You Know It’s a Placebo. So Why Does It Still Work? | WIRED
It's certainly noteworthy that this article is about both the medical use of placebo, and about politics. As, frankly, it should be.
Let's start out talking about placebo. The article mentions that this intervention is ancient. It mentions that the vast, vast majority of doctors use it (for various reasons, under various circumstances, and with various styles). I have. Placebos have a number of kinds of meanings, including becoming what we call "transitional objects." The article talks about one reportedly very imperfect study that showed placebo benefit in most of the patients in that very imperfect study. The fact is that in much more careful, rigorous, and proper study conditions, placebo is reliably effective about 1/3 of the time. I count that as impressively effective. Interestingly, it turns out not to matter whether the prescriber does or doesn't admit the prescribed substance is a placebo. When I was in high school, and I worked for a pharmacist, we used to dispense something called "Cebo-Caps." My uncle, who was an internist, used to prescribe Obecalp (placebo spelled backwards). In my internship, I did an emergency room evaluation of a man who had what we used to call "cardiac neurosis." He reported constant chest pain, was nonfunctional, and always thought he was at death's door. During the history, I asked him about his medications. There was a very long list. At some point, he said he was taking "placebo." I asked him the dose, and he told me. He didn't seem to recognize that placebo was an inert add-on, so the doctor could give him yet something else without causing drug interactions or exposing him to more side effects. And setting aside the purely intentional prescribing of placebo, there's the prescribing of various things (medications, surgery, psychotherapy) that the doctor thinks have clinical value, but they don't. (I just read an article about 18th or 19th C Americans who "reasoned" that tuberculosis was caused by vampires, so they exhumed the bodies of people who died of TB -- and were therefore vampires -- and removed their hearts and burned them, so they wouldn't come out of their graves and give others TB. Sometimes, it's even proven that the interventions don't have clinical value, but the doctor institutes them anyway, either to be able to offer something, instead of nothing, or to create a basis to charge a fee.
But you don't need me to tell you any of the secrets of medical practice. If you read the linked article, some of them aren't so secret any more anyway. This is about more than that.
If, for example, you look at the "Fortunately" paragraph, you will see that a doctor might prescribe an antibiotic for a condition that is not treatable with antibiotics, or vitamins when there is no deficiency. The doctor knows s/he is not doing anything active. But s/he 1) has been consulted, and does not want to feel like a useless disappointment who can't improve the patient's situation, and 2) the doctor has been consulted by a patient who commonly wants something done. The patient neither knows nor cares that what the doctor is doing isn't going to affect/improve the patient's health. The patient just has symptoms, and wants something done. And the doctor gets to pretend to be useful, and gets to charge for the intervention. So it's really a collusion.
"In a deepfake world where AIs masquerade as people, where marketing calls itself wellness...there's probably nothing so refreshing as a tiny step in the opposite direction: prescribing a pill of nothing, and calling it out as such." It's a nervy thing to do -- openly admitting you're not doing anything -- and many doctors can't bring themselves to do it. But as I said, it doesn't change the (1/3 positive) outcome if you do.
"The resulting study" paragraph illustrates how improbably doctors can get away with open label placebo prescribing. They have the patients to help them, by the patients' in effect inventing their own excuses why something that can't chemically work works. It turns out to be essential that the patient provides a good deal of the fantasy that inert materials are somehow effective. In a related setting, voodoo curses "work," because the cursed person believes they work.
"The researcher's bedside manner is crucial...Maybe we start to feel better when someone listens to us, shows respect for our views, and makes common cause with us." Or even pretends to. I left off "against our ailments" because it's unclear what the ailments are, or if there have to be any.
"Perhaps OLPs [open label placebos] are a sort of meta-placebo, a testament to how much we believe in our power of belief...A patient may find relief from an open label placebo, the sugar pill that we know is a sugar pill gives us something that its deceptive counterpart doesn't[!!]. It tells us we aren't dupes who can be fooled by lab-coated experts[!!]." You really have to give those statements careful consideration. Belief is as good as education, training, and knowledge. It may be better. And it allows us not to feel somehow inferior to people who have more education, training, and knowledge than we do. The table is entirely turned. The "lab-coated experts" aren't the experts. The believers are the experts.
"When you venture outside the scientific literature into the world of contemporary consumer marketing, most of the placebos you'll find are still the deceptive kind...Placebos also haunt what the political scientist Murray Edelman famously termed the 'symbolic uses of politics.' In voters' 'anxious search for direction,' --[an 'anxious search for direction;' that tells you something you should keep in mind] -- Edelman argued, they might be drawn to leaders who can dramatize confidence 'in a world many of them find alien' -- regardless of whether that performance achieves anything for the voter. 'In place of impersonal threatening forces, followers are reassured by a dramaturgy of personal coping,' Edelman wrote. That was in the 1960s, but it could just as well have been describing any number of modern politicians." Or snake oil salesmen. (If you just became incontinent of urine, you're paying attention, and you get the point.)
"Increasingly, though, cultural (as opposed to clinical) placebos are becoming open label, too." If you've ever watched Jordan Klepper talk to Trump supporters, and point out their inconsistencies, and the entirely invented, and not remotely true, positions they take, because the "doctor" told them what was the problem, and what was the cure, and they either can't continue the conversation, or they just keep riding the same inane position, you see how the placebo has completely taken hold. You see how the belief trumps (excuse the pun) all evidence of reality, and how the fact of adhering to a belief is somehow treated as an adequate reason to disqualify experts. The ability to form, or adopt, an opinion is more compelling than careful and lengthy education.
"So why, when we know the sham treatment is a sham, does it work? My best bet is that whether we're in a medical setting or casting a vote, we want to feel like someone's taking care of us." If that sounds like the description of a helpless child, dismissing it that way fails to take into account animal behavior, which is reflected in human nature. Many animals, including human ones, rely on a pack mentality and social structure. And it's well known that some non-human animals, and human ones, have a kind of "personal" nature that leads them to lead, and most have a nature that leads them to follow. Ideally, "leaders" who are doctors are interested in their patients' well-being, as Hypocrates suggested they should be. The same cannot remotely be said of people who lead politically, or in business.
There are various kinds of toxic "placebos" foisted on people. Some "leaders" order their followers to take poison, or bully, harm or kill someone else. Others tell their followers that there are barbarians at the gate, and that gate is, for example, the southern border of this country, which vile, greedy, rapacious, criminals want to breech.
It's tragic that they don't just give out sugar pills instead.
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