Science Makes Everything Better

[tongodeon]

Over lunch this week I was talking with a cow-orker about alt-med therapy like acupuncture or reiki. He was already on board with me as far as whether it works (it does) and how it works ( via the placebo effect), but he felt that science was doing a disservice by discovering this because revealing a formerly respected technique as placebo prevents

Comments

[xiphias]

What I want to see is controlled double-blind studies of how effective placebos are when people know they're placebos.

Three groups. One is given an inert treatment, and not told it's inert. One is given an inert treatment, and told that it's a placebo, and that they're testing the effectiveness of placebos when people know they're placebos. One is given no treatment.

I would predict that the first group would do best, but the second would nonetheless do better than the third. But I'd not be surprised if the middle group did as well as the first group. Or as poorly as the third group, either, actually. So, really, I guess, I don't have any idea what would happen. But I'd be curious to find out.

[tongodeon]

Three groups. One is given an inert treatment, and not told it's inert. One is given an inert treatment, and told that it's a placebo, and that they're testing the effectiveness of placebos when people know they're placebos. One is given no treatment.

Actually you really want five groups.
- give a placebo, say it's active
- give a placebo, say it's placebo
- give an active treatment, say it's an active treatment
- give an active treatment, say it's placebo
- no treatment

I'd suspect that for a legitimate treatment presented as placebo you'll see a bit of nocebo effect depending on what's actually being administered.

And to be clear, I'm not saying that acupuncture is a placebo. I'm saying that acupuncture needles, points, and standard practices are placebo elements of a demonstrably beneficial treatment, and that you can improve that treatment by discarding those inessential elements and concentrating on what's actually working (once you've verified that something actually is working).

[xiphias]

Yes, fair enough, since acupuncture DOES have better-than-placebo level results -- just ones that don't change if it's done right or wrong.

[tongodeon]

acupuncture DOES have better-than-placebo level results

Placebo is not a particular level, it is a sham medical intervention. The placebo effect is also not limited to any particular level, it is an explanation for a result. It would be perhaps more accurate to say that acupuncture works via the placebo effect to a surprising degree.

[leighton]

The spouse just gave up on acupuncture to cure her sweaty palms (good thing she isn't on LJ, or I'd have sweaty palms typing this "in public"). It worked for a while, but she lost interest (faith?) in the treatment and costs while still going. Then it stopped working, so she stopped going.

The placebo effect for religion probably works the same way. Veyrons do not.

[tongodeon]

To be clear, I definitely did not intend to imply that the Bugatti Veyron was fast because of the placebo effect.

[leighton]

"We put two W8 engines together behind the seats, under that cover. Now, see if it cures your slowness".

[tongodeon]

Also, perhaps your spouse should read my LJ, especially since I can't spoil her fun since the acupuncture has already stopped working for her. My point is that *something* worked, but it probably wasn't the needles or the points or the custom-tailored treatment. Since sweaty palms are a common stress reaction it's possible that the experience of relaxing in a chair or on a table for a while is what did it. And she can do that at home for free, where she's got more control over the environment to be even more relaxed, plus it's free which means she's not stressing about whether it's worth the money.

[tongodeon]

That's actually a deliberate, old reference to the long-defunct talk.bizarre community. For some reason we referred to people we work with as "cow orkers".

[zestyping]

The problem is, what if the demonstrably beneficial effect only occurs when people believe something that is false? Is it then ethical to continue spreading the false belief?

[deeptape]

Probably.

But as tongodeon writes it is true that "friendly human contact, relaxation, and focused attention" yield positive benefits.

If acupuncture or similar activity is understood as a stylized form of that contact and that's why it works and in that frame it continues to work, then it's probably fine.

And perhaps would result in the withering of the baroque style involving needles?

[tongodeon]

what if the demonstrably beneficial effect only occurs when people believe something that is false

My point in a previous post is that this is, at best, shaky ethical ground. My point in this post is that I think this is a flawed premise. Certainly some people experience a demonstrable beneficial effect from believing something which is demonstrably false, but I question whether it's necessary that the thing they believe is false. If something works because you have confidence in it for misplaced reasons, and then you don't just uncover correct reasons but reproducible, peer-reviewed evidence proving that the new explanation is correct, you ought to have even more confidence in it, right

[tongodeon]

I was listening to a thing this morning about medical ethics that clarified this issue a little.

On one hand it's considered unethical to subject someone to risk without benefit. For example you shouldn't give someone colloidal silver because it puts them at risk for argyria without actually inhibiting bacterial growth. They need to at least be advised of what the evidence shows so that they can make an informed decision. "There is quite a bit of evidence that this is harmful and no evidence that it'll actually do what you want it to do. Do you still want to do this

[coho29]

Kind of a longshot, but I saw this story alleging a "hidden sensory system in your skin" and thought of your skeptical posts on acupuncture. I'd be curious to know your thoughts on that article. It doesn't mention acupuncture, but if they are quote-unquote "on to something," then it seems to me like it could lead to a validation for that practice.

[tongodeon]

It would be one thing if acupuncture was a genuine scientific mystery like dark matter or the pioneer anomaly, where we'd demonstrated that there's something genuine and we're looking for a mechanism to explain how it works.

But as I mentioned in an earlier post, acupuncture "works" as a strongly-proven placebo. In other words acupuncture works just as well whether you do it right, wrong, or not at all. There's no independent effect to validate or explain as far as I know.

And even if there was something to validate, we wouldn't need the "hidden sensory system in your skin" to explain it any more than the patellar reflex; there's already an obvious sensory system in our skin that would suffice.