The dilemma of the placebo

A bomb is about to go off, blowing up hundreds of innocent people. One terrorist knows the location. You’ve got them in custody. Do you torture them to find out where it is?

Thus runs the common moral dilemma beloved of Hollywood movies and TV shows, frequently these days it seems staring Kiefer Sutherland. Are you a mealy mouthed liberal or are you willing to take the tough action necessary to fight terrorism?

Real life isn’t that straightforward – it doesn’t present such clear-cut scenarios, and anyway evidence from torture isn’t reliable: could you really be sure the terrorist told you the truth rather than a fib to waste your time? And the tough-guy macho act in real life all too often results in the innocent being harassed, tortured or killed as you charge off in the wrong direction based on incomplete or misleading information (remember Iraq and its weapons of mass destruction that were supposedly just waiting to be found by US and UK troops?).

However, a case a constituent raised with me recently got me thinking about the placebo effect – and the genuine dilemma it presents, particular for those – like myself – of a liberal mindset who believe in giving people as much information and power over their own lives as possible.

PillsThe placebo effect is seen when people are given treatment, such as pills, where the psychological impact of thinking that the treatment will make you better actually does – even if the pills are inert, containing no health-giving recipe at all. Give people a “medicine” that is really nothing such, but tell them it will make them better – and, lo, it can do.

It’s a weird display of the power of the mind when given a suggestion; a happy flip side perhaps of the power of the mind over the body you so often see when one of a couple who have been happily married for decades passes away – and then the other slips away shortly afterwards as if their mind simply no longer has any desire to keep their body going.

Of course it doesn’t work for all people in all circumstances (that would make the NHS’s job easy if it did!), but it’s a real, solid, verifiable effect – and one that medical scientists have to take into account when testing new medicine because, without allowing for it, their tests may otherwise fool them into thinking that some possible new medicine really does have health-giving properties when in fact it is only the placebo effect at work.

This to me seems as close as we get to modern magic in the sciences. It sounds a mad idea really in many ways isn’t it – the idea that if you think something will make you better, it really does? And yet – that’s just what modern science has found time and time again.

There are all sorts of wonderful details around the placebo effect – such as the colour of the pills impacts on how strong the effect is, because some colours are implicitly more strongly associated with making you better than others – and of course the colours that work best vary from culture to culture!

Which brings me to the dilemma. If a GP telling me that a treatment is extremely likely to work makes it actually more likely to work (because of the placebo effect) then shouldn’t they perhaps lie to me and tell me that even if it isn’t really that likely to work?

Ben Goldacre (I think) made the point well in The Guardian a little while back that this perhaps helps explain some of the popularity of alternative medicines compared with traditional medicine. For traditional medicine, GPs have shifted hugely in their outlook – being told to tell patients the full range of information about possible treatments, their chances of success and possible side-effects – and thereby sowing doubt into patients’ minds. But alternative medicine is often presented by its practitioners with absolute confidence – and so (regardless of any other benefits) scoring an immediate win on the placebo front.

Now – there are all sorts of benefits about keeping patients properly informed, including keeping a checking on conventional wisdom or vested interests getting out of control.

Yet here is the riddle: if doing that means they are actually less likely to get well in that immediate here and now case, who wouldn’t be tempted to shade the information? Would you be tempted to tell you child or partner a small fib about how sure you are the treatment is to work even if you know otherwise? And would that really be wrong?

For that personal circumstance – I am happy to let others make their own judgement in their own circumstances. But overall – there doesn’t seem to be a way to square the circle. Interesting dilemma…!

Lynne Featherstone is the Liberal Democrat Shadow Cabinet member for Youth and Equality.

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  • I hope this article isn’t some sort of not-so-roundabout excuse for Homeopathy and that Lynne Featherstone isn’t going to be backing any loony alternative medicine schemes/bills/EDM/etc…

  • Maybe I’ve misunderstood something here, but I don’t see what the introduction on terrorism/torture has to do with the medical placebo effect, which seems to be the main subject of the article?

    On the placebo effect itself, I’d have to agree with Laurence Boyce – it’s a genuine effect that has to be taken into account in scientific studies, but it’s not anything that can be relied on. And the idea of lying to patients to convince them a medicine will help them is not a good medical technique.

    The placebo effect works both ways – sometimes it can produce a beneficial effect after taking a useless pill, but it can also obstruct the working of a useful one. If you tell someone a pill will definitely help them and then it doesn’t, that might shoot down their faith in any other medicine you give them. So if you later give them more effective pill, they might think “well, you said the last one would help and it didn’t, so this one won’t either”.

  • The placebo effect is a useful clue to a general approach to medicine, but not to any specific treatment. There is no reasonable doubt that in a useful nimber of cases(though very far from all)our minds (however “mind” may be defined)can and sometimes do sort out physical problems. To a very large degree, this process goes on below our conscious thresholds. The conditions for mobilising this capacity seem to be:
    – a degree of confidence or hope that the problem is soluble. Placebos may help overcome this barrier.
    – an accurate and objective as possible understanding of what the problem is: the largely unconscious process seems to use such relevant knowledge as we absorb. Education helps, well-intentioned fibs and pseudo-scientific waffle hinder.

    I have the impression that a lot of good GPs operate on this basis, and that they find that giving the patient all the information she can absorb is helpful.

    Perhaps it is a bit like politics. We voters cannot acquire nor mainatin implicit confidence in politicians unless they tell us the truth as they see it.

  • When I was a child I had warts. Lots of them on my hands and knees and less obvious places. I used to go the local hospital to get them burnt off which was horrible – and more importantly didn’t work. They didn’t go. As a last attempt my mother got some homeopathy tablets from the local health food shop. I took them for few weeks and the warts started to go and I haven’t had any since (20+ years on).

    Now I’m not a homoepathy champion or anything and haven’t used homeopathy since, and as a kid I wasn’t impressed by having to take these pesky small pills so I don’t think there was any placebo effect going on. But the warts went.

    Anyone any ideas how?

  • Alun Griffiths 14th Feb '08 - 10:12pm

    Anonymous @10

    Warts nearly always go away on their own left long enough, so any remedy, including burying a toad under a tree stump on a full moon and expecting the warts to rot as it does will work eventually.

    It is an interesting idea though, however, though in the darkest hours I am sorely tempted, I don’t think we can go back to keeping patients in the dark, so perhaps the answer is to make the quacks explain how little evidence they have behind them instead.

    By coincidence I have just read a glossy brochure from our local enterprise initiative which takes credit for assisting a new business selling mobile health screening which appears to be a machine which claims to be able to identify food sensitivities. Nothing in the write up to suggest that this is nonsense.

  • I agree that the Placebo effect is quite fascinating.
    Did anyone see the t.v series by Professor Kathy Sykes on this and similar subjects.It even featured a surgeon in U.S.A who practices “placebo surgery”.The operation is carried out as normal but no incision is made.The amazing thing is that the success rate is the same as for conventional operations where the patient actually goes under the knife.
    It is such a shame that so many closed -minded people are ready to dismiss out-of -hand alternative remedies without taking the trouble to investigate and understand them.

  • “The amazing thing is that the success rate is the same as for conventional operations where the patient actually goes under the knife.”

    Really? That IS amazing. So amazing that it certainly has never been published in any peer-reviewed journal I’ve ever heard of.

  • Ref colinW @15.
    The item was included in the second episode of the 3 part series.
    The surgeon does open the patient up, but then simply stitches them up again without actually operating on them.
    I can’t think that it was a hoax.There was no reason to think that he was lying.

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