placebo effect

Thoughts on the Placebo Effect

Responding to the latest episode of Russ Roberts’ Econtalk.

Tweet thread starting here:

THREAD. @econtalker Lots of thoughts on this week’s episode on the Placebo Effect and the interview with Gary Greenberg. First, why would something like the Placebo Effect evolve in the human species? 1/12— Tim DeRoche (@timderoche) February 5, 2019

If your body has the ability to heal itself, why would it hold that power in reserve… until a particular type of social interaction triggers the healing response. 2/12

And it is indeed a *social* phenomenon. The patient interacts with another person in a particular way, and then suddenly an ailment begins to wane. As Greenberg says, “The ritual is very very important to the outcome.” 3/12

In the evolutionary environment, they didn’t have hospitals or doctors or trial-tested drugs. So the most likely “ritual” would have occurred between an ailing person and a relative or a shaman of some sort. 4/12

Most of the remedies would likely have been completely bogus or weak, especially relative to current remedies. What would have been the value of the Placebo Effect in that environment? Is it a variation of the Hawthorne Effect? 5/12

We have to assume that good doctors – consciously or unconsciously – make use of the Placebo Effect all the time. 6/12

Do MDs get any training in how to use the Placebo Effect to improve their patients’ health and quality of life? My guess is no, but I’d be pleased to learn otherwise. 7/12

If there was training, you’d want the MDs to understand: (1) In what domains is the Placebo Effect most effective?, (2) What are the ritualistic triggers that enhance the effect?, and (3) In what cases would use of a Placebo put the patient’s health at significant risk? 8/12

If you wanted to cut health care costs (anyone?), wouldn’t greater use of the Placebo Effect be a *huge* tool in the toolbox? Sugar pills barely cost anything. And don’t have any side effects. 9/12

What if – at the bottom of every standard form in the doctor’s office – there was an opt-out box you could check, “I do not grant my doctors permission to administer placebo treatments in order to enhance my health.” 10/12

Assuming that most people would not check the box, doctors would then have the right to administer placebos to most patients, especially in domains where the Placebo Effect is powerful and the risk to the patient is low. 11/12

You’d avoid a lot of unnecessary interventions and empower the patients to heal themselves. (Again, training the MDs would be absolutely critical.) 12/12

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Would we be healthier if our doctors lied to us?

At Slate, the famous memory researcher Elizabeth Loftus proposes that implanting false memories could change our behavior for the better:

AG: Could false memories be used for therapeutic purposes—like reducing alcohol consumption?  EL: Absolutely, yes. I’ve had people say to me, do you think you could cure all kinds of problems with the false-memory technique? I hope other people will give it a try.

It’s hard to imagine how this would be implemented:  If somebody signs off on having a false memory implanted, then won’t it be harder for them to accept that memory as factual?

It’s analogous to the problem of how to harness the power of the placebo effect.  Doctors could be instructed to try a placebo before a “real” treatment, in cases where the life of the patient is not at stake and the potential benefits outweigh the costs.  But the patient would have to sign off on this, presumably  reducing the effectiveness.  Maybe  health insurers could offer patients the option of “pre-clearing” the use of placebos (with a lower premium?)

It seems extremely inefficient that our whole system of Western medicine forbids providers from harnessing one of the most powerful natural healing mechanisms.

But allowing providers to practice deception is also fraught with peril!


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