In the New York Times, Abigail Zuger, an M.D., recently reviewed a book called Snake Oil Science: The Truth About Complementary and Alternative Medicine by R. Barker Bausell — the “truth” being, if I read Zuger correctly, that it’s all baloney. Zuger calls the book “immensely educational”. Not educational enough:
Dr. Bausell starts out with the story of his late mother-in-law, Sarah, a concert pianist who developed painful arthritis in her old age and found her doctors to be generally useless when it came to satisfactory pain control. “So, being an independent, take-charge sort of individual, she subscribed to Prevention magazine, in order to learn more about the multiple remedies suggested in each month’s issue” for symptoms like hers.
What ensued, according to Dr. Bausell, was a predictable pattern. Every couple of months Sarah would make a triumphant phone call and announce “with great enthusiasm and conviction” that a new food or supplement or capsule had practically cured her arthritis. Unfortunately, each miracle cure was regularly replaced by a different one, in a cycle her son-in-law ruefully breaks down for detailed analysis.
Neither Bausell nor Zuger notice two problems here: (a) The alternative treatments worked better than the conventional ones. They didn’t provide permanent relief, true, but apparently conventional medicine (”useless”) didn’t provide any relief. Something is better than nothing — and something is wrong with Bausell’s interpretation of this story. (b) Why didn’t the conventional treatments benefit from the placebo effect?
That Zuger thinks this story supports her claim that the book is good suggests the power of pre-conceived notions, not the power of placebos.
The book is published by Oxford University Press. Bausell has a Ph.d. in Educational Research and works as a methodologist.
Not only do Bausell and Zuger fail to see what the mother-in-law story means, they fail to grasp a larger point: Skeptics are a dime a dozen. The attitude in short supply is sophisticated appreciation.
Thanks to Dave Lull and Hal Pashler.
>Why didn’t the conventional treatments benefit from the placebo effect?
Maybe because the alternative treatments offer something conventionals don´t: a sense of power, not a passive acceptance. People like to read about “natural” treatments in popular magazines that are written for the lay person (they gat an exlpnanation of the suffering) and they let one take charge of their problem and do something active appart from obeying a doctor.
Are you saying homeopathy works?
Beyond the placebo effect, that is?
No, I’m not saying homeopathy works. Prevention magazine doesn’t cover homeopathy, I’m pretty sure.
Nicely said.
Of course, we all know that “Education Research” is just a placebo PhD.
I think Seth’s general point that we should be alert to new hypotheses is well taken; and in many domains new hypotheses can be readily tested through self experimentation — if we could have 1000 skilled self experimenters working together around the world, to judge from Seth’s achievements, we could do a lot of good.
Regarding “placebo”: It’s a concept that hides more than it reveals. It could reflect a dissonance effect resulting from intolerance of psychological contradiction. It’s well known that if you can get people to choose to participate in a second experiment, after going through one already, that causes them to suffer more electric shocks or eat more salty foods that require enduring thirst, their act of choosing causes them not only to say that they are less stressed by the shocks or thirst the second time around, but physiological measures confirm this.
And people in nursing homes live longer if they are given more choice over their environments. It may be that Sarah’s own initiative and choice resulted in symptom reduction, which is real, but caused not by the agent she consumed but by her own positive attitude and belief.
And we have to allow for reporting effects where someone says there pain is reduced and wants it to be when it isn’t; I’ve done this. When I pay good money for something, it’s hard to admit it’s not working.
Second, when is “placebo” just return to the mean? If people seek help when their suffering is bad and will get better on it’s own, a placebo effect may just be an effect of time and not an effect of “belief” or “expectation”.
As I recall, a meta-analysis of placebo effects done a few years ago found zero effects for blood pressure and cholesterol; and very small ones for pain.
“Placebo” is a concept that reflects a lack of precision and rigor in those who use it….