The Strange World of the Placebo

Ben Goldacre a doctor and writer has just completed a fascinating two-parter look at the strange world of the Placebo on BBC Radio 4.

Starting with the story of Eliasha Perkins in the 18th Century and his ‘Perkins Tractor’ a device reported to provide miracle cures by taking away bad electrical influences. It’s funny how bad electricity/magnetism/energy seems to be a popular theme in complementary/alternative therapies. The Perkin’s Tractor provoked one of the first attempts at evidence medicine by Dr John Higham 18?? who conducted a blinded trial of the Perkins tractor and found that the effects could not be accounted for by the tractor itself but by the attitudes and beliefs of patient.

From this start Goldacre covers the effectiveness of the placebo effect in pain control, mood disorders and many areas of medicine. As a strong advocate of evidence based medicine some of the evidence seems quite improbable.

  • Placebo inhalers causing bronchio constriction or dilation depending on what the patient was told.
  • Heart pacemakers that were not switched on having the same effect as active pacemakers including physical changes in heart muscle.
  • Placebo treatments provoking the production of dopamine in the treatment of Parkinsons disease suffers
  • … and so on

It’s an impressive track record for inert substances. The Placebo effect – perhaps it should be called effects – seem to depend on a mixture of conditioned response, beliefs, expectations for the patient and the kind of ritual associated with the therapist/doctor giving the treatment.

In the second episode he continues the exploration of the effects and the relationship between the placebo effect and alternative medicine by way of shamanism and sham acupuncture. Finally he discusses the ethical dimensions of balancing the placebo effect and informed patient decisions.

Ben Goldacre has a bit of a reputation as a debunker of alternative medicines in his (excellent) Bad Science column in The Guardian, but rather than being a hostile sceptic of the field his open minded and thoughtful approach is very engaging. It’s a fascinating introduction to the improbable word of the placebo and how we might make better use of it.

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