Though recurring tummy aches from irritable bowel syndrome are among patients' most common complaints, drugmakers have had trouble coming up with a safe and effective treatment. But in 2008 Harvard's Ted J. Kaptchuk devised a safe remedy that helps far more people than any designer drug ever did.This according to a recent Forbes.com story entitled "For Nothing."
His magic cure: fake acupuncture delivered with lots of warm talk from a sympathetic acupuncturist--but no needles. In a trial of 262 patients with severe IBS, 62% of those who received the fake treatment got better, according to results published in the British Medical Journal. By comparison, only 28% of a control group of patients put on a waiting list saw their symptoms improve markedly. A third group who got the fake acupuncture, but without any warm talk, showed in-between results: 44% improved.
Save this kind of research, I never quite understood why the placebo effect was so routinely dismissed by medicine. It is producing a "real" effect, but because it was not producing a "real" physical effect it was not treated as real, or, as one astute commenter to the story writes, it is treated as "noise."
However, my major problem is that traditionally any results generated by placebos is treated as noise in the experiment. It's a good control, in that it accounts for the role of the action of being treated as a separate variable from actually being treated. Therefore looking for meaning in placebos strikes me as a sort of data mining.While there are certainly concerns about doctors misleading patients, these concerns privilege a certain kind of reality. If the pill works, then to what extent are doctor's "lying." In fact, many of the negative responses to this story expressed this discomfort with doctors "lying" to patients. (I kind of have Nietzsche's "On Truth and Lies in a Nonmoral Sense" in mind here. "Lie" and "deception" assume a reality I am uncomfortable with. I am also thinking about a collaborative project I am working on with a psychologists in Holland: we are investigating "manipulation" and "deception" as social technologies.)
This is not to say that placebos always work or work equally well for everyone, but in this regard they are like any other pill. What is to stop a doctor from lying about any and all treatments? When it comes to ethical medical practices we must rely on the profession and external auditors to review and promote agreed upon ethical practices. Again, such an arrangement is what we always already rely on. A doctor wouldn't (or could just as easily and dangerously) prescribe Tylenol to treat a brain tumor. So fears about placebos in this direction seem unfounded (or at least no different from common concerns about medical treatments and professional ethics).
I think one place the fear comes from (yes, here it comes) is a particular orientation to the real as only the biological/the natural. I have posted on this issue previously here and here. The placebo threatens this biological foundationalism that has been at work in Western thought for a few thousand years. For instance, I think this distrust of the placebo effect can be traced to Plato's treatment of rhetoric as cosmetic (rather than real health, which comes from medicine). In other words, I read into the mistrust of placebo a mistrust of rhetoric.
I hear both then in the following comments on this story as posted to BoingBoing:
- There are massive ethical issues with doctors giving something to a patient, knowing that there is no active ingredient, and lying to make them feel better. I wouldn't want my doctor doing that to me!
- The placebo is, regardless of the intent, a lie. Using placebos as a therapy could endanger the trust in their doctor or doctors in general. This trust is crucial, however, to the function of a doctor. [the irony of arguing that trust is crucial is not lost on me: how could trust possible matter if its is the real cure you are after?]
- There is a real and distasteful paternalism in lying to your patients to make them happy and leave your office.
Update: Here is another story on the placebo effect.