Arnold Kling  

Robin Hanson is Incurable

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From the Boston Globe.


the simplest and least ethically hazardous way to capitalize on the placebo effect is to acknowledge that medicine isn't just a set of approved treatments--it's also a ritual, with symbolism and meaning that are key to its efficacy. At its best, that ritual spurs positive expectations, sparks associations with past healing experiences, and eases distress in ways that can alleviate suffering. These meanings, researchers say, are what the placebo effect is really about.

I take this story (read the whole thing) as implying that people who believe they are being cured are easier to cure. Isn't this bad news for medical skeptics like Robin Hanson? They may be cognitively correct, but they are likely to suffer for it.


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COMMENTS (7 to date)
Bernard Guerrero writes:

Similar to the finding that depressed people have more realistic understandings of their abilities and weaknesses, no? Perhaps the causation runs the other way.

Sean A writes:

Well that doesn't sound very profitable; you can't sell a state of mind. You can sell a means to a healthier way of living--e.g. fitness club membership--but this is an ongoing process that takes dedication. It's much easier to pop some pill, feel the effects and mentally connect those effects with some "scientifically" proven way to cure your ailments. For every case where prescribed pills were necessary there are ten where they were not. I'm reminded of my friend in the military who faked sickness to get out of having to get the swine flu vaccine, and was prescribed oxycodone to remedy his made up ailment.

Jeremy H. writes:

My girlfriend understands signaling, but she still likes it when I send flowers.

Bob Knaus writes:

I'm quite skeptical of medicine myself. I believe strongly that this mindset makes me less likely to get sick. I do seem to suffer less from pain and illness than my friends.

Really! It's true. You see, the placebo effect works for me without any pills or rituals.

The flip side is that once I'm sick, I'm really sick. It takes actual medicine to cure me, not a sugar pill.

Tracy W writes:

Sean A - actually cults do sell a state of mind. The problem is the side effects.

And I agree with you that taking a pill is indeed typically cheaper and faster, if the pill is effective and reasonably safe these strike me as reasons to take the pill. After all, many of those "healthier ways of living" are quite dangerous, one of my brothers nearly died from being hit by a van while out biking and the guy who was bought into the intensive care unit next to him from an accident while diving did die.

Silas Barta writes:

I've said this before, and I'll say it again: we are seriously underinvesting in research into the placebo effect. Given how many different things it's been observed to cure, and how many different effects it can generate, we really need to learn what precisely its mechanism is so that we can exploit it in a more controlled, predictable manner.

Marc writes:

I'm going to give you the benefit of the doubt, Silas, because I'm really hoping you're being sarcastic, but just in case there's someone out there that thinks this is a serious response, there are a couple things very wrong about suggesting exploitation of the placebo effect. Remember--a placebo simply makes people feel like they're being cured and thus provide a positive response to the question "do you feel better?" What it doesn't mean is that the patient actually *is* better. This is why double-blinded controlled studies are used, when possible--you want to compare how effective a given treatment is compared to an inert (i.e. known to have no clinical benefit) treatment, i.e. the placebo effect.

There have been numerous studies on this, the most recent infamous example was the comparison of accupuncture to sham accupuncture (trained accupuncturists designed the regime to ensure no use of real meridiens occured in one case, the use of toothpicks instead of needles in another) and no accupuncture at all, and it was shown that the sham accupuncture was just as effective as the regular accupuncture. Accupuncturists hailed this as "we told you we're effective!" In reality, what was demonstrated was simply that the ritual of providing some treatment, regardless of what it was, is what was really causing the perceived effect, and we know that ritual itself is simply inert treatment-wise. This is, I think, what Robin is getting at. It is also what makes people go to practitioners of completely implausible treatments like Reiki or homeopathy--it's not that the treatments are effective, but rather that the care they do receive, since it's mostly a cash business with far fewer patients per practitioner than conventional medicine, offers more TLC and ritual than a regular visit to an internist. This doesn't mean we should change regular doctor visits into one hour mental examinations to make someone feel vindicated in their search for comfort, but it does mean that unless scientific medicine at least moves a little towards the happy medium of care with more ritual than today there's a big risk of people fooling themselves into thinking they've been cured when in reality they were merely given a placebo.

For those interested, there have been a number of good articles on placebos on a few SBM blogs:

http://www.theness.com/neurologicablog/?p=1130
http://www.sciencebasedmedicine.org/?p=24
http://www.theness.com/neurologicablog/?p=46
http://scienceblogs.com/whitecoatunderground/2009/09/placebo_is_not_what_you_think.php

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