I beg to disagree. There is a very strong body of evidence that placebos don’t work. After all, if they did work, they wouldn’t be placebos…

It seems that it’s become a matter of common belief that the placebo effect is real “effect”, yet the evidence, if you look at it, is far from conclusive either way.

In my own opinion, on balance, I have come to think that the placebo effect is equivalent to no effect.

This is why placebo is the gold standard for double-blind controlled trials.

So when the control group are given a placebo, they are being given a blank, i.e. a pill with no active ingredients (just like homeopathy).

The effects that some people perceive from receiving the fake pill are in fact just background noise, and this is why genuine medical interventions need to be proven to have an effect over and above placebo, i.e. placebo = no effect.

And it bears emphasising that the original quantitative claim that placebo is real (Beecher, H. K. 1955. The powerful placebo. Journal of the American Medical Association, 159:1602-1606) was subsequently thoroughly dismissed (Kienle GS, Kiene H. 1997. The powerful placebo effect: fact or fiction? J Clin Epidemiol. 50:1311-8).

And this is of interest:

“Hrobjartsson and Gotzsche published a study in 2001 and a follow-up study in 2004 questioning the nature of the placebo effect. (Hrobjartsson 2001, Hrobjartsson 2004) They performed two meta-analyses involving 156 clinical trials in which an experimental drug or treatment protocol was compared to a placebo group and an untreated group, and specifically asked whether the placebo group improved compared to the untreated group. Hrobjartsson and Gotzsche found that in studies with a binary outcome, meaning patients were classified as improved or not improved, the placebo group had no statistically significant improvement over the no-treatment group. Similarly, there was no significant placebo effect in studies in which objective outcomes (such as blood pressure) were measured by an independent observer. The placebo effect could only be documented in studies in which the outcomes (improvement or failure to improve) were reported by the subjects themselves. The authors concluded that the placebo effect does not have “powerful clinical effects,” (objective effects) and that patient-reported improvements (subjective effects) in pain were small and could not be clearly distinguished from bias.

These results suggest that the placebo effect is largely subjective. This would help explain why the placebo effect is easiest to demonstrate in conditions where subjective factors are very prominent or significant parts of the problem. Some of these conditions are headache, stomachache, asthma, allergy, tension, and the experience of pain, which is often a significant part of many mild and serious illnesses.”
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=11372012&cmd=showdetailview&indexed=google

i am a skeptic of homeopathy who has benefitted from homeopathy on the rare occasion. so, does placebo work? to my surprise, it worked for me, once or twice. yay, placebo.

do i know why it worked? was it even “it” that worked? haven’t a clue. besides, while the treatment alleviated acute symptoms it was useless for the chronic condition. please note: my sudden belief that it might actually do something didn’t make it any more effective.

so what is placebo? where does it come from? the following is my own unresearched opinion, so read at your own risk.

something has to be considered the baseline against which the efficacy of all other treatments is measured. for what it’s worth (and it’s worth quite a lot) placebo is the zero point for normalization. which, as the positive control, makes a lot of sense.

however, i’m willing to bet that equating placebo to a zero –and then forgetting why we do that– is the reason placebo is thought of in common parlance as “no treatment.”

under this guise, it’s not surprising that any benefits under placebo equate in the imagination to a result of self-delusion.

people then feel compelled to protest against a delusional state, but this is where the point of confusion may arise: on a relative scale, placebo is statistically zero. on your own personal & absolute scale, perhaps no change would equal zero.

people want to get well, and they want to feel that they have some control over their lives, so maybe it’s easier to start repeating wholistic cliches than it is to risk losing whatever benefit is derived from believing you must believe.

[i might add that you can cycle through placebos like a cheese platter, and always come up with something new and intriguing that alleviates a sense of being untaken-care-of. if you can afford it, it's kind of nice, in the sense that stress-reduction is good for you.]

myself, i’ve never quite understood why magical thinking is preferable to admitting to placebo effect, but there it is. (let me recapitulate: yay placebo.) maybe it borrows on the human instinct for spiritualism. maybe it’s because people just forget how to ask questions. i don’t know.

the point is, i don’t think that this ambiguity in human nature excuses any professional from recommending any treatment that promises protection but ends up leaving someone open to harm. (e.g., Aids, malaria, cancer…)

the alt med community, warm and fuzzy and non-confrontational though they are (how delightful!), desperately needs to step up and act like the professionals that they want everyone to accept them for.

The interesting line of research would be surely to explore the known and obvious effects of ‘mind over matter’ – I believe I will get well therefore I will get well. How and why do placebos work? Not trying to prove the ludicrous notion that ‘magic water’ has anything other than a placebo effect.

I say ‘ludicrous’ because if the Homoeopaths are right then ALL of physics as we currently understand it and ALL western science is wrong. All of it.

Given the choice between the Juggernaut of peer-reviewed western science (imperfect though it is) and a few random “My cold got better after taking a teaspoonful of water, that once met a teaspoonful of water…

…that once met a teaspoonful of water that had a garlic atom in it.” testimonials. I know which I would back.

As for ’shutting down debate’. There IS no debate. The world is not flat, the moon is not made of cheese, Homoeopathy has no validity other than as a placebo.

Well done on getting the photos though.

Of course Ben has already expressed an interest in placebo science that is much greater than my own – sorry.

I agree with everything you say. The placebo thing is difficult; as you say (to paraphrase anyway), the placebo effect is called an effect for a reason, and it’s easy to alienate people by the cultural connotation that they’re being credulous or duped. I’m not sure there’s a way around this, some people want to see the term dropped, this seems like a fudge to me, like the people who want to rename shizophrenia to escape prejudice, without changing the diagnostic criteria, apparently unmoved by the argument that once the new term settles they’ll be back where they started…

The only thing I’m thinking is that more research about placebo and its uses can perhaps bring it back ‘from the cold’, i personally could imagine it one day being used in an ‘opt-in’ scheme in conventional medicine – there’s a thread about this in the badscience forum (“thoughts on the placebo effect- effectiveness of lying”)

What I would say with respect to this ‘orrible lot is although they do sound quite combative to a person with fresh ears, if you look into some of the debates that go on you’ll find yourself empathising.

Certain homeopathic regulatory bodies have repeated phraseological inexactitudes so often that they can no longer be dismissed as innocent mistakes.

An Autism blogger (Left brain / Right brain) seems to have been hounded off the net by the inexcusable personal behaviour of a militant anti-vaccer.

The fact is, you might find a bulletin board somewhere with a more measured tone, but if it becomes popular, the rabid elements of the opposition turn up, and then we either capitulate, or call in the cavalry.

And I agree, we need to keep them in check – its horrible when you do see someone asking an innocent, if misinformed question, and being pounced on.

But compare a site like this with, say, JABS, who seem to me to only allow countervailing opinions for the same reason a cat allows a mouse its final, desperate breaths, and I think you’ll realise that they’re actually doing a sterling job.

http://www.dagbladet.no/magasinet/2007/11/29/519685.html

It’s very interesting that placebo works at all. Ignoring the ethical dilemma of what to give someone who wants/needs help getting well, the argument about whether homeopathy is placebo begins to seem more like a semantic question than a medical question. Sort of a shame that one can’t prescribe placebo outright on occasion.

Pluhceeboh. Pleceabow. Plazebo. (Well I thought it could be rebranded. Maybe not.)
——-

I noticed that I must now “bee” logged in to make a comment?

I always worry that your good work is dismissed by non-Guardian readers as “Guardian reader stuff”.

I too got some stuff in the Daily Mail this year – photos of man fighting the police with a sword!

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=467551&in_page_id=1770

<blockquote>quoted stuff</blockquote>

Oh, and BTW the DM’s comments appear to be open for new comments again.

With the DM (probably?) spearheading the rubbish anti-MMR campaign I’d suspect a significant proportion of the readership believes it is harmful. When homeopaths advised against the MMR I’d [cynically] suspect that the readership will side with the homeopaths (a ‘well why not? It’s dangerous isn’t it?’ attitude).

Perhaps a well-known and politically successful example could be used in its place? Smallpox maybe…
Then at least the preaching would more likely be to the converted.

People like to hear what they already believe.

To me, the research showing that homeopathy is as good as placebo is extremely interesting – and when you phrase it that way, it opens up lots of interesting questions for the curious. Like – what is it in some patients’ own toolbox for self-healing that a placebo is able to engage? Can the effect be amplified (Ben says, intriguingly, that some research indicates it can)? Is “belief” the critical feature that makes it work, or does the placebo effect work equally well for some sceptics? Lots of interesting questions for the scientifically curious to get stuck into, simply from framing the same research evidence in a positive way.

Whereas, if you frame it in a negative way, Homeopathy = placebo = no healing at all, you do two things that are unscientific, to my mind. One, you simply shut down the debate and imply that there is nothing more of any use that can be said about it – this shutting down of debate (the answers are all known already) has all the hallmarks of religion, not science. Two, you fail to see that when someone says “homeopathy worked for me” (cue everyone reading this reaching for the tar and feathers) you tell the people who have received healing in this way (placebos do work, sometimes, remember – and when they work, the effect is real, remember)that their experience is not real, which they simply cannot accept, and so you have succeeded in cutting them out of a much more interesting debate which might possibly have engaged their own scientific curiosity.

I think that editor is no longer with the DM (although I don’t know that as fact)

Well exactly. Would have been a perfectly legitimate point in a purely hypothetical situation in which their editorial line had shifted discernibly.

Scotlyn:

New to this blog / forum, so don’t speak for anybody, and haven’t read the DM bit…

But it seems to me that arguments about this are going to coalesce around certain ‘centres of gravity’, and this, although militant, is a fair one.

You certainly raise a legitimate point: if we are trying to enlighten people, then often combative language is to our detriment. People just see us as arrogant and close minded.

But counterposingly if we are unduly lenient, if we accommodate the onslaught of idiocy without the sense of humour that realistically we are going to have to maintain for the sheer purpose of survival, then we lose many of our best points, and many of our best posters.

Any rationalist community that doesn’t exist purely for the gratification of the egos of its regulars is trying to convince people.

And the people we are trying to convince aren’t those posting about homeopathy; they are probably so passionate that only changes in their life, not entrenched, as you say, opinions on the internet, will move them.

So we are aiming for an equilibrium between abuse and dry and detached technicality; and i know if i, naively, read a blog like this, it would be obvious which side was on top.

And sadly Ms Winterson is hardly a spokesperson for the industry anyway.

Do we know she isn’t being paid by them? They would know that celebrity endorsement trumps evidence every time, so it has great marketing value.
I’m surprised some strapped-for-cash UK University isn’t offering degree courses in celebrity endorsement recognition. A sort of alternative to critical thinking.