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Posted by on Sep 14, 2012 in Science, Skepticism | 32 comments

The Placebo Effect

I’m not going to go into an explanation of why homeopathy is bunk — if you don’t know, there’s an excellent video on the topic posted on YouTube by James Randi of the James Randi Education Foundation. But many studies have shown that homeopathic remedies are not dangerous and can have a positive placebo effect, so I wonder, are they inherently harmful and totally unnecessary? Isn’t believing that you feel better part of feeling better? While I would never advocate for homeopathic remedies instead of traditional medicine when it comes to treatable or preventable diseases, what harm is there to trying them once traditional medicine fails? And what harm is there to using them to treat symptoms (e.g., pain) when traditional medicine for those symptoms has significant and even permanent side effects? Are people really being scammed out of their money if correct information is easy to find via google, and they experience a positive effect from a homeopathic remedy?

Thoughts?

  • Hambil

    One could ask the same question about religion. That is a longer discussion though. However, having been in both (at different times) significant physical and mental pain, I would not begrudge anyone something that makes them feel better, as long as it’s safe.

    • I feel the same way. I will tackle the same question as to religion separately, because there are so many more issues involved. But this is the simplified version.

      Absent harm, both relate to the ultimate value of truth.

  • BramKaandorp

    I hope you’re playing devil’s advocate, because this;

    “Are people really being scammed out of their money if correct information is easy to find via google, and they experience a positive effect from a homeopathic remedy?”

    This sounds like victim-blaming. Just because the info is online, that doesn’t mean people will look it up.

    Even worse. Someone who happens to live in a family/community where conventional medicine is not-done is less likely to trust the good information on the internet.

    So if someone has the feeling that conventional medicine has failed them, it might be better for them to look a little deeper into it before going to the scam medicines.

    And if conventional medicine has actually failed them, for instance if no pain killer has any effect, then homoeopathy isn’t going to work at all (not even as a placebo), unless of course if the problem was that there was a nocebo effect involved when taking the conventional pain killers.

    I’d say that in such a case having a loved one beside you would be a much better thing than taking a sugar pill.

    For one thing, a loved one can care, whereas a pill obviously can’t.

    • I’m not suggesting placebos as a cure for anything. But if a placebo helps with pain as much as Tylenol, then why risk the liver damage? Because Tylenol has no other permanent (or helpful) effect.

      Also, people have to seek out medical care, choose doctors, and do research in that regard. Are you saying they shouldn’t be informed (if capable) about their medical care? I think it’s wise to be, and that’s certainly not “victim-blaming.” Some doctors are terrible, and it serves a person well to find a good one.

      I’ve seen no studies where family company works as a placebo, nor does one preclude the other.

      Yes, I am playing the devil’s advocate, but only to an extent.

      • BramKaandorp

        I’m saying that, though people should indeed do their own research, I think it’s unrealistic to think that many people find the most helpful sites.

        The info being there is not enough, and fortunately a lot of organisations are hard at work informing people about where to find it.

        As for homoeopathy in stead of Tylenol;

        Isn’t there some other medicine which doesn’t have a bad effect on the liver?

        But at the heart of it, I think it’s a simple case of not wanting to fool people outside of the theatre, no matter how well-intentioned it may be.

        So even if the placebo literally makes them make themselves feel less pain, I still wouldn’t think it to be a good idea.

        • There’s aspirin and other NSAIDs, but those cause stomach bleeding for people like me. There are opiates and synthetic opiates but they’re extremely addictive and rarely prescribed unless the pain is extreme. Interestingly, placebos are often found to be just as effective. So if a placebo helps just as much, it would actually be the safest remedy. Massage is another potentially helpful option in certain situations.

          But I appreciate your points. I’m not arguing for homeopathy per se — it’s a documented scam — I’m just wondering if there’s any room for use of placebos in traditional medicine, really.

          • BramKaandorp

            The problem I see is that of labelling.

            Say you call it “Placebo”, and explicitly point out on the package that there’s nothing in it (a sort of honest homoeopathy, if you like), then there are always people who will not respond to it.

            if you don’t label it that way, but in stead don’t mention what’s in it at all, people are going to have mistrust, and a nocebo effect might occur.

            Another alternative is to label it as whatever it is prescribed to do, but that would be dishonesty, and personally (although I am not a doctor so what do I know) I’d feel guilt for doing that, and then there’s the potential huge blow-up in the media about doctors prescribing “nothing”. I’d rather reserve that honour for homoeopaths.

  • Vagrarian

    I have a knee-jerk reaction of a firm NO!, simply because I’m against any money going to manufacturers of homeopathic stuff. I know very little about biomedical ethics so I don’t know the viewpoint of an actual doctor.

    In the past, I’ve felt that those who have painful or chronic conditions should have automatic counseling or therapy, to help with the stress of their situation and also deal with how a chronic condition can turn your life upside-down. (Do they do that now? I honestly have no idea.) Good counseling/therapy can probably help in ways that a placebo effect can’t.

    That’s my fumbling, inexpert view…

    • You raise an excellent point — often practitioners of homeopathy have a better bedside manner than traditional doctors, and that, in and of itself, can be helpful.

      I think the viewpoints of doctors vary on this point. Not all are skeptics. I’ve seen quite a few suggest homeopathic remedies and largely useless vitamins (in conjunction with proper treatment). That’s anecdotal, of course.

  • Spence

    Firstly – hi Maria, long time no talk! Glad you’ve now got a blog I don’t have to log in to šŸ™‚ and it looks like an awesome group of blogs you’ve become a part of here.

    This topic interests me, and has come up before on the JREF forums. There are a couple of problems, I think, with accepting and using the placebo effect.

    Firstly, the placebo effect isn’t unique to homeopathy. Any procedure can have a placebo effect; so even if we did want to exploit the placebo effect, it doesn’t make sense to tie it to homeopathy per se. But I appreciate that homeopathy is probably just an exempli gratia here.

    Secondly, it creates an ethical bind. The doctor – who knows the procedure has no physical mechanism to work – must lie to the patient for the placebo to be effective. That creates all manner of problems of ethics and trust issues – how do you know when the doctor is then prescribing a treatment that is real, or fake just to make you “feel” better? A loss of confidence or trust at the patient / doctor interface would be a recipe for much bigger problems than the placebo effect could resolve.

    • Hambil

      Isn’t that just called a control group? Doctors lie to patients for studies all the time. I’m not saying it is exactly the same thing, but it gave me pause. I don’t know that the intent of the initial blog (but Maria can address that better) was to address the placebo effect in general (hence her saying she’d get to religion later).

      • Spence

        No – you are mixing up scientific experimentation and treatment.

        In the experiment, there will be a control group who will be on a placebo. There is no need to lie; the group will be aware that there is a “real” procedure, and a placebo; they will simply not be told which they are on (and the doctors issuing the treatment will not know either, as this causes problems as well, hence the need to double-blind).

        There is no lying required even in the scientific experiment, there is certainly no lying required when treating patients with proven medicines or procedures.

    • Spence

      A little update – I dug up one of the JREF discussions (back from 2007!)

      http://forums.randi.org/showthread.php?t=100824

      • The discussions on JREF are lively and fun, as always.

  • Egbert

    The best position, in my opinion, is the sceptical position. In other words, not to take anything on faith, or dogmatically, but be sceptical of both doctors and alternative healers.

    • I don’t think one should be equally skeptical of both. Those positions substantiated by evidence are obviously more accurate than those that have been proven wrong. That doesn’t mean that there isn’t a margin of error going in both directions; there is. But it does mean that there’s enough data to determine which remedies are more effective, prolong lives, cure diseases, and so on.

      • Egbert

        Perhaps not equally, but I do encourage people to question authority, including doctors. Of course, people have different experiences and might have less reason or suspicion to be skeptical.

  • Acleron

    Is the placebo effect all that effective? Most of what is ascribed to the placebo effect is probably people getting better from self-correcting ailments.

    Giving people placebo’s for treatment involves deception. Do we really want doctors to gain a reputation for deceiving patients?

    Prescribing placebo’s will allow the quacks to claim that their particular woo works just as well as medicine. So third question, do we want to give quacks a reason for continuing to defraud patients?

    • That’s a definite no as to your third question. To answer your first question, some studies have shown placebos to be just as effective as morphine for pain, for example. No studies have shown that placebos work as a cure for anything. The second issue is the crux of the matter – is truth so important that (real) doctors should be unable to administer placebos under any circumstances? I would argue that some already do by telling people to take a vitamin supplements daily, or giving people false expectations about the effectiveness of a remedy, etc.

      Also, not all natural or alternative remedies are as bogus as homeopathy.

  • A lot of people do chose homeopathy over traditional (i.e., actual) medicine, so that is harmful. Also, homeopathic treatments are not free, and are often expensive.

    Rebecca Watson recently demonstrated, as SkepchiCON, how a particular scam worked to sell some sort of crystal, which would give a person strength. A few years ago, a friend of mine who was a personal trainer was fooled by the same exact method into thinking that a particular homeopathic treatment would provide her with strength, to ward off a deteriorating foot problem. She got homeopathic instead of traditional treatments and is no longer a personal trainer because she can barely walk. Another friend of mine ended up in surgery for five hours having his intestines rebuilt because he opted for homeopathic treatment for what ended up being a serious and worsening gut blockage. And so on and so forth.

    Keep in mind also that there are homeopathic treatments that “work” really well.

  • Sorry, that last sentence was meant to go before the second paragraph, the point being that people can become convinced to buy into homeopathy to the exclusion of real medicine.

    • I agree with the substance of your post, Greg, and I still can’t understand why what is basically false advertising is permitted by law. You’re right in that real harm can be caused when people forego traditional medicine in favor of homeopathy or other ineffective alternative remedies (which is most of them), and you’re also right that a substantial number of people choose to do so, despite the abundance of reliable information and studies on the topic.

  • Hambil

    Wait a sec… homeopathy is a specific thing. The belief that what makes healthy people ill will cure sick people. While there are examples (if you stretch a bit) like vaccines, homeopathy as a philosophy has been debunked. It is confusing me to bundle it with all alternative medicine, like massage, acupuncture, etc…

    • My response to you is unthreaded, for some reason, and appears right below this. šŸ™‚

  • No, I’m addressing homeopathy specifically, and actually suggesting that some alternative remedies can be effective — like massage, for instance. Acupuncture and traditional chiropractic medicine (but not physical therapy) have been debunked as well, BTW. So these are also examples of placebo effects. But things like a healthy diet, exercise, and possibly even certain supplements can do a world of good — in addition to traditional medicine.

    • Egbert

      No one really seems to understand the placebo effect, and yet it is the primary positive effect in health.

  • qbsmd

    If I was involved in medical research, I would be really interested in studying where the placebo effect comes from. Perhaps using fMRIs on people while they’re taking a placebo and feeling pain relief would show certain brain states involved in the process. I’m sure there’s a way to duplicate and probably optimize the placebo effect with some meditation or biofeedback technique, and I think that’s the only solution that takes advantage of the effect in an honest way.

    • There have been some studies done that show the placebo effect to be more than psychological — for example, the body is trained to release endorphins in response to certain stimuli.

      • Hambil

        So when we create a pill that can create a placebo effect is it a placebo? :p

  • Copyleft

    While the placebo effect in islation could have medical value, the problem with homeopathy is that it doesn’t take place in isolation. It’s part of a system of dismissing and evading legitimate medical treatment. To gain the placebo pain relief, you have to buy into the mindset that “evidence-based medicine is bad, or at least optional.”

    And that comes at a very high cost indeed.

    • This.

      The placebo effect is fine. Just liking kissing a 5-year-old’s bobo. It makes them feel better. But we all know it doesn’t actually do anything. Some things (like a scraped knee) aren’t about pain or injury, but about the need for security.

      I watched my kid fall the other day. He got up, looked around, then walked over to the garage and started crying for mommy. He was physically fine, he just seemed to have been mentally or emotionally shaken by falling and needed the attention.

      Homeopathy though, is a total rejection of modern science and medicine. Not to mention outright impossible. The rejection of the the germ theory of disease is reason enough to reject homeopathy.

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