Foreward
The word “Placebo” is a word that is frequently misunderstood. Most people think that it refers to a fake or ineffective treatment. If this were the case, then medical researchers would not need to go to such great lengths to account for it. The term placebo describes a therapeutic phenomenon that is very real and can be quite effective. Maybe you hear the word placebo as an insult. If I think that you need a placebo, or that some treatment that you depend on is a placebo, then you will likely think that I am implying that you are stupid or naive.
What I’m really saying is that, “You think like a human.” IQ and life experience are not the issues. Individuals in America who have more education and have obtained a higher socioeconomic status are the ones most inclined to use Placebo Medicine. The real question is, “How does the human brain process information?”
“Thinking like a human” is not a logical way to think but it is not a stupid way to think either. You could say that our thinking is intelligently illogical. Millions of years of evolution did not result in humans that think like a computer. It is precisely because we think in an intelligently illogical way that our predecessors were able to survive.
Just because some caveman got a little sick from a flu virus and happened to have eaten a mushroom doesn’t mean that it would be logical to think that all mushrooms are poisonous. However, I bet the illogical guy who believed this and rigidly ate no mushrooms survived while his more logical friends did not. What do you think?
My use of the word placebo may also cause people to associate me with a particular philosophy. I have no pre-set agenda. I am not trying to sell or promote any particular form of medical therapy and I have no emotional connection to any ideology.
I’m not even selling this book. You can read it for free on-line, assuming that you noticed the “READ FOR FREE” link above the cover image.
Therefore … and I want to make this one point perfectly clear … I’m trying to be a neutral observer. The only agenda I care about is reality and truth.
When I titled this book Placebo Medicine, I was not trying to make fun of people who employ medical therapies that don’t have genuine physiological effects. Rather, I was looking for a term that would most accurately describe a unique category of medical therapeutics. This category employs non-pharmacological mechanisms to facilitate the brain to cause therapeutic chemical changes in body chemistry.
This category also uses misdirection and misperception to make people think that something therapeutic has occurred. Placebo Medicine is an effective form of treatment but it is tricky to study and seems to be poorly understood by most people, including physicians.
The main purpose of this book is humor and entertainment but a secondary goal is to help people understand a peculiar aspect of human nature that embraces ideological rather than physiological therapies. In other words, therapies whose mechanism of action involves the way we think about therapy rather than the actual effect of the therapy.
How can the way we think about a therapy have a therapeutic effect?
As I indicated previously, the way we humans think is not logical. Does anyone disagree with that statement?
We have evolved to survive, not to play chess. Survival requires quick and decisive decision making. It requires rapid integration of information from multiple sensory inputs. A decision needs to be made without flooding and overloading the conscious brain with too much information.
Our brains rapidly process visual, olfactory, tactile, and gustatory information in addition to auditory information. Then, an instinctual or “gut” decision is made. We are often not even aware of exactly why we make such decisions. This is why we are susceptible to fanciful explanations. This is why we create superstitions.
There is way too much information in the environment for our tiny brains to comprehend. We need a decision tree that takes into account that our knowledge will be significantly incomplete. Since purely logical thinking without accurate “intel” might lead to our destruction, we need a thought process that is clever enough to ensure our survival.
If we observe that sleeping outside under the stars results in being squashed by a meteorite, then we might always sleep inside in order to avoid future meteorites. Since it is safer to sleep indoors to avoid a variety of other things that we don’t know about, this illogical thought process will have greater survivability than a more logical way to think in this situation. All decisions we make and conclusions we draw must improve survivability and error on the side of caution.
Every species develops its own survival strategies and for humans the strategy that has been most successful is to associate with others in a very intimate way within a small group or “herd.” Variability among individual members of the herd is protective to the entire group against changing environmental pressures.
It is essential that members of the herd disagree on a small scale in order to solve problems but totally agree on a large scale in order to maintain the integrity of the herd.
We need brains that rapidly process an enormous amount of incomplete information and draw conclusions that ensure survivability and promote group cohesion.
I would suggest that if Garry Kasparov had lived forty-thousand years ago, he would not have survived. He would not have passed his genetic material to subsequent generations. He is not a team player. He does not make quick decisions. He does not form strong alliances and he does not think and do as others want him to. He is stupidly logical rather than intelligently illogical like the rest of us.
Garry Kasparov at the third Dissenters March -Saint Petersburg, (9) June (2007)
Scientists expend an enormous amount of time and energy going to school in order to learn how to undo the effects of evolution so that they can investigate natural phenomena in a logical way. Still, many of us continue to be influenced by illogical thought processes handed down over the course of a millennia. Therefore, we must have an extensive review process to make sure that science is proceeding in a rational way. Is it any wonder that the common person on the street might have some degree of difficulty drawing logical conclusions when they witness new or novel phenomena?
We are predisposed to draw illogical conclusions when we observe events in nature. If you see a plane for the first time and you watch it crash then you might believe that all planes crash. If a flu virus causes you to throw up after eating a ham sandwich, you will likely believe that a ham sandwich will cause you to throw up. If you have a dream where you see your sister die in a car crash and then she really does die in a car crash, you may believe that you have a special ability to foresee the future. If a football player fails to wash his underwear and then wins a game he may not wash his underwear for the rest of the season … and so on, and so on.
Do you think that this might apply to medical therapeutics?
If you have an illness like the common cold, whose natural course is to get better, and you do something like wearing juju beads might you begin to believe that juju beads cure the common cold? Thus, if you misperceive what is actually happening, then you could easily believe that something therapeutic has occurred.
Misperception can be one way that we think about a therapy that apparently leads to a therapeutic effect but, in reality, there is no therapeutic effect at all.
Is there any way that we can think of an effect and then a real therapeutic effect actually occurs?
Surprisingly, yes.
Your body is comprised of a complex set of chemical reactions that are neurologically controlled by your brain. You have naturally occurring endorphins, hormones, stimulants, sedatives, and immune active chemicals flowing all over your brain and body. Whatever you are thinking can alter the balance of these chemical reactions. If you are stressed, you might produce less immune active agents and be susceptible to illness. If you are in pain, you might produce natural endorphins. If you are in love and having great sex, you might produce a lot of hormones and immune agents and your general health will be good.
Why don’t we try a little experiment. I predict that I can make your heart rate and blood pressure increase even though I am not touching you or putting any exogenous compound into your body. In fact, I am not even in the same room or even in the same time that you are in right now. Are you ready? OK, here goes …
YOU ARE A STUPID MORON!
Well, it would work better if you could actually hear me say it with a bit of inflection, but you get the point, right?
No?
Then you really are a moron! Ha, did I get you that time? he…he…
OK, what is your heart rate and blood pressure now?
The basic idea is that a human needs a mechanism to facilitate the brain to alter its chemistry in a way that is therapeutic. I may have been wrong about the juju beads. It could be that wearing them may have been a mechanism that actually caused your brain to facilitate an increased production of immune agents. Your cold may have ended sooner as a result.
A key point here is that we are talking about neuro-chemical changes that are compensatory in nature. Like when your brain produces endorphins to reduce pain. Hypnosis, acupuncture, and most forms of placebo medicine work for pain. There may be other compensatory things that can be done through non-pharmacologic mechanisms but no holistic therapy can kill a bacteria, reverse a congenital anomaly, or cure an enlarged heart .
Most forms of Placebo Medicine (Holistic, Integrative, Naturopathic, Complementary and Alternative) are good at affecting brain mechanisms. Of course, they use a lot of trickery and false paradigms that might fool you into thinking something therapeutic has occurred but they also affect your thinking in a way that can actually affect your body.
Alternative treatments, by definition, have not been shown to be superior to placebo. However, they have often been shown to be as effective as placebo. Since placebo can be pretty effective, especially for certain individuals and for certain ailments, I must ask, “Can’t we figure out some way to incorporate placebo medicine into mainstream practice?”
The main downside is that a lot of practitioners fully buy into whatever illogical paradigm they are selling. If this is the case, then they may not make recommendations that are in your best interest. Deception in medicine is unacceptable.
On the other hand, if the practitioner understands that they are using Placebo Medicine and they are willing to work in concert with a standard physician and they use no deception at all then, possibly, I mean, could it be, maybe, Placebo Medicine, in all its various forms, could truly be a complementary form of medicine?
Theoretically it makes sense.
Please do not get the idea that I am saying that a placebo treatment such as acupuncture can cure a brain tumor by stimulating increased immune function. Our bodies natural immune defenses are extremely complex. When complementary advocates claim to “boost” the immune function us MDs wonder what in the hell they are talking about. They may cause generally better health but attacking and killing specific cancer cells is another thing altogether.
In any case, I want to make sure you understand that I am not a zealot trying to promote a radical new medical policy. My goal is to cause you to think about alternative medicine in a new way. I think it should be integrated into mainstream medicine. I also want to stimulate debate.
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