Thoughts on the Placebo Effect

Responding to the latest episode of Russ Roberts’ Econtalk.

Tweet thread starting here:

THREAD. @econtalker Lots of thoughts on this week’s episode on the Placebo Effect and the interview with Gary Greenberg. First, why would something like the Placebo Effect evolve in the human species? 1/12— Tim DeRoche (@timderoche) February 5, 2019

If your body has the ability to heal itself, why would it hold that power in reserve… until a particular type of social interaction triggers the healing response. 2/12

And it is indeed a *social* phenomenon. The patient interacts with another person in a particular way, and then suddenly an ailment begins to wane. As Greenberg says, “The ritual is very very important to the outcome.” 3/12

In the evolutionary environment, they didn’t have hospitals or doctors or trial-tested drugs. So the most likely “ritual” would have occurred between an ailing person and a relative or a shaman of some sort. 4/12

Most of the remedies would likely have been completely bogus or weak, especially relative to current remedies. What would have been the value of the Placebo Effect in that environment? Is it a variation of the Hawthorne Effect? 5/12

We have to assume that good doctors – consciously or unconsciously – make use of the Placebo Effect all the time. 6/12

Do MDs get any training in how to use the Placebo Effect to improve their patients’ health and quality of life? My guess is no, but I’d be pleased to learn otherwise. 7/12

If there was training, you’d want the MDs to understand: (1) In what domains is the Placebo Effect most effective?, (2) What are the ritualistic triggers that enhance the effect?, and (3) In what cases would use of a Placebo put the patient’s health at significant risk? 8/12

If you wanted to cut health care costs (anyone?), wouldn’t greater use of the Placebo Effect be a *huge* tool in the toolbox? Sugar pills barely cost anything. And don’t have any side effects. 9/12

What if – at the bottom of every standard form in the doctor’s office – there was an opt-out box you could check, “I do not grant my doctors permission to administer placebo treatments in order to enhance my health.” 10/12

Assuming that most people would not check the box, doctors would then have the right to administer placebos to most patients, especially in domains where the Placebo Effect is powerful and the risk to the patient is low. 11/12

You’d avoid a lot of unnecessary interventions and empower the patients to heal themselves. (Again, training the MDs would be absolutely critical.) 12/12

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Three Identical Strangers – an emotionally devastating meditation on Nature vs. Nurture

If you can get past the annoying re-enactments, Three Identical Strangers is a fascinating and emotionally devastating documentary.  On the surface, it’s the story of three triplets separated at birth and reunited in their early 20’s.  But it resonates far and wide.

When I was younger, I very much leaned toward the Nurture side in the Nature vs. Nurture debate.  In college, I remember telling my roommate Marc that I had an aversion to bugs because — when I was a kid — I was trying to catch a grasshopper, and he ended up getting squished between my hands.

Marc’s response was, “Yes, but what were the chances that you were going to encounter a squished bug at some point in your childhood?  Probably close to 100%.  So you were going to end up hating bugs no matter what.  What about somebody who has no aversion to bugs as an adult?  Don’t you think he squished a bug at some point? His reaction to that same experience was different than yours, probably because he has different genes.”

Hmmmm….. That made me think.  It’s not quite so easy to separate out the effects of genes and environment.

Later on, I was taking a psychobiology class, and the professor said something that I’ll never forget.  “Your genes create your environment.”  He was trying to say that every organism is instructed — by its genes — to pay attention to certain things that are very important to its survival and reproduction and to pay little attention to everything else.  The simplest example of this is that human beings have evolved to only see certain wavelengths of light.  Other animals have evolved to see a different set of wavelengths.  In a way, our genes have taken a guess at which wavelengths contain the visual information that we will need to survive and reproduce.  Those are the ones we’re capable of seeing as a part of our environment.  In some real way, UV light is not even a part of my environment, because I’m incapable of detecting it.

But the interaction between genes and environment also goes in the opposite direction.  That same professor talked about certain reptiles whose eggs were sensitive to the  temperature.  At certain temperatures, the eggs would produce males, and other temperatures the eggs would produce females.  Certain genes were being turned on or off by the temperature. The environment was determining gene expression!  (Of course, you could argue that this, too, is under genetic control, and so the genes are determining how much say should be given to the environment.)

This whole line of thinking was sparked by this week’s episode of Econtalk, in which Russ Roberts interviews the Oxford psychologist Teppo Felin about the vagaries of human attention and its dependence on our goals in any situation.

Anyway, no spoilers here, but Three Identical Strangers does have something very specific to say about Nature vs. Nurture and the domains of human experience where each one might have the upper hand.

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