Placebo Effect is Physical not Imagined

August 28, 2005 10:27 AM

Placebos Trigger Opioids.New research indicates that the placebo effect is physical, not merely "psychological." Brain scans show that people who believe they are getting a medication to control pain trigger the release of opioids in their brains. Those natural endorphins reduce pain.
When Karl Marx said that religion in the opiate of the masses, he may have been literally correct. If faith in an useless medication can release natural painkillers, won't faith that God will make your life less painful do the same? This might also help explain why religion is so addictive, and why many people like the POTUS pass through the gateway drugs of alcohol and cocaine only to migrate to religion and jogging, which also releases endorphins.
posted by MonkeyC (66 comments total)

Just because it's physical means it isn't psychological? Perhaps this is simply one of the links between the chemistry of the brain and the mechanisms of the mind.
posted by Citizen Premier at 10:37 AM on August 28, 2005

Also, you have not provided any evidence that religion releases endorphins. I know plenty of people in which it obviously doesn't.
posted by Citizen Premier at 10:39 AM on August 28, 2005

New research indicates that the placebo effect is physical, not merely "psychological."

Well, chalk your surprise up to a misunderstanding of the placebo effect. This was well known in 1989, when I began uni in psych. The brain research wasn't as advanced, of course, which is what this is really about. But physical effects were demonstrated long ago.
posted by dreamsign at 10:42 AM on August 28, 2005

It's just a fairly concrete reasoning that if a pill can affect your endorphin response then anything else which you assume to be reducing your pain can. I mean, it's not implausable that a sense that, say, praying will reduce your pain would somehow not be eligible for the same effect but it's not ridiculous either.
posted by abcde at 10:45 AM on August 28, 2005

So religious people are addicts. Nice, real nice.
posted by oddman at 10:45 AM on August 28, 2005

The Endorphin-Deficiency Explanation of Narcotic Addiction

Endorphin deficiency and other metabolic models suggest a course of progressive and irreversible reliance on narcotics that actually occurs in only exceptional and abnormal cases of addiction. Those with inbred metabolic defects could conceivably account for only a small percentage of those who become addicted over their lifetimes. Why would the narcotic addiction that disappeared for most Vietnam veterans (or for the many other addicts who outgrow it) differ fundamentally from all other kinds of addiction, such as the kind that persists for some people? To accept this dichotomous view of addiction violates the basic principle of scientific parsimony, by which we should assume that the mechanisms at work in a large portion of cases are present in all cases. This is the same error made by psychologists who concede (without empirical provocation) that some alcoholics may indeed have constitutional traits that cause them to be alcoholic from their first drink even as research shows all alcoholics to be responsive to situational rewards and to subjective beliefs and expectations.

Stanton Peele: Theories of Addiction

The wide range of activities that stimulate the pleasure centers of the brain -- including sex, eating, working, chocolate -- should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction. Most people experience orgasm as among the most pleasurable sensations -- yet how many people become addicted to orgasms? Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolates or sweets. Apparently, stimulation of a pleasure center is only one small component in the entire addiction syndrome. Moreover, if any activity can be pleasurable -- from work, to sex, to parenting and so on -- identifying activities as stimulating the pleasure center simply begs the questions: Why do people find different things pleasurable and Why do different people react in destructive, addictive ways to some of these things, while others incorporate them into a balanced overall lifestyle?

This is, after all, the mystery and the problem of addiction.


Stanton Peele: Brain images tell nothing about addiction

Our current conception of addiction is a historical anomaly, one that has arisen independent of laboratory or epidemiological data about drug use. This concept has never reflected actual patterns of heroin use, and it currently does no better at describing cocaine use. Neither this vision of heroin addiction nor an equally popular, complimentary model of alcoholism accurately reflects data on the cause, epidemiology, life history or consistency of addictive behavior. Nonetheless, versions of addictions based on these images of narcotic addiction and alcoholism have become increasingly popular in the second half of the twentieth century and have been generalized to whole new areas of behavior, where they succeed no better at explaining the data. These concepts, moreover, have considerable potential for doing harm.

Addiction as a Cultural Concept
Annals of the New York Academy of Sciences, 602:205-220, 1990.
posted by y2karl at 10:53 AM on August 28, 2005

Isn't it self-evident that any psychological effect also produces a physical effect? Unless you're a dualist...

I'm not a psychologist or neurologist, but I've always thought the distinction between the two to be more one of levels of abstraction and convenience than as illustrating anything particularly profound, like the divisions between physics, chemistry and biology.
posted by Jon Mitchell at 11:10 AM on August 28, 2005

Psychological is merely the manifestation of the physical.

... and what Jon Mitchell said wrt monist/dualist
posted by PurplePorpoise at 11:18 AM on August 28, 2005

The placebo effect also has a flip side, the nocebo effect; people who expect to feel worse do, and the symptoms can be disabling .

You can read about it in Harvard Magazine.
posted by Jatayu das at 11:25 AM on August 28, 2005

Google: religious experience brain chemistry

AFAIK you can become "addicted" (small 'a') to more or less any experience which significantly affects the chemistry of the brain - religion, when it's actually engaged with as in e.g. an energetic gospel session, is a good example, I think. (Others include sex, fighting (military or otherwise), work, attending sports matches like football, doing extreme sports...) weaker examples might be going to bars or gigs or clubs.. reading a book in bed.. meditating, making art..
posted by Drexen at 11:47 AM on August 28, 2005

Oh yeah, gambling is another major one. Anything which gets enorphins, dopamine, adrenaline, serotonin (?), DMT (??), or other brain chemicals flowing..
posted by Drexen at 11:48 AM on August 28, 2005

that was an intresting editorialization. From brian chemistry to bush bashing.
posted by delmoi at 11:48 AM on August 28, 2005

delmoi... Bush is not the end-all to religion. You are the first to mention Bus in this post.
posted by Citizen Premier at 12:42 PM on August 28, 2005

> AFAIK you can become "addicted" (small 'a') to more or less
> any experience

The downside of this notion is that it has the impact of
completely underplaying the real qualitative and quantatative
differences of that thing that we generally refer to as 'addiction'.

I mean, how many people have *you* met who suck cock to
raise the money to pay their gym membership fees or make
their church's weekly tithe?
posted by PeterMcDermott at 12:42 PM on August 28, 2005

So, if people do something you think is ok, it's just having a good time, but if it's something you don't like, such as religion, then it's addictive? Cute.
posted by unreason at 12:46 PM on August 28, 2005

Citizen Premier: delmoi... Bush is not the end-all to religion. You are the first to mention Bus in this post.

FPP: ...and why many people like the POTUS pass through the gateway drugs of alcohol and cocaine only to migrate to religion and jogging, which also releases endorphins.

I hate Bush. I mean, hate Bush. But the superiority complex so many atheists get is something that really irks me, too.

Any statement on the number of gods in the universe--zero, one or ten thousand--is a statement of faith. There's no more evidence that there is no G-d, than there is evidence for one. Or ten thousand. The only pure stance on that issue is the truly agnostic.
posted by jefgodesky at 3:41 PM on August 28, 2005

There's no more evidence that there is no G-d, than there is evidence for one. Or ten thousand.

There never will be evidence that there is "no" God. You can't prove a negative, it's a violation of the laws of logic. The burden of proof is on those who assert the positive.

Since there is no evidence that God exists, and therefore no way to prove it, people must rely on faith. If there was proof, there would be no need for faith.

A rational atheism is not about believing the negative, "There is no God." It about being unwilling to use faith, which cannot be tested or ever validated, to drive your thinking or your values.

If belief that a pill which has not been shown by evidence to relieve pain can cause the release of opioids, then does belief in a God that has not been shown by evidence to exist or relieve pain, also cause the release of opioids? If that is the case then we know that the act of believing, in and of itself, relieves pain.

It's a valid scientific hypothesis. It should be tested if it hasn't been already.
posted by MonkeyC at 4:33 PM on August 28, 2005

A rational atheism is not about believing the negative, "There is no God." It about being unwilling to use faith, which cannot be tested or ever validated, to drive your thinking or your values.

Which I can get along fine with. But it's a very different proposition than, say, "Haha, darling, point and laugh at the silly theists!"
posted by jefgodesky at 4:43 PM on August 28, 2005

Ugh, I hate "POTUS." My mind must have glazed over it.
posted by Citizen Premier at 4:54 PM on August 28, 2005

God spelled backwards is doG; however it is unclear whether this means dogs are close to God or if they are satanic. The fact that neither the former or the latter have been demonstrated is proof enough for me that there is no God.
posted by Citizen Premier at 4:57 PM on August 28, 2005

So, if people do something you think is ok, it's just having a good time, but if it's something you don't like, such as religion, then it's addictive?

change religion to drugs.. see how that works?

attaching the addiction label remains just as meaningless, but everyone believes you if you say drugs and laughs if you say religion. not because one is true and the other is false, but because everyone is taught one is true.

religion could be as addictive for some people as drugs are for others, you just don't think of it in those terms because religion is socially acceptable, and attaching negative labels to it is strongly discouraged.. whereas drug use is unacceptable and negative labeling strongly encouraged.


PeterMcDermott: I haven't met anyone who sucks cock to pay the preacher, but then tithing is almost never mandatory. Religions give their product away, because they are a long con, while drugs are short. On the other hand, what people have done and continue to do in the name of religion makes everything ever done for a fix insignificant.
posted by ulami at 5:04 PM on August 28, 2005

Am I the only one who finds it suspect that they used only "fourteen healthy males" for this experiment. Why not women?
posted by ed at 5:10 PM on August 28, 2005

If belief that a pill which has not been shown by evidence to relieve pain can cause the release of opioids, then does belief in a God that has not been shown by evidence to exist or relieve pain, also cause the release of opioids? If that is the case then we know that the act of believing, in and of itself, relieves pain.

Not quite. A placebo has been shown by evidence not to relieve pain. We know that the object of belief in the first premise cannot relieve pain. We cannot say the same thing in the second because we have no evidence for or against. It's a subtle distinction but I suspect it renders your comparison meaningless.

That said, if you used a variety of monotheist, polytheist, et al subjects and they all had the same response, you could make a more convincing case that belief was the underlying cause as opposed to 'belief in X' or 'X'.
posted by Sparx at 6:21 PM on August 28, 2005

Artificial opiates like heroin are for losers. Real people get their opiates through nirvana.
posted by caddis at 7:24 PM on August 28, 2005

So, if people do something you think is ok, it's just having a good time, but if it's something you don't like, such as religion, then it's addictive? Cute.

Well lets see, he listed Religion and jogging, side by side. so lets see if this adjustment feels right:

So, if people do something you think is ok, it's just having a good time, but if it's something you don't like, such as jogging, then it's addictive? Cute.

Nope, I don't see you snapping back defensively because someone said something you felt disparaged jogging, so I gotta assume you are just oversensitive and defensive about religion.
posted by Jezztek at 7:40 PM on August 28, 2005

The problem with the "addiction as a cultural construct with no biological basis" is this guy up the street who culturally constructed himself to death with heroin, and now his parents are culturally constructing some grief at his absence.
posted by mecran01 at 7:58 PM on August 28, 2005

Now starting up recruitment for our new Church of the Divine Junkie. Get in at the bottom and reap the rewards!
posted by nightchrome at 11:06 PM on August 28, 2005

mecran01: He didn't say there's no such thing as addiction. He said the model of addiction we use today is a cultural construct that fits our societal values. He's particularly saying (I'm wildly restating here, discount accordingly) that conclusions we draw from our socially-constructed model of addiction may be wrong -- have no scientific basis -- and are therefore very dubious when incorporated into rulesets such as laws. In effect, he's saying that the way our culture interprets addiction today is every bit as morally founded as in the days of temperance. The major difference between then and now is that religion has been replaced with hospitalization (Foucault would be proud). Sobriety is the new Saved.

Makes that mention of POTUS in the FPP not so out of place.
posted by dhartung at 11:16 PM on August 28, 2005

What a weird thread. Forget poliitics and religion for a moment. The placebo effect would obviously involve physiology to anyone but a member of the medicalo mafia. I have first hand experience of doctor's writing off an alternative cure of cancer by saying "Oh, it was only a placebo effect." They also claimed misdiagnosis, and, a particularly good one - spontaneous remission. But more important:

"A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.

Health Care expenditures in the US have reached 14% of the Gross National Product and a staggering $1.6 trillion in 2003. No wonder, one might be tempted to say. With such an appalling record of efficacy and such an unbelievable death rate for the treatments routinely administered, the current medical system can only be said to be in great need of deep reform. "

and by the way, placebos are generally expected to work in about a third of subjects
posted by donfactor at 4:13 AM on August 29, 2005

I forgot to point out that the long quotation is from:
The Drugs Don't Work  
------------------------------------------------------------------------
OK they work in some cases but are not the answer to everything as some doctors are trained to believe. Probably not a new idea to most of you guys but interesting that it makes the front page (top story) of today's UK newspaper 'The Independent'.

http://news.independent.co.uk/world/science_medical/story.jsp?story=471139


Glaxo chief: Our drugs do not work on most patients
By Steve Connor, Science Editor

08 December 2003

A senior executive with Britain's biggest drugs company has admitted that most prescription medicines do not work on most people who take them.
Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them.
posted by donfactor at 4:30 AM on August 29, 2005

Donfactor, I am one of the many people who would be dead today were it not for Evil Greedy Jew-and-Illuminati-Run Western Medicine, so kindly fuck off. What you're doing is pretty evident to anyone with half a brain: because EGJIRWM is not one hundred percent effective in one hundred percent of cases, so it's obviously worthless, right? It's all a scam, right?

Because the way I see it fifty percent is pretty good compared to the cure rate of, say, homeopathy, which has a cure rate of exactly zero, or of that herbal shit you hear about on the Art Bell show that'll just turn your skin gray.

Oh, and incidentally, that article? The one you half-assedly linked? It just redirects to the Independent's front page instead of properly resolving, which you would have known had you actually read the article, instead of getting a shitty, inaccurate summary from the geniuses at like SeaweedCuresHomosexualityandCancer.net. In any case, I actually read the full text - located, among other places, here - and it's clear that Roses isn't admitting an awful secret of the pharmacology world, but stating a basic truth: we don't yet know everything there is to know about the human body.

But we're learning.

So if you want to give up on all that modern science-based medicine has to offer, fine. Your choice, your funeral. But don't try to blow smoke up our asses with your shitty non-links and your conspiracy theories.
posted by Optimus Chyme at 5:05 AM on August 29, 2005

I think you might be assuming too much, Optimus Chyme. Do you have any evidence to say that non-Western medicine has a 0% success rate? Because I've seen a lot of evidence that says otherwise.

I took a medical anthropology course in college that was very illuminating. "Ethnomedicine" is anything a people believe to be effective as medicine. In our culture, that's Western biomedicine. And it's more effective than not, I think the overall figure was somewhere around 75%. Every culture believes that their ethnomedicine is the only effective one, and that all others amount to nothing more than a bunch of mumbo-jumbo.

But the really crazy part was, shamanism's effectiveness is damn near the same. So was traditional Chinese medicine. Pretty much every ethnomedicine hovered within the same margin of effectiveness.

Which makes sense, if you think about it. People wouldn't keep it around if it didn't work. Part placebo, part ethnobotany, part trial and error (or maybe even an accurate model of how the human body works?), well, that's pretty much the recipe for every ethnomedicine--including ours.

I might've said the same thing as Donfactor, but I wouldn't have meant to infer by it anything about Jewish conspiracies, sinister cabals, or even to insinuate that somehow our ethnomedicine was the only one not worth pursuing. Rather, I would have meant by it to temper the over-exuberance of others who go to the opposite, equally ludicrous extreme, falling into the trap that our ethnomedicine is the only one worth pursuing. Every culture believes that, and, I think, every culture is right and wrong--right that their ethnomedicine is worth pursuing, and wrong that no one else's is.
posted by jefgodesky at 6:28 AM on August 29, 2005

I thought it was interesting that in the lisst of web links The New Scientist included the Wikipedia entry on the placebo effect.
posted by OmieWise at 7:03 AM on August 29, 2005

Do you have any evidence to say that non-Western medicine has a 0% success rate?

Well, for instance, there is zero evidence that standard homeopathy has any effect on any condition that is non-ideogenic, except for possible placebo effects. Because there is no real model by which the homeopathic technique can work, the burden of proof is on the quacks who claim it does.

As for the medicine of "other cultures," I can't say that they are all failures. Maybe someone somewhere has a totally awesome root he recommends that has natural analgesic or antiseptic or properties or whatever, but that doesn't mean that the method behind selecting it is sound, or that his knowledge of that herb is part of a rational framework that can pave the way for further developments.

People wouldn't keep it around if it didn't work.

I see.
posted by Optimus Chyme at 8:34 AM on August 29, 2005

It is my belief that reason, logic and the scientific method is a really great way to gain information. It is also my belief that it is by no means the only way to gain information, nor even necessarily the best way. It's my personal favorite, but I can't make any claims beyond that. I'm a huge fan of science, don't get me wrong. What bothers me is the notion that this is the only way. Why, for instance, would shamanistic processes be so deeply tied into our brains, if it weren't helpful? Humans are capable of reason and intuition, why not use both? As JMS put it in Babylon 5, "Religion and science are like the shoes on your feet: you'll get farther than both than you will with just one!"

No, ethnomedicine isn't scientific. Science is our culture's method of gaining knowledge. We gain knowledge scientifically, so the things we know are part of a rational framework and all the rest you mentioned. To say that something is unscientific isn't necessarily to say that it's wrong, only that it's been derived by other means.

Anyway, I'm not interested on ripping on Western biomedicine or science. I'm just suggesting that it might be to our benefit to occasionally consider the wide world of diversity beyond our ethnocentric bubble.
posted by jefgodesky at 8:54 AM on August 29, 2005

As JMS put it in Babylon 5, "Religion and science are like the shoes on your feet: you'll get farther than both than you will with just one!"

Truly he is our greatest modern philosopher.
posted by Optimus Chyme at 9:13 AM on August 29, 2005

Has anyone done research on the placebo effect in cases where patients get real medication? Just because a real drug is prescribed does not mean that is what cured them, right? Or maybe it's 60/40. Would there be any way of measuring this?
posted by weapons-grade pandemonium at 10:01 AM on August 29, 2005

I'm really disappointed that Monkey C threw in the pot-shot at the President, because it pre-emptively lowered the level of discourse in what otherwise could hav been a very interesting thread about the placebo effect, and NOT about friggin' US politics.
posted by raedyn at 10:24 AM on August 29, 2005

weapons-grade, most if not all perscription drugs are tested against placebo. Give modern medical science some credit.

Sparx: "A placebo has been shown by evidence not to relieve pain." I'm assuming that you RTFA ("...placebos relieve pain by boosting the release of endorphins"), yet I still don't know what you're saying.
posted by fleacircus at 10:30 AM on August 29, 2005

Just because a real drug is prescribed does not mean that is what cured them, right? Or maybe it's 60/40. Would there be any way of measuring this?
- weapons-grade pandemonium

Isn't this why we have control groups? In order to be able to say that Pill X has any efficacy, we compare against the results in a group that got a 'useless' pill and we must see more of the desirable results in the group that got Pill X. However, I'm assuming that control groups get a useless pill. If the control group is not offered fake treatment, then there isn't a control for placebo effect.

Interesting problem, WGP. Does anyone know how this is dealt with in drug trials?
posted by raedyn at 10:31 AM on August 29, 2005

What wgp means is that, suppose 30% report improvement with placebo, and 40% with pill. Maybe, the actual efficacy of the pill could be lower if people are given the treatment unsuspectingly, as in spiked with something else. Even in double-blind, there's still the same expectation of receiving non-placebo. So, what amount of the treatment in the non-placebo group should be attributed to the endorphins?
posted by Gyan at 11:06 AM on August 29, 2005

There's no harm in herbal remedies unless you have a problem with being horribly mutilated.
posted by Optimus Chyme at 11:12 AM on August 29, 2005

Yes, that's my point, Gyan, and the drug companies have a financial interest in discounting the placebo effect, while at the same time using it.
posted by weapons-grade pandemonium at 11:16 AM on August 29, 2005

Optimus, shall I also trot out a list of malpractice suits against Western doctors? My own aunt could provide a number of (nearly life-threatening) examples.

That there are incompetent practitioners of a given medicine does not invalidate it. That you can find incompetent practitioners of herbal medicine no more invalidates herbal medicine than the list of anecdotal malpractice in Western medicine invalidates biomedicine.

Or did "medicine" appear, without precedent, a mere two hundreds years ago in Europe?
posted by jefgodesky at 11:44 AM on August 29, 2005

If the herbal "remedy" in question had been put up in front of the FDA, it would have failed, and it would not be on the market. There are FDA-approved drugs that can harm you, but none that will cause serious injury to most of the people who take it.
posted by Optimus Chyme at 11:58 AM on August 29, 2005

Sure there are. Any drug or treatment used improperly can cause serious problems, and even death. FDA-approved or not.
posted by jefgodesky at 12:24 PM on August 29, 2005

Yes I read TFA. In it, it says "Placebos are treatments that use substances which have no active ingredient". Therefore it's not the placebos themselves that cause the release of endorphins, but something else. If it's belief that placebos may work that triggers it - that is still distinct from the placebo. If you gave the placebo to someone not in pain, I doubt you'd get the same endorphin release. How is this not clear?

As JMS put it in Babylon 5, "Religion and science are like the shoes on your feet: you'll get farther than both than you will with just one!"

JMS is an self-proclaimed atheist. Those are just some pretty words he thought up.
posted by Sparx at 3:13 PM on August 29, 2005

Sparx: If it's belief that placebos may work that triggers it - that is still distinct from the placebo.

The dummy treatment is required, in order to incite that belief.
posted by Gyan at 3:27 PM on August 29, 2005

Sure there are. Any drug or treatment used improperly can cause serious problems, and even death. FDA-approved or not.
posted by jefgodesky at 12:24 PM PST on August 29

I only wrote two sentences and it looks like you didn't even bother to read the second one.

I said: "There are FDA-approved drugs that can harm you, but none that will cause serious injury to --> MOST <-- of the people who take it."

If any FDA-regulated drug caused half of the people who took it to be horribly disfigured, it would never be approved in the first place. But call it an ancient Oriental herbal preparation and you can do whatever you want.
posted by Optimus Chyme at 3:48 PM on August 29, 2005

The dummy treatment is required, in order to incite that belief.

Is it? What if you lied and told them they were given a placebo while they were asleep?

(Can't seem to access the site right now so I'm not sure if this is covered)
posted by Sparx at 5:08 PM on August 29, 2005

oi vay.

jefgodesky, I don't know what it means to be "75% effective" at being medicine. You don't either, so let's just pretend this statistic never happened.

Take a look at life expectancy. Yeah. Uh-huh. Thought so.
posted by mek at 5:14 PM on August 29, 2005

JMS is an self-proclaimed atheist. Those are just some pretty words he thought up.

Yes he is--and yes they are. I happen to think they reflect the reality of the situation much more then the weighty philosophical tomes I've read, so I quote them. Not because I think JMS is a sainted, enlightened philosopher, but because it very effectively sums up my own thinking on the matter.

But JMS is the kind of atheist that I regularly get along with well--the one who has his own belief, is content to allow you yours, and won't spend the next three hours lecturing you or mocking you for the inferiority of yours to his. A self-righteous atheist is no less insufferable than a Christian evangelist simply because he's selling a different number of gods.

I only wrote two sentences and it looks like you didn't even bother to read the second one.

See, I parsed that remark as, "most people who take it will not be seriously injured," that is, no matter how you take an FDA-approved substance, only very few people will be hurt.

So your argument is, essentially, that because Western medicine places the onus for making sure your practitioner is not a total quack in the hands of the state, it is superior to ethnomedicines that place that onus on the individual? I'm afraid that argument just doesn't sway me, but that's probably just because I only barely trust the state with my mail, much less determining my health.

I appreciate where you were coming from with your initial statement, Optimus, that you owe your life to modern medicine ... but on the flip-side, my earliest memory is from when my brother very nearly died when he got meningitis from a meningitis vaccine. I know all kinds of wonderful tales of the triumphs of medicine--like the conquest of cholera and polio. Then again, I also know all kinds of horror stories, too--like how the conquest of cholera led to polio. Like everything else in this world, there's good and bad to it, so both extremes--that it's useless, or that it's the only type of medicine we should ever listen to--are equally wrong.
posted by jefgodesky at 5:24 PM on August 29, 2005

jefgodesky, I don't know what it means to be "75% effective" at being medicine. You don't either, so let's just pretend this statistic never happened.

(how many patients come in)/(how many are cured)

It's a very difficult thing to calculate, and I read this years ago. I certainly wouldn't swear by that figure, that's why I said "somewhere in the vicinity of." What I do remember is that they were all very close to each other. That surprised me.

Take a look at life expectancy. Yeah. Uh-huh. Thought so.

If we factor out infanticide (which I think is fair, since that's hardly a health issue, it's a cultural issue), then hunter-gatherer life expectancy is in the 60s and 70s. After the Neolithic, that plummets to the 30s or 40s, and slowly rises until the twentieth century, when we manage to inch our way back up to the 70s again.

Sooo ... what was your point?
posted by jefgodesky at 5:28 PM on August 29, 2005

Sparx: Is it? What if you lied and told them they were given a placebo while they were asleep?

If that works, it amounts to the same thing. The belief that the treatment will work, coupled with the belief that the treatment's been administered, which substitutes for the belief that the treatment is being administered (as you watch yourself swallowing that pill). But I suspect the effect will be weaker.
posted by Gyan at 6:09 PM on August 29, 2005

Hmmm. I'd say it demonstrated the difference between the effect being due to belief alone and the effect being due to physical events + belief, which is not of no consequence. Think of the saving in sugar pills alone!
posted by Sparx at 6:18 PM on August 29, 2005

Sparx: I'd say it demonstrated the difference between the effect being due to belief alone and the effect being due to physical events + belief

But the physical event, in of itself, is immaterial. Which is why it's a dummy pill. If I told you that a placebo will be given, but secretly spike your food or water with it, then you'll still be waiting. It's the belief that the treatment is underway, which is based on sensory confirmation or communication that triggers the expectations. Ultimately, it's all beliefs. The belief that something will make you better, coupled with the belief that something has been done. We both agree that the physical placebo itself is inert.
posted by Gyan at 6:28 PM on August 29, 2005

The placebo effect also has a flip side, the nocebo effect; people who expect to feel worse do

Don't forget the little-known arecibo effect, in which people who expect to have aliens beam messages into their brains actually receive those messages.
posted by stavrosthewonderchicken at 7:33 PM on August 29, 2005

...or the "place si beau" effect, where a secret paradise is spoiled immediately upon revealing it to others.
posted by weapons-grade pandemonium at 8:17 PM on August 29, 2005

OK...a secret, ungrammatical paradise.
posted by weapons-grade pandemonium at 8:20 PM on August 29, 2005

cite, cite, cite.
posted by [expletive deleted] at 2:34 AM on August 30, 2005

Gyan:

But I suspect the effect will be weaker

But the physical event, in of itself, is immaterial

I suspect you may be being inconsistent here. But I also suspect we are both defending common ground against each other. Hence I respectfully withdraw.
posted by Sparx at 3:08 AM on August 30, 2005

"Donfactor, I am one of the many people who would be dead today were it not for Evil Greedy Jew-and-Illuminati-Run Western Medicine, so kindly fuck off. What you're doing is pretty evident to anyone with half a brain: because EGJIRWM is not one hundred percent effective in one hundred percent of cases, so it's obviously worthless, right? It's all a scam, right?" (sorry the italic button doesn't work on my mac.)

I am happy to hear that you survived, optimus. But you sound pretty angry and defensive. That can't do your health much good. There is, believe it or not, a body-mind connection. And if you want evidence, there are volumes of it largely published during the past 30 years or so. I made no claims about any conspiracy other than what might be considered such by the fact that in placebo controlled double blind studies, all the drug under test has to do is beat the placebo. Usually the placebo scores around 30% success so all the drug has to do is beat that by a statistically signiificant amount - probably about 40% success. But ordinary folks don't get told that.

For me the great mystery is that over the years nobody has even considered asking What is it that makes placebos appear to have an effect in some patients? Enough work has been done though to show that the placebo is not just a statiscal anomaly. And the new, study, mentioned above, shows that it actually has a physical effect, surprise, surprise.

What I am arguing is not a conspiracy but a shared ignorance in much of the medical profession where the only further education that doctors get is that sponsored and payed for by the drug companies and the only research that gets funded is that which contains the possibilities of making money, if successful.

Oh, and BTW, homeopathy does not have zero results. It has, to my knowledge never been properly tested except by those who want it to fail. In other words, they use an over the counter self-prescribed type remedy and run it against another more orthodox drug. In those cases I would bet that it gets a typical placebo score which is never zero. Anyone who has ever consulted a homeopathic physician will know that prescriptions are given only after very thorough examination and then they are regularly adjusted as symptoms change. It would be very difficult if not impossible to do a standard double-blind study on such a protocol.
posted by donfactor at 7:01 AM on August 30, 2005

Oh, and BTW, homeopathy does not have zero results. It has, to my knowledge never been properly tested except by those who want it to fail.

Well, isn't that convenient. Those evil scientists want it to fail, so somehow their thoughts magically reduce the efficacy of homeopathic preparations to - you guessed it - zero.

Anyone who has ever consulted a homeopathic physician will know that prescriptions are given only after very thorough examination and then they are regularly adjusted as symptoms change.

Anyone who has ever consulted a voodoo priestess will know that rituals are performed only after very thorough examination and then they are regularly adjusted as symptoms change.

It would be very difficult if not impossible to do a standard double-blind study on such a protocol.

Bullshit. Here is a methodolgy off the top of my head, and remember that I'm not even a trained researcher:

Group A gets homeopathic preparations. Group B, the control group, gets the placebo. If Group A does better than Group B to a statistically significant extent, that is evidence that homeopathy has some beneficial effect. If that study is repeated by a separate, independent group, and the results are similar, that's very good evidence for homeopathy. You and your quack buddies are free to adjust "prescriptions" as soon as you give us some evidence that homeopathy has any measurable effect.

But strangely, none of these pro-homeopathy studies have been successfully replicated. Can you tell me why?
posted by Optimus Chyme at 9:15 AM on August 30, 2005

Usually the placebo scores around 30% success so all the drug has to do is beat that by a statistically signiificant amount - probably about 40% success. But ordinary folks don't get told that.

Yeah, it's only on the back of every drug advertisment in every magazine it's published. What a cover-up.
posted by Optimus Chyme at 9:18 AM on August 30, 2005

"But strangely, none of these pro-homeopathy studies have been successfully replicated. Can you tell me why?"

Nor have any of them been unsuccessfully replicated. Nobody has bothered. Such tests are expensive and there would be no payback at the end regardless of results.

And your idea for a good test protocol is flawed by the assumption that it is only the one-to-one effect of the remedy that is involved.

It would be interesting to test conventional drugs where the same drug is administered by a warm, caring physician to one group and the other group is given the drug by a cold impersonal researcher. What do you think the results might show? I know where I would put my money.
posted by donfactor at 5:15 AM on August 31, 2005

Nor have any of them been unsuccessfully replicated.

Nope, never. Your research is fucking impeccable. It's rare - not non-existent, however - because it's a waste of fucking time. There aren't many studies that attempt to replicate the use of fairy dust on gaping, infected wounds, either.

Such tests are expensive and there would be no payback at the end regardless of results.

Yeah, only the complete overturning of several fields of thought and models of the physical universe. Nope, no scientist would want the credit for that, no sir.

And your idea for a good test protocol is flawed by the assumption that it is only the one-to-one effect of the remedy that is involved.

Then it's non-falsifiable, not science, and you should just take whatever the fuck you feel like when you get sick, and you deserve whatever happens to you.
posted by Optimus Chyme at 12:00 PM on August 31, 2005