Thursday, August 25, 2016

I believe in you, placebo!

Fascinating article about the myth of the placebo effect ("The Myth of the Placebo Effect," strangely enough) in The New Atlantis.

The article does a pretty good job of explaining why we believe the things we do about the efficacy of placebos, and then demolishes them. I'm not saying that the article is one big pile driver on the lowly placebo; it's much too well researched and restrained for that. Instead, it clarifies a lot of the assumptions we all have about the mysterious placebo effect, explores its history in legitimate medical journals, and explains what contrary scientists have found.

One of the interesting points that had never occurred to me was that you can't test the placebo effect using the gold standard---the double blind randomized trial: "they cannot be double-blind. Patients receiving no treatment will necessarily be aware that they are receiving no treatment. For self-reported outcomes this increases the risk of systematic error, or bias," writes author Nick Barrowman.

I'm not going to sum up all the arguments (except to note that the conflation of causation and correlation is important). My main concern is the implications that follow if we accept these conclusions. What does this say about:

* Laughter being the best medicine? Reader's Digest will have a lot to answer for.

* Maybe people who thought themselves better on useless nostrums were dumber than we thought.

* That basically a whole industry of junk science, from nutritional advice to herbal supplements to everything else, is exposed as nonsense wherever it is based on the idea that the mind had magical healing powers for the body. Those powers are what we loved about the placebo effect, and now they're shown to be nonexistent. (Note that I'm not saying good nutrition is useless, nor that supplements are all ineffective for anything; just that anyone who tells you that these things, or the right attitude, or anything else "unlocks healing power" is wrong. Or a freaking liar.)

* Mind over matter? Matter won.

So these are all points to ponder (that column is still good, Reader's Digest!) as we go forward. And, of course, it looks like Steve Martin will need to find something new to get stoned on.

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