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Thursday, 20 February 2014

Placebo; something about nothing!

I am sorry to dissent from the general chorus of both lay and scientific praise for the Horizon placebo program (Medicine's of the Mind "Power of the Placebo"). Many people seem to have found it fascinating, I'm not one of them. I thought it was all nonsense (if you are quick you can still watch it here)!
One of the disappointing things science can do is take a really simple phenomenon and make it more complex. Science should attempt to do the opposite.  So to clarify; most lay people have never (IMHO) had a problem understanding any of the following cliches:
  • If something excites you (not like THAT) your heart to beats faster.
  • You get a performance boost from confidence and/or positive mental attitude.
  • Under-performance can result from under confidence.
  • Fear can turn your stomach.
  • Fear can make you go weak at the knees.
  • In a fight situation, humans and other animals can suppress pain and don't really hurt until they are out of the danger zone....
There are so many of these its crazy. Placebo is just another one of these; if you truly believe you will feel better, you will feel at least a little better.
In teaching its a critical factor.  Telling students they will all do well WILL improve their performance.  And if you are my students worry not, it's no trick, I don't mind if you read this because I am absolutely sure you WILL do well.  There is nothing like confidence for optimum performance.  I have seen students in the past so nervous they couldn't even write their own name on the front of the papers.  Guess what?  They do terribly in the rest of the exam too.  Listen to my voice my students:  you WILL do well, really you will!
Now the program went to great lengths to show that there were real chemical changes in the body whilst this was happening (after people took placebo). But HELLO!! we are little more than a collection of chemicals. Everything you sense, think or do involves changes of chemicals. If you see something, glutamate is released in the eye and various neurotransmitters are released throughout the brain. If you think or imagine something, chemical changes take place in the brain. If you believe you will feel better, of course chemicals will change. If you lift your own leg... chemical changes take place in the process.
A couple of specific points about the program; the cyclists performing better and/or feeling they performed better?  Well people are absolutely hopeless at assessing their own feelings to start with (as I discussed here), and any good coach would know a bit of appropriate inspiration at the right moment will improve performance.  Why do people break so many world records at the Olympics?  This is exactly the same as the benefit of a so called "pep talk".  The the "mystery" of the placebo was further illustrated with a patient who's symptoms improved even though she was told she was going to get placebo.  All that matters is whether you feel you will feel better.  ...and typically of course the disease they chose was IBS "irritable bowl syndrome".  This is notorious for being a "there's nothing wrong with you get out of my surgery" type of disease.  Frequently people can be really ill with it too of course, and disturbingly, my guess would be that people "diagnosed" with IBS are frequently suffering from undiagnosed Crohn's or coeliac disease. Nonetheless, in many cases it the GPs way of saying, "I don't deny there is something wrong with you, but I can find anything to account for the symptoms you are reporting".  Bottom line (pun intended).. its not a great vehicle for demonstrating the magic of placebos.  
So giving people placebo, results in them thinking differently to non-placebo people and this change in thinking results in change of chemicals. To me, it is no big deal.
So why am I so evidently wound up by this? For two reasons.
(1) The idea that we are anything other than a collection of swirling chemicals and electricity is patent nonsense.  I feel there is no place for such arcane pre-science gobbledygook.  If you are surprised that chemicals change in the body when people "think positive" where have you been!? ...and if you thought that and you are even a biological scientist... Wow.
(2) Throwing your hands up in the air with amazement when someone shows that thinking changes chemicals in the brain is opening the door for woo. Why do I say that? ...because the next thing will be TV showing how people feel better after taking homeopathic remedies (aka water) and correlating this to chemical changes in the brain. Look they will say, homeopathy changes chemicals in the brain... So it was true all along. Well no it wasn't. Homeopathy is nonsense and just try and remember chemicals are constantly changing within the body. And will do so until well after we all die.
And on that cheerie note, I think I shall go and buy a high fat pizza and bring my own demise a little closer!!