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.