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

I warn you up front, this is likely to be long, likely published in pieces as I find the time.  But I can’t help it.  I find this whole topic to be damned interesting.

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.

First, though, a note on the Skeptics.

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 T. 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 neurochemistry. The body’s neurochemical 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.

“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 bronchodilator, even when they weren’t. 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 sigmoidoscope (“The Placebo Prescription” by Margaret Talbot, New York Times Magazine, January 9, 2000).

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, 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.” 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 reanalysis 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 reanalysis 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 misjudgment, psychosomatic phenomena, misquotation, etc.”

(Now, it should also be noted that Beecher (1904-1976), 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-WW 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’s 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’s 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.

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.)

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’ll 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.

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