Placebo

I’ve had a year blessedly full of work, but that volume has caused me to let my own blog mostly lie fallow. To make up for this, I’m going to try for a post a day in December. About just about everything. Funny. Serious. Anything goes. Here is Day 1.

Not long after I was diagnosed, I read a book called Mind Over Medicine, whose thesis was that instead of Western medicine acknowledging and working to avoid the placebo effect, we should harness it. 

Dr. Rankin wasn’t discounting Western medicine’s utility. She was pointing out that it’s ignoring something that we know works. 

Her argument made sense to me then, and it still does. Even when patients are fully aware they’re getting a placebo, it helps. And it works on all kinds of clinical outcomes, not only subjective measurements like pain or mood. Trial design is fundamentally based on the concept of the placebo effect. It’s why we double-blind. And that’s important, of course. We need to try to understand exactly how effective the actual compound is.

But why aren’t we also using the placebo effect to our advantage? Well, there are a few reasons. What sponsor would pay for the trials of testing… nothing? What patient would feel comfortable getting… nothing? What provider would feel ethical treating with… nothing?

But adjunctive placebo is what interests me. Not instead of. Along with. 

Recently the New York Times Magazine published “What If the Placebo Effect Isn’t a Trick?“, an article with a more complex bent than its title suggests. One of the topics it covers is the clinical evidence for placebo response. There’s a genetic predisposition: a brain enzyme has been found to correlate with response. There’s proof that it’s not just imagination: MRI’s show brain activity . 

We are a long, long way away from understanding exactly how to trigger and mediate placebo response with any precision. But even now, there are any number of ways to harness its power when it’s financially responsible and medically ethical. Saying that treatments like acupuncture might rely on the placebo effect isn’t, to my mind, saying that they’re ineffective. It might just be saying that we don’t yet know quite how they work, who best to use them with, or what they might work best for. But that’s science. Not knowing, and figuring out.