Placebo

Dear Students,

The placebo effect is a perfect topic for any science class, and nearly always comes up when discussing the scientific method. It comes up in the house all the time as well. Boys are sick, and the want some cough medicine. Or a money chit to buy some health product. Or to buy that particularly Canadian version of pseudoscience, Cold FX.

The placebo effect is when a pill, agent or treatment is given that should not have any chemical, physical or mechanical effect, but a cure occurs because of the treatment. A sugar or starch pill instead of pain medication, creating an incision without actually performing surgery, etc.

Of course it's not just that. It isn't just taking a sugar pill, and then getting better. People get better for all sorts of reasons, including the disease just running its course. The sniffling, snorting colded up person who's finally had enough goes and buys some pills and gets better in two days. It doesn't matter what they took: cold Fx, echinacea, chicken soup, nothing, etc. The cold's almost done, and no matter what, you're going to be better in two days. We just naturally credit the last thing we did to address the problem. A real placebo effect would require that a sugar pill actually prevent or reduce the duration of a cold.

As the preceding single example shows, it's complicated. There's lots of reasons people who are sick can get better, so much so that even the placebo effect itself is disputed. It is also differs depending on what you're trying to cure. Pain is notoriously amenable to the placebo effect, possibly because pain is so much a product of our mind and our expectations. Many women endure the pain of childbirth more than once, and apparently willingly. Yet if one forced such a pain onto a person against their will would be an agonising and traumatic event. Regrowing an arm or a leg, however, is a completely different story. (If you're thinking that the placebo effect works best on those areas that alternative medicine seems to emphasize, you're right. Funny kind of coincidence...)

So it would be obvious that any attempt to determine if a procedure or pill works, one would have to put a lot of effort into checking if it actually works.

Cold-FX did that. For example there are two separate studies, both of which showed that it did nothing. Then they combined the studies with some fancy statistical footwork, squinted their eyes, and presto! A faint result.

Even if one accepts the faint result, it does not claim to work as people think Cold-FX works. People feel a cold coming on, so they start popping some Cold-FX pills, expecting it to work like real medicine such as tylenol or antibiotics. Then, no matter how ineffective Cold-FX may be, some people will get better. Whether that's a misdiagnosis (they weren't really getting a cold after all!), luck (3 day cold instead of 7, hurrah!), ignorance (my cold only lasted 7 days!) or placebo (it worked just like a sugar pill!), for some people, for some of the time, anything will work. Throw in some good marketing, word-of-mouth, and a healthy dose of Skinner, and soon you'll have perfectly ordinary people claiming drinking urine is good for you.

Once you have a large group of people giving anecdotal stories, evidence and science are often ineffective. See all of this for examples.

The point of this long introduction, was that a student mentioned gluten-free diets, and asked for my opinion. I, naturally, don't have one, but as a science teacher our classes often examine evidence, learn about credibility, and how to determine true from false information. In essence, it might work, it might not, there's no real good evidence that it does according to what sites we could find that weren`t biased. At most, some parents found it helpful, which isn`t much given what we know about how easy it is to fool oneself.

What it does have, however, is the placebo effect combined with concerned parents. If my daughter needed help, and if someone told me that something as simple as changing her diet would help, I'd try it. And I would desperately want it to work. Add in all the previous caveats about why people can get better, plus all the reasons why someone could appear slightly better, and multiple positive anecdotal reports would be expected. Changing the diet of an autistic child appears unlikely without really good, plentiful evidence outside of anecdotes.

People like to pick on pharmaceutical companies for making expensive drugs. Nobody seems to recognize the vultures picking over the worry and guilt of parents that is the alternative health care industry.

There`s a lot of garbage out there. My students know not to believe me, but it bears repeating. Research. Check credibility. Periodically re-examine the evidence. And remember that when you think you`ve found the truth, and all the scientists are on the other side, you might want to double-check your results.

A bonus question for my student ethicists. If the placebo effect does work, it involves lying to patients. Should a health care professional be allowed dishonesty in order to cure their patients this way? Is charging for it justifiable?

Cheers,

Ron Neufeld
Canada's Best Boarding School