Friday, April 7, 2017

Placebo Effect Ignorance

I was recently asked this question on Quora: "What is the true impact of placebo effect on science?" My answer:

Ignorance. The true effect, at present, of placebo effect on science is ignorance. Ignorance of cause, ignorance of consequences.

I am talking about the actual impact of placebo effect on science, and doing so in the hope that someday we can change that effect to something as powerful and useful as placebo effect actually is.
First, we need to clearly define some terms. I'll use Webster's. It's a a good place to start. Placebo effects don't “work”. We know that placebos work. But the question is about placebo effects, not placebos.
Webster's defines “placebo effect” as “improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used”. Placebo effects are real positive effects that are not caused by the treatment. Therefore, by definition, placebos DO NOT cause placebo effects. This is a common misconception. Oxford's dictionary makes this clear, but then heads over to the “ignorance” position.
Oxford's definition of placebo effect “A beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself”. Correct. But then Oxford cites the “common sense knowledge” (AKA ignorance), finishing their definition with nonsense “ and must therefore be due to the patient's belief in that treatment”.
This is the common nonsense, and it leads to ignorance of cause. Let's be clear:
1. every positive effect has a cause - by definition.
2. Placebo effects are effects where we do not know the cause,
3. Placebo effects are effects where we believe we know what DID NOT cause the effect.
When we assume that the effect is “due to the patient's belief in that treatment” it's easy to ignore the cause and ignore, to not study, the effect. Ignorance.
In actual fact, this creates two problems.
First of all, if the effect is NOT caused by “the patient's belief”, we cannot find the true cause, because we are not searching for the true cause, we are ignoring it. Ignorance.
Secondly, if the effect IS CAUSED by the patient's belief in the treatment, then things get really complicated.
For example, we might try to study how to create or induce the “placebo effect”. But there's a problem. If we can create or increase the patient's belief in the treatment, and our actions cause an improvement in the patient's condition, It's NOT placebo effect any more. It's a real effect, caused by a deliberate action, caused by a real treatment technique. Beneficial, yes. Placebo effect? No.
Also, if we try to induce placebo effect, by increasing the patient's belief in the treatment, then we assume the improvemets are caused by the “placebo” action. This results in dismissal of other potential causes, because we can easily attribute all effects to “placebo effect”. Ignorance.
We need to study every case of placebo effect to find the real causes. Dismissing placebo effect as “caused by the patient's belief in the treatment” is ignorance of other possibilities. There are always lots of other possibilities. Patients are living breathing entities. Their health, their bodies, minds, spirits, and communities are all taking actions to fight the illness. Making the assumption that all of those effects have a single cause, the patient's belief, is simple ignorance of the complex reality.
If we are to understand placebo effects we need to study every case, not dismiss "placebo effects" as “all in the mind”. Every placebo effect is a real effect, with a real cause. Assuming the cause is ALL in the mind of the patient is ignorance of other causes.
When science studies every placebo effect to find every cause, we will learn more about real treatments, real causes, and real effects.
But today, we deliberately design “double blind placebo controlled clinical studies” to IGNORE placebo effect. Nonsense. Ignorance. That is the current impact of placebo effect on science. It's time for a change.
To your health, tracy
Founder: Healthicine