An article posted by Cara Santa Maria about banning homeopathy for pets got me thinking about a recent conversation I had with my father about the placebo effect, specifically when it came to homeopathy. While it is well known in the scientific and skeptic community that homeopathy is garbage, and takes full advantage of the placebo effect and anti-modern medicine marketing for its success, my father took the stance that there is an inherent benefit of “prescribing” placebos to patients under certain conditions.
His reasoning was this: if you have a patient that is suffering from insomnia, which is not due to a hormonal imbalance but rather due to an unaddressed anxiety or stress, and a sugar pill helps that patient to sleep at night, isn’t that better for their health than taking potent sleeping aids? Similarly, if a sugar pill helps someone with a generalized anxiety disorder feel more relaxed, or relieve a tension headache, or help a hypochondriac wait out a common cold they are convinced is deadly pneumonia, isn’t that better than giving that person the pharmaceutical counterpart to the homeopathic remedy? While he agrees that placebos are harmful in the context of an ulcer, or cancer, or other conditions in which a patient thinking they feel better will only make them wait for proper treatment and worsen their condition, he posited that using placebos in certain contexts could do a patient far more good than going straight for the heavy duty drugs. After all, sugar pills and drops of distilled water, while being useless cures also carry no side effects, so if plain water helps the condition, why expose the patients to the inevitable side effects, however minor, of drugs with real active ingredients?
While this reasoning has some merit on it’s face, it also ignores some serious downsides to this approach, especially when it comes to homeopathy.
First of all, while there is some evidence that placebos can work even if you know they are placebos, they are still going to work better (especially for hypochondriacs or people with anxiety) if the patient does not know that they are taking a placebo. This means that doctors, while being fully aware of the useless nature of homeopathy, would still have to lend it an air of legitimacy when prescribing it to their patients. Homeopathic industries seize on this, and make no distinction between conditions which are unharmed by the use of a placebo, and ones which would be. If homeopathy works for some kinds of insomnia, why not for some kinds of ulcers? Or some kinds of heart conditions? Or some kinds of liver disease? Using the cloak of legitimate medical doctors, it would be unreasonable to assume that homeopathic producers would limit themselves to only those conditions that could be resolved without risk by a placebo. There is also the inherently scummy nature of charging patients the same, if not more, for a small bottle of water or a packet of sugar pills which have no effect as a packet of real medicine, but that is another aside.
The second point against this method is that taking placebos might not be as harmless as all that, and simply be a band-aid over an underlying problem. What if those tension headaches are actually a symptom of something more serious? What if you feel less depressed now by taking those sugar pills, only to fall into a much deeper and dangerous depression later because your doctor prescribed you sugar pills in an effort to figure out if you were “really depressed” or not, instead of sending you to therapy? While a responsible doctor could make sure to both give you the placebo and give you the necessary tests to make sure that there is not a more serious underlying problem, there is also the inescapable fact that people are less likely to follow up if they think they are already being treated for the problem. I was anxious, now I have this sugar pill and I don’t feel so anxious anymore, why do I need to discover the underlying root of my anxiety? I have a solution and I’m busy, more digging is not on the top of my priority list.
Finally comes the moral objection to perpetuating lies. Knowingly handing out sugar pills to patients who come to you for help is no better than treating them like toddlers. Lying to them smacks of laziness and condescension, of not even bothering to trust them with the truth of their health, their bodies, and the ability to make their own decisions in that regard. This does not mean that I think that doctors should prescribe the heaviest sleeping aid imaginable to the first person who complains of having some trouble sleeping, far from it. Rather, explain that the more potent the drug, the heavier the side effects, so lets start with an investigation of the problem. Let’s start with a sleep diary, a food diary, and some mild sedatives like Chamomile tea, or Valerian. Let’s see if changing your diet, or doing some stress relief exercises does the trick. If not, we can move up to the next step, and run the appropriate tests that are needed to discover the root of the problem. I know, that requires effort and follow up, but at least it’s honest.
While I came out on the side of getting rid of homeopathy completely, getting rid of homeopathy for pets is a no brainer. Pets don’t know they are taking a placebo, the placebo effect is for the owners, who think they have given their pet a pill and convince themselves that they look better, thus not bringing them back to the vet to get them sorted out properly. I can also personally attest to the fact that homeopathic remedies for dogs cost twice what the normal medicine for dogs costs. It’s a scam that needs to stop getting so much public and legislative support.
What about you? What are your thoughts on the use of the placebo effect in the medical world?