co-opting of certain themes or passages to defend a position held a priori. The bible has been used in (roughly) equal measure to both protest and defend things like slavery, war, homophobia, sexism, xenophobia, evangelism… you name a topic, there are passages that both support and decry it. Thereafter, there are bitter fights among the religious to find out which is the real interpretation – for the rest of us, it’s a relatively unimportant detail if the Bible is for or against something. What matters is what the consequences are to people.

Most of the time, this cherry-picking and selective interpretation irritates me – people hold up the bible as some sort of inerrant guide for the world, when it is a largely-incoherent group of stories from either a pre-literate society or the half-remembered recollections of hearsay. However, in this particular case I will tip my cap to Pastor Skosana’s willingness to take a fable and use it to teach a much-needed moral lesson about acceptance. Jesus would have been on the side of those with HIV – they are the lepers of today’s society. If you wish to follow his example, you would have to drop the stigmatization and outright oppression of those who are stricken with the virus.

However, as with any religious debate, there are people who vociferously disagree:

For Pastor Bele, portraying Jesus as HIV-positive means he becomes part of the problem, not the solution. “The pastor needs to explain how it came about for him to bring Christ to our level, when Christ is supreme and is God,” he says. “There is a concern that non-believers would mock Christ and try to generalise Christ as opposed to the powerful force we believe him to be.”

And the facepalming can begin.

So I guess I have to walk back my original statement a bit. I agree with Pastor Skosana’s use of the story to teach a moral lesson about compassion. I disagree with Pastor Bele’s religification of the story – intentionally disregarding the dozens of passages wherein Jesus ministers to the sick and tells others to do the same – in order to advance some kind of untouchable, inhuman deity. I think they’re both wrong to say that one should follow one school of thought or another because YahwAlladdha says so – nothing could be further from the truth. The word of YahwAlladdha says all things and nothing, and should be used only like Aesop’s fables – using simple, childish stories to flavour moral lessons.

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Vancouver vultures circling for cash

Hello readers, I’m Crommunist. I’m not a witch. I’m not anything you’ve heard. I’m you!

No, actually I’m not you. I’m me. But none of that is important, because I can predict the motherfucking future. You may remember back in April of this year I talked about the so-called “liberation therapy” for Multiple Sclerosis (MS). In that post, I said this:

When you’re sick, you have only one goal: getting better. Millions of years of evolution have hard-wired a strong survival instinct into all living species, and human beings are no exception. People suffering from disease and their families are willing to do just about anything for a chance at recovery, and logic plays nearly no role in the decision-making process. The problem with this is that people suspend their disbelief and are willing to jump at any chance, no matter how remote, unlikely, or unproven.

When the stakes are high, we will abandon logic and chase after whatever seems right – putting rational thought to one side in favour of quick and dirty heuristics. It’s why the Republican party is so adept at getting votes – they stoke the fears of the populace (the Muslims are coming to get us with their socialist Obamacare!) to shut down the critical thinking part of the brain (the part that notices that Republicans are bad on security, bad on the economy, bad on individual freedoms, bad on pretty much any measure you can think of). Once critical thinking has ceased, your lizard brain takes over and you make decisions based not on evidence or critical thinking, but on gut reactions (blame illegal immigrants!)

The sudden popularity of the new treatment has prompted Jeff Donegan of Chilliwack, B.C., to sign up to get the therapy through another company in California. “When [liberation therapy] first came out, I was very skeptical,” said Donegan, 31. But five years of constant nerve pain, blindness in one eye and severe fatigue have been a nightmare, he said. “Every day is different,” he said. “I don’t know what I’m going to wake up to.”

The stakes could not possibly be higher when you have a debilitating, degenerative disease. And like the Republicans, there will always be those who are willing to put ethics and common decency aside for the sake of profit:

A Vancouver-based medical tourism company is cashing in on the reluctance by many provincial governments to fund a controversial therapy to treat multiple sclerosis. Passport Medical has arranged for foreign treatment using so-called liberation therapy for more than 350 MS sufferers from all over North America, said company owner Mark Semple. The company’s two-week trips include surgery and recovery care in Costa Rica for about $13,000.

Semple said the outcome for many of the patients is encouraging. “Some of the things I’ve seen could only be described as miracles,” he said. “Is it a cure? No. Is there a vascular component of the disease? I can only say yes.”

Safety regulations got you down? Is The Man telling you that you can’t have this experimental surgery that has no proven efficacy and will likely as not do nothing to alleviate your illness? Got 13 grand to spare? Fuck it then, give me your money, I’ll send you to a place that has no safety regulations. You’ll come back $13,000 poorer, and no better off than you were before (for all we know). Also note the complete lack of confidence on the part of the owner, who admits it’s not a cure. He likens it to a miracle – not a good thing when you’re talking about a medical procedure. You don’t want miracles in science, you want regularly-occurring phenomena that can be predicted and replicated. If it’s ‘miraculous’, you’re probably looking at the placebo effect.

But yes, I called it in April, and it’s happening now. People are flocking to Costa Rica to get surgery, paying ridiculous sums for it, and Mark Semple is laughing all the way to the bank.

I’m you!

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The real Doctor Evil

Stuff like this chills me to the bone:

A doctor struck off by the General Medical Council for exploiting people with multiple sclerosis could be facing legal action by patients. A firm of solicitors said hundreds of “vulnerable people” who travelled to the Netherlands for treatment may seek compensation. Dr Robert Trossel treated them at his clinic in Rotterdam, following initial assessments in the UK. He charged thousands of pounds for unproven stem cell treatments.

I take heat from friends, from colleagues, and especially from my nemesis for my stance that sometimes the patient is the person who is the least equipped to make the decision about his/her health care. The reply inevitably comes that “people have a right to make their own health care decisions,” or that “scientific orthodoxy” is dangerous so we shouldn’t trust the evidence. I even field regular criticism from friends that think that we should be allowed to pursue unproven medical techniques (or even those that have been shown not to work) because it might benefit some people (either through placebo or through some kind of individualized magic powers that therapies supposedly have that isn’t detectable through clinical trials).

I offer this case study as an example of why I hold the position that I do, and am happy to defend it without shame. This doctor abused and perverted the trust that his patients placed in him as a caregiver, and used it to perform illegal experiments on them. The reason he was able to do it is because he led them to believe that his ‘treatment’ was going to help them recover from multiple sclerosis – a disease that can paralyze you and take away your autonomy. It is no small wonder to me that people would be willing to do just about anything to obtain relief from a disease like this, even if it’s something that is simultaneously expensive and risky.

As before, I am dismayed that I didn’t pay more attention in English class, or that I’ve largely ignored the vast bodies of literature in the English language, because I find myself at a loss to adequately put my disgust for this kind of predatory and exploitative fraud into words. The kind of callous disregard for the obligation that a health care provider has toward their patients, and for human decency in general, that this doctor has exhibited shocks me to my very core. He drew thousands of dollars from people based on a combination of their trust and desperation for a cure. These are dollars that these people could have used to get home care, or travel, or invest in real research, that have instead been wasted because Mr. Trossel (a doctor no longer) thought that he was above petty concerns like clinical equipoise or biomedical ethics.

It’s for this same reason that I am opposed to expediting the research process for this so-called “liberation therapy” proposed earlier this year. While I am hopeful that the procedure works, my optimism is tempered with a healthy amount of skepticism, precisely because the support for it is emotional rather than rational. This is why we have channels through which research must go – to avoid tragedies of the type perpetrated by this vulture.

After a fleeting improvement, Mr Pear’s [a patient who received the experimental procedure] condition has now deteriorated significantly. Mrs Pear said: “When you are sitting in front of a neurologist who is saying ‘look, there is nothing you can do’, you clutch at straws. I am not saying we are the most intelligent people on God’s Earth, but we certainly are not completely stupid.”

It’s almost a shame that there is no god or supernatural force to hold accountable those who would prey on the vulnerable like this. Luckily, we live in a world that has systems in place to provide a measure of justice, and I hope that someday Mr. Trossel comes to realize how evil and heartless his actions were.

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Update: Harper government actually stands up for science… wha?

It’s no secret that I’m not a fan of our current Federal government. They are decidedly opposed to any use of science in decision-making, preferring instead to appeal to ideologies rather than reality. The study of science and logical positivism make you, on average, more liberal than conservative – preferring to side with what works rather than stapling yourself to what you agree with. As Stephen Colbert so succinctly put it, “Reality, as you know, has a strong liberal bias.”

That’s why I was shocked to read this news story:

The Canadian government will not fund a clinical trial of the so-called liberation therapy for multiple sclerosis at this time, Health Minister Leona Aglukkaq says. Aglukkaq spoke to reporters in Ottawa on Wednesday, a day after a panel of North American experts announced they unanimously recommended against supporting a clinical trial of the treatment in Canada as yet. Aglukkaq commissioned the expert panel’s report from the Canadian Institutes of Health Research, which funds medical research, and the MS Society of Canada. “I feel the most prudent course of action at this time is to accept the recommendation of the country’s leading researchers,” Aglukkaq told a news conference (emphasis mine).

Did I say shocked? I should have said ‘floored and rended into a state of utter disbelief’. The Harper government (so called because he calls the shots, and everyone else runs his plays) actually relying on the expertise of people who know what they’re talking about? Surely I must be hallucinating. Particularly from a party that talks a big game about letting people make their own decisions, regardless of how unwise those decisions may be (a view apparently shared by my “nemesis”).

I’ve been skeptical of this ‘liberation therapy’ since it was first announced. My skepticism isn’t merely because it’s a stark departure from accepted practice, but because as a person who works in and is trained in health research, I recognize that many times these ‘radical’ approaches fail to stand up to rigorous scrutiny. A panel of experts recommended against CIHR fast-tracking large-scale clinical trials until smaller, well-controlled trials showed a benefit to the treatment. This is simple pragmatism to anyone in the health research community – it’s not a good idea to experiment on a large group of people unless you are reasonably sure they will actually benefit from it. Ethics boards actually demand this exact type of rigour before allowing research to go through. I am hopeful and optimistic that this treatment could potentially make a positive impact in the lives of people suffering from a horrible disease, but I temper my optimism with skepticism to say that I won’t advocate its use until we know for sure if it works or not.

So the Harper government thinks we should listen to the experts, and make our decisions based on that. Could this be a sign that they’re not as anti-science and ideological as I thought?

No, it’s not:

An RCMP report that evaluates the long-gun registry as cost-effective, efficient and an important tool for public safety hasn’t changed the mind of the Conservative MP behind a bill to scrap the registry. In an interview Tuesday on CBC TV’s Power and Politics with Evan Solomon, Candice Hoeppner says the report told her nothing new. “My position remains steadfast as does our party’s position,” she said. “We believe the long-gun registry needs to end. As legislators, that’s our job, to look at policy, to decide what’s in the best interests of Canadians and make those decisions. So, nothing has changed.”

So instead of experts using their training and experience to help decide what’s the best use of public funds to protect the lives and property of Canadians, Ms. Hoeppner thinks that political appointees are better suited to do it. Political appointees, I’ll add, that have no experience or training in anything other than politics. Even conservatives will have to agree that if someone’s going to be making our decisions for us, it would be better if they actually knew what they were talking about.

Then again, maybe they don’t have to agree at all:

An article in the Canadian Medical Association Journal slams the federal government for its efforts to shut down Insite in downtown Vancouver, Canada’s only safe injection site for drug addicts… The paper points out that soon after it was elected, the Conservative government removed harm reduction as one of the four pillars of its National Anti-Drug Strategy. The four-pillar strategy, endorsed by the World Health Organization also includes treatment, enforcement and prevention.

I mean, just because a bunch of eggheads who have spent years of their lives studying the problem and potential solutions doesn’t mean that they know what they’re talking about, or that you should listen to them. It definitely doesn’t mean you should accept the evidence that’s right in front of your face.

No wait, that’s exactly what it means.

MS Patients demand access to unproven procedure

You may have heard a few months ago that an Italian scientist discovered a promising new method of treating Multiple Sclerosis (MS). It involves inflating a balloon in veins in the neck to alleviate blockages that he (Dr. Zamboni – true story) alleges contribute to the progression of MS. Anyone who has had a family member suffer from this disease knows how horrible the symptoms can be – loss of motor control, paralysis, loss of speech, dysphagia, and others. I first became aware of MS when a close family friend was diagnosed back in the early 1990s. She became wheelchair-bound, could no longer work, and her family life began to fall apart at least partially as a result of her own frustration and anger at the loss of her mobility. It was further dramatized later in one of my favourite TV shows, The West Wing.

Needless to say, MS is a terrifying disease. What makes matters worse is that both the etiology (what causes it) and a viable treatment method have yet to be found. Dr. Zamboni’s work potentially provides answers to both of these questions. It is for this reason that several patients are demanding that the federal government provide access (funding) for afflicted people to seek this treatment:

“While studies in Canada get underway, some patients are travelling overseas, paying for tests and surgery out of their own pocket. Others are lobbying for the Canadian health-care system to cover the diagnostic tests to look for blocked veins in people with MS.

I’m not even going to pretend that I know what it’s like to have a debilitating illness, or that I can do anything besides blandly sympathize with people who are suffering from MS. However, this story highlights an important and seldom-talked-about fact of health care and health policy. Patients should not be the ones calling the shots. We have grown to feel entitled to be in the driver’s seat when it comes to health. Respect for the autonomy and wishes of the patient is paramount in medical ethics, and I have no beef with that. An individual patient’s needs and wishes need to be respected. However, this does not mean that health policy should be decided by sick people.

When you’re sick, you have only one goal: getting better. Millions of years of evolution have hard-wired a strong survival instinct into all living species, and human beings are no exception. People suffering from disease and their families are willing to do just about anything for a chance at recovery, and logic plays nearly no role in the decision-making process. The problem with this is that people suspend their disbelief and are willing to jump at any chance, no matter how remote, unlikely, or unproven. This says nothing of the fact that patients are not nearly as well-informed as they think they are.

Health policy should be guided by evidence, not sentiment. The fact is that this MS procedure has not been tested for efficacy. We don’t know whether or not it actually works, we have only the case reports of one surgeon to rely on. Far be it from me to suggest that Dr. Zamboni is being dishonest, but there is a mechanism for determining “truth” in science, and it comes from systematic appraisal of facts while controlling for alternate explanations, not simply believing what somebody says. The claims about how well this surgery works need to be tested before we give it the green light. This is another reason why patients should not be making these decsions – they can’t dispassionately appraise the evidence and weigh the pros and cons. It’s all ‘pro’ – there’s a chance at life.

“So what?” you might say “anything that gives people hope is better than having no hope at all.” That sounds nice, but it’s frankly untrue. False hope is not superior to honestly confronting reality. False hope carries a double-edged sword: not only will they be devastated when the object of hope doesn’t work, but they will also be out money and time that they could have otherwise used either on efficacious treatment or something else that would enhance their quality of life (travel, time with family, etc.). While it seems draconian and heartless to make decisions without putting patient suffering first and foremost in mind, the results of this process is that the greatest good will be consistently enjoyed by the largest number of people, rather than a scattershot approach that will be wrong as often as it is right.

Not only is it wrong to give false hope, there is a significant risk associated with surgeries, especially new surgeries for which many surgeons are not well-trained. All medicine is performed with a risk/benefit calculation in mind – basically, so long as the incremental benefit justifies the increased risk then the procedure is warranted. Surgery is particularly risky because of the risks of dying on the table, complications following closing, risk of hospital-borne infection, allergies to anesthesia, and others. What makes this particular surgery even more risky is that surgeons don’t have a lot of experience performing it, so the risks of complications and fatality is even higher. Without consistently establishing the size of the procedure’s benefit, it’s completely irresponsible to give patients access to the risk.

It’s also fascinating to me that every time a health governing body decides to push through a relatively new, somewhat untested treatment (like H1N1 or HPV vaccines, to cite a recent example), there is consumer backlash in the form of “we don’t know what the long-term consequences of this thing is, so we shouldn’t do it.” However, in this case, we’re getting backlash toward the health care governing bodies in the form of “you’re not moving fast enough.”

While I deeply sympathize with anyone who has to live with any catastrophic illness, I am firm in my stance that patients should not be the ones calling the shots when it comes to policy and decision-making, especially when it comes to untested interventions. Science takes time, and we will have an answer on this issue soon. In the meantime, it helps nobody to jump at every whiff of a cure, and could end up being far more harmful than we anticipate.

Measles outbreak in Vancouver

I’m sure some of you have been following this story:

The BC Centre for Disease Control asked health-care professionals and the public to be alert for measles on Tuesday after eight of the 14 cases were diagnosed in a single household with unvaccinated members. None of the cases identified to date had received two doses of the measles vaccine, which is needed for full protection, officials said in statement.

My stance on anti-vaccination groups has been stated quite unequivocally on a previous post. To put it briefly, they are prime examples of the Forces of Stupid, a group of people who seem to think that ignorance is a virtue and anyone with access to the internet is equally equipped to give an informed opinion, regardless of the process by which they arrived at their knowledge. Part of the reason I started writing this blog is to challenge the idea that everyone is entitled to an opinion. Some opinions, when left unchallenged, result in calamity. This measles outbreak is a prime example of what happens when we “leave well enough alone” and allow stupidity to take root.

Obviously, there should be robust debate about important issues. However, there is no room to debate facts. Facts are not subject to democratic approval. Something either is or it isn’t, regardless of whether or not we agree with it. If you disagree, find evidence to support your belief. The evidence needs to be stronger than the evidence that supports your opposition. That is how progress gets made.

Which is why it’s so painful to see articles like this one:

Unvaccinated students are being sent home from school because of the growing measles outbreak in Vancouver, and that has at least one parent concerned that the policy is unfair.

A student’s mother chose to refuse the measles vaccination for her daughter, citing fear of a reaction to egg albumin in the vaccine. That’s a completely reasonable stance to take if there’s legitimate concern over an allergic reaction. What isn’t reasonable though, is expecting everyone else to bend over backwards to accommodate her decision.

“I think every parent, whatever decision they make, it’s always because they love their kids, and they want to do what’s best. It’s not a right or wrong issue,” said Conley [the mother]. But Conley said the length of the quarantine is too long because she believes measles is only infectious for up to 14 days.

Good for her. What do people who know something believe? I couldn’t care less what some random lady thinks about a disease. Luckily, she’s not in any position to set policy and has been overruled by the school board, who cite the science dictating a 20-day possible incubation period. They are, reasonably, erring on the side of caution. Not only that, but in this case it is a “right or wrong issue”! You might be right to safeguard your kid, but the school board is more right to refuse to allow your decision to potentially infect hundreds or thousands of kids in BC and Quebec.

So why does this grind my gears? Because they put the mother’s testimony first. The opinion of a parent is not news. It’s certainly not a balance for scientific fact, and given that people tend to think of the top of the article as being more authoritative and informative, CBC seems to be suggesting that this random mom’s wacky opinion is superior to the science. It makes for a nice headline to the story: Brave Mom Fights for Child’s Rights. Here’s a better (or at least more accurate) headline: Mom Told to Live with the Consequences of Her Decision. You don’t vaccinate, you don’t get to participate.

Another thing I found interesting is that as soon as she was told there was a field trip at stake, she got her kid vaccinated right away. Where did the allergy concerns go?

Far be it from me to suggest that ideas are stupid a priori. The vaccination/autism link was certainly plausible when it first appeared on the scene. So what did we do? We tested the idea. Upon testing, we found no evidence to support it. We kept testing, trying to replicate the studies that trended positive. Again, we found no link. Once an idea has been shown to have no evidence supporting it, it then becomes stupid. Sticking to belief in a stupid idea isn’t admirable, it’s dangerous. Luckily, at least in this particular case, better-informed heads prevailed. I feel bad for the kid, but there are consequences to these decisions that the kid, and her mom, have to live with.

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.