Medicine and The Placebo Effect

· homeopathy
Authors

Guest Post Written by Vinton McCabe (The Author)

I have been doing a lot of thinking lately about the “placebo effect.”

Mostly because I have noticed that the Skeptics—that crazy-quilt of organizations in the English-speaking world who are making such a noise on the internet when it comes to something near and dear to my heart, homeopathy—tend to use the term “placebo effect” as those being cross-examined in court use the Fifth Amendment, as way of putting an end go conversation and a means by which they can always claim “victory,” even if it is of the Pyrrhic sort.

I think we are all aware of the idea of what a placebo is and what the placebo effect must therefore be, but, when you stop and think about the manipulation of reality that the blanket term “placebo” covers, you have to reconsider both what the term means and what the implication of its existence—and no one doubts its existence, apparently, not even the Skeptics themselves (and they doubt everything it is possible to doubt, as we shall see)—means.

Skeptics

First, a though, a note on the Skeptics Guide.

If you haven’t had the pleasure, you should look into the activities of the various groups that comprise the movement, sort of a Tea Party of the medication, philosophical and metaphysical realm.

I have recently become quite enamored by one of the Grand Old Men of the Skeptic’s movement, one Robert Todd Carroll, PhD, who hosts the site The Skeptic’s Dictionary, on which he gives his viewpoint—and, more important, the reasons for his viewpoint—on topics ranging from, as he puts it, “Abracadabra to Zombies.”

Carroll’s academic background serves him well in his Skully-ish search for the “Truth.”  He was, until his retirement four years ago, a professor in the philosophy department of Sacramento City College—a position he held for thirty years.  Somewhere along the way—he is kind of cagey about his personal evolution as “skeptic”—he got downright skeptical and, as a result, has built a very interesting website.

Because the purpose of that website is skepticism—it is called The Skeptic’s Dictionary, after all—he has quite a lot to say about religion, science and, of course, “alternative” medicine.

Now, regular readers of my blog and of my books all know how I hate the term “alternative” medicine, it that the term itself establishes allopathy as the thing that homeopathy, et. al., are alternative to—in other words, allopathy is medicine, and everything else is an alternative.  My belief is that either it is medicine or it is not.  Hippocrates spoke of both homeopathy and allopathy (not by name, of course, but by philosophy) two millennia ago, either establishing both as systems of medical treatment, or setting himself up as a target for the Skeptics to go running after…

But the hated “alternative” term aside, Carroll has much to say about the topic at hand, “placebo effect,” in his Skeptic’s Dictionary.

Here’s a taste:

“A person’s beliefs and hopes about a treatment, combined with their suggestibility, may have a significant biochemical effect, however. Sensory experience and thoughts can affect neuro-chemistry. The body’s neuro-chemical system affects and is affected by other biochemical systems, including the hormonal and immune systems. Thus, it is consistent with current knowledge that a person’s hopeful attitude and beliefs may be very important to their physical well-being and recovery from injury or illness.

“The psychological explanation seems to be the one most commonly believed. Perhaps this is why many people are dismayed when they are told that the effective drug they are taking is a placebo. This makes them think that their problem is “all in their mind” and that there is really nothing wrong with them. Yet, there are too many studies that have found objective improvements in health from placebos to support the notion that the placebo effect is entirely psychological.”

The New York Times Magazine

[1] “Doctors in one study successfully eliminated warts by painting them with a brightly colored, inert dye and promising patients the warts would be gone when the color wore off. In a study of asthmatics, researchers found that they could produce dilation of the airways by simply telling people they were inhaling a broncho-dilator, even when they were not. Patients suffering pain after wisdom-tooth extraction got just as much relief from a fake application of ultrasound as from a real one, so long as both patient and therapist thought the machine was on. Fifty-two percent of the colitis patients treated with placebo in 11 different trials reported feeling better — and 50 percent of the inflamed intestines actually looked better when assessed with a sigmoid-oscope. It is unlikely that such effects are purely psychological.”

First, let me encourage everyone to read the whole of Carroll’s long consideration of the placebo effect at his website.  I cannot include the entire article here due to its length, but I do think it is one of the better articles on his site.  (Some, like his article on Naturopathy are both factually incorrect and academically weak due to Carroll’s biased stance.  Like most of the Skeptics, he proves himself far from being actually skeptical about anything other than the specific topics that define their group focus.  About allopathy, for instance, he shows no skepticism at all, no matter how toxic various forms of allopathic treatments have been clinically shown to be.)

I want to borrow one more bit from Carroll’s article on placebo effect before sharing my thoughts on the matter.  Consider H. K. Beecher (1904-1976), who brought the concept of placebo into the modern age.  Indeed, he is credited with coining the term “Placebo effect” in his 1955 paper entitled “The Powerful Placebo.” [click to tweet] Mid-twentieth century, he was intrigued by the fact that more than half of patients with certain conditions—common complaints like heart trouble and digestive disorders—could be significantly helped by doing nothing other than suggesting that they had been helped.  To explore the idea, he set up a number of studies.  Carroll comments on what happened next:

“Beecher started a wave of studies aimed at understanding how something (improvement in health) could be produced by nothing (the inactive placebo). Unfortunately, many of the studies have not been of particularly high quality. In fact, it has been argued by Kienle and Kiene (1997) that, contrary to what Beecher claimed, a re-analysis of his data found “no evidence of any placebo effect in any of the studies cited by him.” The reported improvements in heath were real but were due to other things that produced “false impressions of placebo effects” The re-analysis of Beecher’s data claims that the improvements were due to:

“Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgement, psychosomatic phenomena, misquotation, etc.”

(Now, it should also be noted that Beecher, who was born Henry Unangst in Peck, Kansas, took the name “Beecher” as a young man in order to align himself with the New England Beechers, perhaps with famed preacher Henry Ward Beecher (not the similarity of the names), although he had not actual relation to them.  And it should be noted that Beecher is known to conspiracy theorists internet-wide because of his alleged involvement with the CIA in human drug tests, most notoriously on post-World War II German prisoners.  Apparently, no placebos were used in these tests.)

Moving forward, let’s try to find some meaning in this mess.

Let’s start from the place of agreement:  the placebo effect exists. There may be some disagreement as to exactly what it is, how it works and how effective it is (what it limits are in terms of health and healing), but all sides agree that there is some validity connected with the idea of the placebo effect.

Now to get some sort of working definition.  My computer’s built-in dictionary defines the term as:  “a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must, therefore, be due to the patient’s belief in that.”  Not the greatest definition, but what do you expect from the dictionary that comes built in on your computer for free?  Much as dislike definitions that use the term itself or any aspect thereof in defining the term, let us use this, at least for now.

The key word, for me, in that definition is “belief.”

Which brings to mind something that Carroll wrote in this consideration of the topic: “Patients suffering pain after wisdom-tooth extraction got just as much relief from a fake application of ultrasound as from a real one, so long as both patient and therapist thought the machine was on.”  While we are not given full information here and do not know the differential between those therapists who did not think the machine was one and those who did, the point is made.  For the pain to be relieved, both patient and therapist had to believe the machine was one. Again, belief seems to be the key.

Skeptics and Atheism

This summons a scripture from some lobe or other.  Matthew 18:20.  “Where two or three are gathered together in my name, there I am in the midst of them.”  There’s a great deal of power to be had in the gathering of twos and threes, especially when they gather in a state of belief.

I know that the Skeptics would be choking on their Saltines if they were reading where this is going, because I have noted how often the path of skepticism leads to atheism and have seen how many of the groups of Skeptics are connected with groups of atheists.  And I know the issue that many Skeptics have with medicine that will not stay in the box labeled medicine that they have constructed for it, but instead expands to include the idea of healing, even to the point of placing it over the concept of curing, a simple change that leads to huge consequences, especially as one looks again at medicine from the viewpoint of healing and not curing.  (More on that another day.)

Conclusion

Nearly two thousand words in and all we have so far is that we are all agreeing to one degree or another that the placebo effect exists, even if the scientific proof of its existence seems scanty at best (making your wonder why the Skeptics are so quick to grab hold of the phenomenon as the blanket explanation for why homeopathic and other “alternative” therapies work).  And the only other thing we have established so far is my own addition that, in the center of the concept of the placebo effect is the idea of belief.  But what the definition of “belief” is and the revelation as to exactly what that belief is based on and targeted to, well, that will have to wait until another day.

For now, I will stop here.  But I await hearing from some of you, to know what you think so far and what your beliefs are where the placebo effect is concerned.

References

[1] “The Placebo Prescription” by Margaret Talbot, New York Times Magazine, January 9, 2000. http://www.nytimes.com/2000/01/09/magazine/the-placebo-prescription.html

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About the Author: Vinton McCabe

Vinton McCabe

Vinton McCabe

Vinton McCabe was a student of homeopathic medicine three decades ago and in the years since has authored ten books on homeopathy including the now-classic Practical Homeopathy and his personal favorite, The Healing Bouquet: Exploring Bach Flower Remedies. He also is the author of a growing number of publications on subjects related to holistic healing through the “Homeopathy in Thought and Action” series of McBooklets, a Kindle exclusive, which will be published in print form by Basic Health Publications.

Vinton served as the past president of the Connecticut Homeopathic Association,a not-for-profit educational organization through which he trained lay persons and medical professionals alike in the practice of homeopathic medicine. McCabe has served on the faculty both of the Open Center in Manhattan and the Wainwright House in Rye, New York as a homeopathic educator. He also taught homeopathy at the Learning Annex, the Omega Institute, the New York Botanical Garden and the Seminar Center in Manhattan.

In addition to his work with homeopathy, McCabe is an award-winning journalist, poet and playwright. He has produced television shows for PBS and has hosted his own talk radio show. He continues to be sought after as a guest on numerous radio and television shows. He is a published novelist,

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The above article was originally published by Vinton McCabe on his blog Psora Psora Psora on 7th April 2011 and is republished here with his explicit permission. The Copyright is reserved with the author (Vinton McCabe). All opinions are that of the author.

The above Guest Post is the twelfth in the GUEST BLOG SERIES. For reading previous Guest Posts check out https://drnancymalik.wordpress.com/2012/08/23/guest-blog-series

WordPress bloggers are requested to reblog this post. Use up-votes to bring attention to thoughtful, helpful comments.

13 Comments

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  1. Christina Strang

    Although not a homeopath, Prof Healy is a very interesting speaker: http://www.youtube.com/watch?v=A3YB59EKMKw

    • Dr. Nancy Malik

      Thank You Christina for educating us that the side effects of the conmed needs to be reported. This will give the feedback to the concerned.

  2. DanaUllman

    Ironically, very ironically, Beecher did an experiment that, to him, verified the “power” of the placebo. He gave a drug (Ipecac) to people who were nauseous and told them that it was a drug FOR nausea. The fact that this drug seemed to relieve people’s nausea was, to Beecher, strong evidence for the power of the placebo. And yet, another OBVIOUS explanation for this effect is the good ole homeopathic effect. Ipecac helped relieve people of nausea because it is known to CAUSE nausea in healthy people. If this drug were given to healthy people, they would have gotten nauseous…and yet, because it was given to people who had nausea, it provided relief. This is NO surprise to those of us with an appreciation for homeopathy…

    It is amazing how much the deniers of homeopathy (I refused to call them “skeptics” because I have too high of an appreciation for good skepticism!) spin information that could and should give support for homeopathy and instead turn it on its head to prove something else. It is always interesting how they spin and counter-spin and counter-counter-spin information. The twisted minds of the anti-homeopathy people are predictable to watch…and oh so sad.

    • Dr. Nancy Malik

      Dana, I agree with you calling skeptics medical fundamentalist because they are anti-science. Their religion is to oppose almost everything which is good and positive.

      • Reactive Ooze (@ReactiveOoze)

        If anything skeptics are the most pro-science people you can find. They require acual evidence based on scientific process. That is to say the objective results of repeatable testing under certain conditions, rather than hearsay and anecdote. For a skeptic it is not enough just to say something is the case, proof must be provided. As long as there is a lack of that proof there is, in theory, the potential for a claim to be proven wrong. Also, skepticism is really not a religion and nor do skeptics simply oppose everything that is supposedly good and positive. A skeptic would say, “OK, prove to me, by using scientific method or checkable objective data, that your claim is correct”. If you can do that they would have no problem with you claim.

        • Alex

          So called skeptics reject well known facts simply because they do not fit into official theories.
          And this is unscientific behavior.

  3. Dr. Nancy Malik

    Thank You Vinton for your insights into the placebo effect. Regards

    Medicine has nothing to do with religion.
    Placebo Effect bears some relationship with faith it seems but I am not sure.
    Placebo Effect is equally present in all systems of medicine.
    Homeopathy has the first-mover advantage of using ‘placebo effect’ to its use.
    Any treatment is effective because of the both specific (pharmacological/physiological) and non-specific (psychological/placebo) effects.
    As of now, it’s not possible to quantify the non-specific effects.
    I wish to know more about the difference between healing and cure.

    The Placebo effect: Is it all really in the mind? http://www.psychmechanics.com/2015/03/the-placebo-effect-is-it-all-really-in.html

    British Medical Journal 2008: Survey of 1200 US rheumatologists: 62% says prescribing placebo ethical, 3% use saline as placebos http://www.bmj.com/content/337/bmj.a1938

  4. Heidi Stevenson

    Perhaps I’m a curmudgeon, but I find this article to be a ramble without a conclusion. The placebo effect exists. Okay, no problem with that. But it doesn’t tell us anything.

    What of those who don’t even know that a homeopathic remedy has been applied, such as animals? What of those who heal in spite of not believing it can work? Where’s the placebo effect there?

    And please, keep religion out of it! If we need religion to support homeopathy’s efficacy, then I personally wouldn’t be involved. Homeopathy does NOT require any kind of belief of any sort to work. (And it happens that I do know atheist homeopaths who are quite good at applying homeopathy. Belief is simply not a requirement.)

    The article goes along telling us only that … well, yes, the placebo effect does exist.

    In the end, the skeptics need to explain why homeopathy is able to heal people who try it as a last resort, not believing in it but having nowhere else to turn after the methodology of their chosen method, allopathy – the one they believe in, which should have had a placebo effect, by definition of placebo being a result of belief – allopathy didn’t work.

    • Vinton Rafe McCabe

      Nancy asked me to respond to this, and so I shall.
      The nub of what I felt on reading this comment had to do with a simple phrase in Heidi’s comment. She wrote: “Please, keep religion out of it!”
      To this I respond two ways.
      First, thanks for saying please.
      Second, No. I will not.

      I personally see no reason why religion, or more correctly, faith, (for religion connotes churches and dogmas that are not a part of this discussion) needs to be removed from the healing equation. Indeed, I personally believe that faith is at the center of the healing process.

      Heidi may not want to work with the healing art in that way, and that is her right, but that does not mean that matters of faith in no way intersect with matters of healing for those of us who choose to believe.

      It should be noted that this post is a reprint from my personal blog, Psora Psora Psora. If it’s style tends to ramble, well, that is the nature of my thought process. And of my blog. And if it lacks a firm conclusion, well, let me note that the original post reprinted here had the words “Part One” at the end of the title. This post was part of a series of posts on the nature of healing, and not meant to be a conclusive look at the placebo effect. It also lacked the subheads and the illustration that Nancy chose for her repost.

      Also, I guess I should also note that my work with homeopathy has, over the decades, evolved to become more and more involved with the concept of healing. I am personally not as involved with the concept of the cure. I am far from scientific in my thinking or in my approach to the remedies. I believe that we have a far more profound ability to heal than we ever have been told. And I believe that the homeopathic philosophy is itself healing, before a single remedy is touched.

      I also suggest that the best way to work with the remedies is the way that works best for you. Too often, perhaps in our attempt to shout down the flying monkeys and silence the critics, we tend to out-allopath the allopaths. Grasping at the straws of the latest study. I’ve studied enough over the years to know that there are many filters through which homeopathy may be viewed. You can, for instance, get all Jungian about it, or you can reduce case taking to a mathematical equation. For me, because my background is in story telling, case taking is about narrative. About listening to the life story that you are being told and discerning the themes, the characters, the rising and falling action, etc. Like literary criticism. Apply the laws of cure to that narrative, place it up against the materia media and bingo.

      But, again, I am rambling. It is my nature…
      –Vinton McCabe

  5. Alex

    Good time of the day!
    There is a good article about so called “placebo effect”, in this article the author Robin Nunn simply tells us that concept of placebo is unscientific and should be abandoned.

    http://www.bmj.com/content/338/bmj.b1568

    • Dr. Nancy Malik

      allopathy/conmed Dr. John D. Loeser using sugar-water placebo injections to treat osteo-arthriris of knee http://www.reuters.com/article/2013/05/23/us-sugar-water-injections-idUSBRE94M16K20130523

  6. Rekha Srini

    Reblogged this on drrekhasri.

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