What’s wrong with the placebo effect?

April 15th, 2004 by Ben Goldacre in bad science, placebo | 5 Comments »

What’s wrong with the placebo effect?

Talk about bad science here

Ben Goldacre
Thursday April 15, 2004
The Guardian

· For some strange reason I’ve never understood, pseudoscientists tend to get huffy when you suggest that their cash cow only works through the placebo effect; perhaps they were so distracted by their sea of flawed research into alternative therapies that they missed the excellent crop of good scientific studies on the placebo.

So we know that placebos can affect lots of things, especially stuff with a subjective component, like pain, or mood; and we know that two placebo sugar pills have a bigger effect than one, and that an intramuscular placebo injection is more effective than a placebo sugar tablet. But what grumpy alternative therapists miss is that placebo goes well beyond dishing out sugar pills: it’s the ceremony, and the cultural meaning of the treatment.

Confidently waving an ultrasound machine around someone’s face is effective for post-operative dental pain, regardless of whether the machine is switched on. Likewise, in the 1950s, we used to ligate the internal mammary artery to treat angina: but when someone did a placebo-controlled trial, going to theatre, making an incision, but only pretending to ligate the internal mammary, the sham operation was as effective as the real one. Like morons, instead of applauding the power of the placebo, we just stopped doing the procedure, assuming that it was “useless”.

· It goes on: pinky red sugar pills are more effective stimulants than blue sugar pills, because colours have meanings. And a four-way comparison, with either sugar pills or aspirin, in either unbranded aspirin boxes or mock-up packaging of the Dispirin brand, showed that brand-name packaging, and the wealth of advertising and cultural background material that packaging plays on, had almost as big an impact on pain as whether the pills had any drug in them. So in some ways, it’s not irrational to believe that costly Nurofen is more effective than cheap unbranded ibuprofen, even if they’ve both got the same active ingredient.

· Pseudoscientists, and alternative therapists, being expensive and long-winded, have more time to weave ceremony and cultural meaning, and maximise their placebo effect, than a rushed NHS GP. It’s placebo, but that doesn’t mean it’s useless. If you wanted to maximise everyone’s health, then doctors would confidently lie to their patients about effectiveness of treatments, the way they did before we began championing choice and informed consent over efficacy; and people like me would stop debunking placebo alternative therapies. No chance.

The homeopaths strike back

October 2nd, 2003 by Ben Goldacre in bad science, celebs, dna, homeopathy, magnets, placebo, very basic science | 5 Comments »

The homeopaths strike back

Ben Goldacre
Thursday October 2, 2003
The Guardian

· You probably don’t have to be a physics expert like bad science spotter Professor Donald Simanek to spot that the new £2 coin, celebrating our scientific heritage, has an odd number of gears interlocking around the edge, creating a system that could not possibly turn.

· Down at Tower Bridge, illusionist David Blaine has genetically modified supermen working on his security team. They only got worried about people shining laser pointers at Blaine because, as one of them told the Daily Mirror: “In America a dot of light means someone’s aiming a gun at you using an infrared sight.” That’s “infrared” as in below the range of human vision.

· Meanwhile, according to Jack Straw, speaking in parliament last week, Iraq is a difficult place to find weapons of mass destruction in because it’s twice the size of France. That’s presumably the same Iraq that is 437,072 sq km, as opposed to France, which is (according to the, er, CIA World Factbook) 547,030 sq km.

· But there’s more. Writing about the unbelievably excellent Henry Wellcome artefacts exhibition at the British Museum, Time Out tells us about “a lock of George III’s hair that is undergoing DNA analysis to determine whether the king was, in fact, mad”. Looks like psychiatrists are out of a job, then: perhaps his DNA could tell us if he was bad and dangerous to know too?

· And just in case you thought I was going to give complementary therapy bashing a rest this week, may I proudly offer you the fantastic randomised control study from this week’s Journal of the American Medical Association which shows that magnet therapy does not work for heel pain. That’s one quack cure down, only 5,363,672 to go.

· One last thing. I have received, from the director of the Society of Homeopaths, what is possibly the longest letter ever written to any newspaper on any subject. How any alternative therapist who has ever read a newspaper in Britain could possibly claim that they get a bad deal, considering that dark ages superstition has now become the contractually-enforced journalistic norm, baffles me, but in the spirit in which this epic letter was clearly intended I present it here diluted one part in one hundred thousand, in the vain hope that it has more impact on you than it does on me: “Placeb…”