Part two of my Radio 4 show on the placebo effect, 9pm tonight (Monday)

August 25th, 2008 by Ben Goldacre in bad science, onanism, placebo, podcast | 31 Comments »

image So tonight at  9pm on BBC Radio 4 (Monday) you can hear the second episode of my two-part miniseries on the placebo effect, one of the most effective and neglected evidence based treatments known to man.

In this show we look at the ethical and practical implications of research into the placebo effect, and discuss whether it’s okay – or even necessary – to lie to patients. The answer, from me at any rate, is “no”.

You can listen to it after 9pm from the listen again link here:

www.bbc.co.uk/radio4/science/rams/sci9_mon_20080825.ram

And for those of you who don’t want to install Realplayer, a thoroughly stupid piece of proprietary software that messes with your computer and has the arrogance to put the “Real.com Message Centre” in your taskbar to harrass you with stupid pointless adverts about celebrities (the BBC, of all people, what on earth are they thinking…) then I will illegally record my own programme off the radio and post a proper normal mp3 file on this page once it’s been broadcast, unless someone important reads this and tells me not to.

Here it is.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

Oh, and part one got the radio equivalent of linky love from Pick of the Week, which you can hear here:

www.bbc.co.uk/radio/aod/radio4_aod.shtml?radio4/potw

I genuinely love radio 4 science, as I’ve said before. It takes days and days and days to make a programme, and there’s absolutely bugger all money in it, but they really are the only place in the media where you can find clever people to generate and broadcast intelligent science content (Matt Silver, the producer, was brilliant, and is off to do a PhD in bioinformatics now). I’ve been trying to get them to let me do a short series on the crimes of the pharmaceutical industry, which is what I teach medical students and doctors, and it’s riddled with interesting bits of science and anger-provoking badness. The pitch is in for this round I think, so fingers crossed and all that.

Oh, and my book is out next Monday. It really is. And it’s actually pretty good. I should start going on about it soon.


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If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

31 Responses



  1. Bob O'H said,

    August 25, 2008 at 5:36 am

    Oh, cool about your book. Will you be able to hawk copies on Saturday?

  2. Pro-reason said,

    August 25, 2008 at 8:52 am

    MP3 is stupid and proprietary too, you know?

    I’d appreciate Ogg Vorbis if it’s not too much hassle.

    I managed to listen to the first part, but I can’t get this part to play.

  3. muscleman said,

    August 25, 2008 at 10:51 am

    Pro reason, you have to wait until after the program has aired tonight. That is why it is called listen *again*.

    Seems to be flavour of the month, New Scientist this week has a big piece on the placebo effect. For those with login access it is here:
    www.newscientist.com/channel/being-human/mg19926700.300-the-power-of-the-placebo-effect-.html

    Interesting points that some bioactive compounds only work when the patient is aware of taking them and they may not work directly only trigger endorphin cascades through association. Not true placebo since sugar pills are not bioactive in that way. Some funky stuff to come from this, provided we can ethically do the experiments…

  4. Pro-reason said,

    August 26, 2008 at 6:39 am

    Thanks, muscleman.

    It’s a fair bit after 9 o’clock over there in the UK by now, isn’t it? I still can’t get any audio. I hate streaming media. Oh for a simple .flac or .ogg file.

  5. gazza said,

    August 26, 2008 at 9:47 am

    Just some ‘thinking out loud’ views on the placebo info coming from Ben’s radio programmes – and I have no medical background either, so bear with me!

    Firstly, it seems obvious to me that placebo, in any of its pill-like or other forms, would be of use to patients who have illnesses where, dare I say, psychomatic effects are present, or at least where ‘mood’ is playing a role in a illness which normally be controlled in a normally healthy person. That doesn’t surprise me at all. And any supposed immorality arising from deliberate use of placebo in such circumstances by a GP, treating a cold, or sore throat, for example, seems to me to be of no importance – just the equivalent of soothing words.

    Secondly, the big surprise is that placebos can induce bio-chemical changes in the body, and that this may help in the treatment of some more serious illnesses. This was the fascinating aspect to me. As Ben indicates, the moral aspect of using placebos here seems a minefield and isn’t clear to me.

    Thirdly, no comment was really made in the programmes on the limits of placebo for ‘serious’ illnesses (let’s say most cancers, heart disease, HIV, etc). In these cases I can imagine placebos having no important biochemical impact – I cannot believe there’s a placebo contribution to chemotherapy, for example. But possibly they could help induce a ‘positive mental outlook’ in the patient on the basis of false hope which could improve quality of life for a time anyway. I’m not recommending it as it’s immoral certainly, and of no long term benefit but arguably an alternative approach for those who can’t face a terminal diagnosis. It’s this hope via placebo that quack therapies are offering to the seriously ill and why they can claim to offer some benefits in such circumstances.

    Anyway, just some thoughts stimulated in me by these fascinating programmes which I thought I’d share!

  6. rogerhyam said,

    August 26, 2008 at 10:53 am

    It is a little known fact that the pills in the first Matrix film were a placebo. Keanu Reeves only had to be acknowledge the existence of reality to himself – he didn’t need a drug. (This may be ruined by the sequels which I never saw on the grounds I have never met anyone who thought they were worth watching).

  7. Ben Goldacre said,

    August 26, 2008 at 1:14 pm

    don’t have my normal laptop / internet at the mo (moving) so if anyone happens to be able to record this and bung me an mp3 i will be able to stick it up in that form much quicker, ie immediately. otherwise realaudio’s not THAT bad….

  8. casper_gutman said,

    August 26, 2008 at 3:38 pm

    If anyone’s after an alternative to Real Player to listen to Ben’s prog, I’ve had great success with “Real Alternative” (google it). Does everything you would want (i.e. makes sounds when you click the link) without the unnecessary “features” like the “Real.com Message Centre”….

  9. ephemera said,

    August 26, 2008 at 8:27 pm

    Hmmm..

    As a clinical hypnotherapist and NLP Master Practitioner and Trainer, I have come across the placebo effect and have some theories about how it works.

    The mind and body are the same system, and a change in the body will cause changes in the mind, and vice versa. Simply changing your physiological state (for example sitting hunched over, looking down, will tend to depress your mood. In contrast, try to be unhappy whilst looking up and sitting or standing tall. There will always be exceptions to this ‘rule’, however!

    From the standpoint of drugs, however, it does get a little more complex. (I will say here that I am not medically trained and these are my own musings!) Using the example of Pavlovian response training, is it possible that the body can replicate the effects of some drugs merely by taking a similarly shaped and tasting pill, and in the full belief that it is the pill the body has taken in the past? And taking this further, even to the point of telling the pill recipient that the pill is even stronger than the expected medication, without the side effects, if any, of the old pill…

    Of course, the moral arguments still remain, and if the patient knows the pill is a placebo does it have the same effect? I guess I’ll have to listen to the podcasts to find out…!

  10. Getonyerbike said,

    August 26, 2008 at 11:10 pm

    Whats goes against a holistic view of health in which the cultural, economic, psychological, physiological (etc) are integrated, is not allopathic bio-medicine per se. but politics, specifically a contemporary political agenda that seeks to atomise health by breaking it down into measurable parts for economic measurement and profitable gain. As Atul Gawande has pointed out (i don’t have the reference to hand but you could start here www.gawande.com/articles.htm), the most effective way to improve healthcare is by allowing clinicians to spend more time with their patients, not by doing more investigations and procedures.

    Most doctors and other health workers will recognise patients who are aware that they are as they are because of their life experiences and circumstances. They need ‘care’ in as full a sense as is possible (women’s hour today gave a fine example of the Iceni project in Ipswich www.bbc.co.uk/radio4/womanshour/)

    In these cases (as in much of General Practice) care extends far beyond drugs and placebos.

  11. peterd102 said,

    August 27, 2008 at 5:08 am

    if you were investigating Sugar for a medical purpose in pill form, what would be the placebo? Theres a Dragon’s Den opportunity here lol

  12. Dudley said,

    August 27, 2008 at 9:16 am

    Signing up to the Bad Science iTunes podcast was a rewarding experience this week.

  13. gyokusai said,

    August 27, 2008 at 11:39 am

    THX, mdimmick. That’s what I’ve been looking for. (You have to kill the period at the end of the link, though.)

    Still, it would be great to have it stored on harddisk as an mp3/ogg file. It might come in handy in family disputes and the like :-)

    ^_^J.

  14. used to be jdc said,

    August 27, 2008 at 4:11 pm

    @Gazza: “Thirdly, no comment was really made in the programmes on the limits of placebo for ’serious’ illnesses (let’s say most cancers, heart disease, HIV, etc).”
    Yes, that’s something I thought about too. For example, a fair few homeopaths have healer fantasies about curing serious diseases (like those you have named) with their sugar pills and magic water. I find the discussion about the ethics of lying to patients interesting, but surely it is something that could not even be considered in cases such as cancer etc.

  15. jb said,

    August 28, 2008 at 9:53 am

    For those that want an MP3 version (128k), I’ve uploaded both parts here…

    Part 1 – 27:55 min – 25.6MB…
    www.mediafire.com/?wgl3jg9itmx

    Part 2 – 27:51 min – 25.5MB…
    www.mediafire.com/?dyczdcdfdgl

    The RealMedia (spit!) stream downloaded by Net Transport…
    www.xi-soft.com/
    Then converted to MP3 by the free Switch File Converter…
    www.nch.com.au/switch/

  16. Ian said,

    August 28, 2008 at 11:12 am

    thanks jb!!
    but is mediafire always so slow – I know my connection is often slow but 6KB/sec??

  17. Ian said,

    August 28, 2008 at 12:23 pm

    I’ve just listened to the 2nd program and what struck me was the bind a placebo puts a knowledgable patient in…. You’ve had the placebo (and good doctor patient relations) and you havn’t been able to persuade your body to respond, so it is all your fault that you are not getting better…..

  18. geehigh said,

    August 28, 2008 at 2:08 pm

    Whoops that’ll teach me to read the posts above before sticking my oar in. Anyway hope the link is useful.

    Graham :)

  19. Getonyerbike said,

    August 28, 2008 at 2:29 pm

    Clearly placebo effects are limited, but if you have heart disease or cancer you won’t recover with anti-hypertensives or chemotherapy alone; you need empathy, hope, motivation and encouragement -all apparently components of the ‘placebo effect’

    What Ben’s progammes have demonstrated is that placebo effects are real and complex and involve a patient expectation, the doctor’s behaviour and social factors (and more)

    Placebo effect is too simple a term to adequately describe this range of processes, so we/you/ Ben(!) need(s) urgently to develop the necessary lexicon so that when we say ‘snake oil’ we’re not talking about good communication skills.

  20. Pro-reason said,

    August 28, 2008 at 3:16 pm

    25MB? That’s a bit much. The size of the whole Realaudio stream is only 14MB. There’s no point trying to re-encode it at such a high bitrate. You’re trying to encode data that ain’t there.

    I’ve re-encoded it as Ogg Vorbis, with a low, variable bitrate. You can hear the compression, but it’s worth it for the file size. I could add a few MB and make it sound perfect.

    Part 1 (8.42MB):
    www.mediafire.com/?ujmodjjrmdb

    Part 2 (8.45MB):
    www.mediafire.com/?s7hhiwdgh0h

  21. Lemonade Lily said,

    August 28, 2008 at 5:14 pm

    Thanks for mp3 JB – will now enjoy Placebo train journey tomorrow am. Am not sure what to do with Oggs but they sound nice.

    Ian – agree – can intelligent, reasoning sceptics benefit from the placebo effect?

  22. Getonyerbike said,

    August 28, 2008 at 6:13 pm

    Yes Lemonade, definately. A couple of centuries back in the philosophers believed that intelligent, reasoning sceptics had separate centers for emotion and reasoning but now scientists believe that the separation of reason and emotion is not only futile, but impossible.

    That said, there’s a vast amount of ignorance about science and scientific method, statistical analysis and psychology that all contribute to the wonders of advertising, consumerism and new-age evangelicalism that rightly raise indignant heckles and Ben has to be cheered for trying to help us battle those who would exploit us with their false promises and dodgy marketing.

    We should be grateful that we’re better educated, less anxious, less narcissistic (and hence less vulnerable to exploitation) than others, and do our (Christian) moral duty by protecting those who are.

  23. Finny said,

    August 29, 2008 at 8:59 am

    Ben

    Off the thread I know, but related to your high BBC media profile.

    Good chat on the breakfast sofa this morning on superfoods.

    I’m not sure how far rational persuasion is going to get on a programme where one of the main headlines is ‘Line-up on Strictly Come Dancing announced’.

    Are Richard and Judy still going?

  24. Getonyerbike said,

    August 29, 2008 at 5:45 pm

    hmm
    i just tried using the phrase “the published evidence doesn’t support specialist referral because there is no evidence that it confers any benefit”
    and the patient said, “i don’t care!”
    The irony is that the specialist is keen for referrals despite the absence of evidence because that’s how they get paid and the patient wants a referral because they don’t believe that their problem could be of a self-limiting type that can resolve without a ‘specialist’ intervention.
    In this case the placebo is the ‘specialist’ (being special)

  25. HypnoSynthesis said,

    August 30, 2008 at 10:43 am

    “A vivid imagination compels the body to obey it, for it is a natural principle of movement. Imagination, indeed, governs all the forces of sensibility, while the latter, in its turn, controls the beating of the heart, and through it sets in motion all vital functions; thus the entire organism may be rapidly modified. Nevertheless, however vivid the imagination, it cannot change the form of a hand or foot or other bodily member.” (Aristotle, cited by Coué, My Method, 1923: 4)

    Autosuggestion, Coue stressed, does some things but not others. It’s sphere of effect is probably virtually the same as the placebo effect. Stress, anxiety, pain, and depression seem to be particularly responsive to autosuggestion, and to some extent physical illness, which is sometimes exacerbated by stress. As Coue long ago said, in his seminars,

    “For instance, if you have a leg cut off, and you imagine the leg will grow again, it is positive it will not grow again, because till now we are not able to produce such miracles; but if we have sad ideas, if we have organs which do not work well, if we have pain in a part of our body and we imagine that the sad ideas will be replaced by pink [sic.] ideas, that our organs will, little by little, function better; that the pain we have, in whatever part of the body, will disappear, it takes place, because it is possible.” (Coué, 1923: 111)

  26. Robert Carnegie said,

    August 31, 2008 at 2:13 am

    Each alternate survey on the effect of mental attitude on cancer outcome reverses the previous published conclusion, turn about, it helps, it doesn’t. I don’t think there’s been one to say that being terrified and certain that you will die in agony improves the chance that you won’t, it’s positive thinking that is supposed to be the medicine.

    I think we have discussed a psychology experiment where the perceived value of financial advice in an investment simulation depended on the price charged for the advice, or somethiing like that. This probably maps to the abstract psychological element of placebo effect – someone is doing something nice for you – but that isn’t necessarily the whole story.

    Haere’s a thought: placebo vaccine. Bad iea, yes?

  27. ips said,

    August 31, 2008 at 9:28 pm

    Very interesting as usual . I am writing my MA project on ‘Placebo’ (cultural aspects …things like belief, role of religion and authority etc…) Dylan Evans has an interesting theory on placebo called the ‘acute phase response’ (you can download the pdf from his site). I like his idea that placebos largely ‘work’ with ‘defensive’ biological problems (this was Patrick Wall’s opinion with pain interventions). Dylan looks at conditions such as depression/anxiety/pain and some types of inflammation as amenable to ‘meaning responses'(Dan Moremans idea) As these problems contribute to a considerable amount of suffering in general society than the factors that enhance placebo reactions are probably worthwhile studying and attempting to enhance in clinical practice.
    For anyone that is interested Anne Harrington has a very interesting book out called the Cure Within – A History of Mind-Body Medicine which is relevant to the debate.
    ian

  28. Tony Sidaway said,

    September 7, 2008 at 6:33 pm

    I accidentally listened to Radio 3 but it was still a fantastic programme.

  29. Getonyerbike said,

    September 8, 2008 at 10:26 am

    A suggested definition to help:
    Placebo: A intervention designed to mirror a trial intervention except for that aspect of the trial intervention under investigation.

    So for example in testing homeopathy to test whether the pills are active you would use the homeopathic consultation but with sugar pills.

    A placebo therefore can ONLY exist as a mirror intervention, it cannot exist in its own right. This helps clear the dillemna, ‘what is a placebo effect?’ because instead we can say, ‘what is the effect of sugar pills, or pink lights on a physiotherapy machine, or confident friendly consultation skills etc. i.e. calling these things what they are instead of lumping them under the catch-all, ‘placebo’

    Additionally it can help doctors to be more aware of the complex way in which they are healers and not simply evidence-based prescribing machines.

  30. BigEoinO said,

    September 9, 2008 at 3:07 pm

    See the December BMJ for a quirky look at the requirements of evidence based science…

    “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials”

    link:
    www.bmj.com/cgi/content/full/327/7429/1459?ijkey=425457f110f8db584617b87a1eace92eaa39ff02

  31. Robert Carnegie said,

    September 11, 2008 at 1:52 am

    Re 39: a placebo doesn’t have to imitate a realistic non-placebo therapy except in the mind of the patient. For instance, mumbo-jumbo with a crystal swung on a string over your body could be a placebo process. And placebo isn’t only relevant to trials. The placebo effect may be all that a patient needs to relieve, say, chronic back pain, psychologically at least: so why do anything else? To avoid placebo side-effects perhaps – so we -do- need those trials.

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