The “myth” of placebo effects

Heidi Stevenson amuses me.

The reasons are legion. Be it the time when Heidi lectured scientists on anecdotal evidence (which she values far more highly than scientists, of course, declaring it the “basis of all knowledge”); launched a vile and nonsensical attack on Stephen Barrett; argued against prior plausibility with using a straw man argument so massive that if it were set on fire (which she did) it could be seen from space; or made an even more idiotic argument to try to “prove” that wi-fi signals and EMF cause autism, Heidi never fails to deliver the stupid in mass quantities of black hole density. Of course, what does one expect? Stevenson is a homeopath, after all. Anyone who can believe the pseudoscience and wishful thinking that underlies homeopathy is already almost by definition lacking more than a little something in the logic department. Certainly she’s missing a lot in the science department as well. All of this is why she amuses me so much and why on occasion when she catches my attention I feel like laying down just a touch of that not-so-Respectful Insolence that you all know, love, and crave. True, sometimes I feel as though I’m slumming, but in actuality Stevenson’s very useful in that she is very good at demonstrating logical fallacies and misunderstandings of science that provide a number of what we in the science and skeptical blogging biz like to refer to as “teachable moments.”

Yesterday, Stevenson provided yet another in her long line of teachable moments in the form of a post entitled, Busting the Placebo Myth: Placebos Don’t Cure. In it, she rails against us nasty, pointy-headed skeptics who point out that placebos only make people think they feel beter and don’t actually make people better. The hilarious thing is that she uses studies that I’ve blogged before in order to come to exactly the wrong conclusion. Stevenson’s great that way. Even better, since I’ve blogged these studies before, I can try to get a handle on my logorrhea in this post. Well, no I can’t. As Hans Solo said, “Hey, it’s me.” I can keep it short for a while, but sooner or later the logorrhea always returns. Whether it will return during this post or not, you’ll just have to keep reading to find out. We’ll have to see if it works out. Either way, it’ll be entertaining and educational. I promise.

Clearly, Stevenson is really, really peeved at the criticism of her quackery that labels it as “placebo medicine.” Of course, as I’ve discussed time and time again the vast majority of so-called “complementary and alternative medicine” (CAM) or, as it’s called now, “integrative medicine,” is based on placebo medicine and the idea that wishing makes it so. I realize that Stevenson doesn’t like that, but that’s just tough. Reality is reality, quacks are quacks, and science is science, and never the three shall meet at the same time. In any case, Stevenson starts out:

One of the most frequent epithets tossed at people who make claims of alternative medicine is that it’s just the placebo effect. But that is based on the myth that placebos can cure. The reality, as clearly documented by science, is that they don’t. So the skeptics base their favorite claim on a myth, not reality, and most assuredly not on science.

Stevenson then goes on a brief rant about what she refers to as the “myth” of placebos, including that placebos don’t heal, that placebos are a “complete flop,” that no one is ever “cured” by a placebo. Of course, these are not myths. They are more or less true, except for the second one. Even skeptics don’t say that placebos area a “complete flop.” we’re all for studying placebo effects and determining ways to maximize it during treatment with actual…oh, you know…effective medicine. What we don’t approve of is relying on placebo effects alone, which is what the vast majority of CAM is. Not only is it unethical to lie to patients that way, but it doesn’t help the pathophysiology of the condition being treated. To most ethical, science-based physicians, that’s a double whammy against using placebos that can’t be overcome. The first funny thing is that, in order to make her point, Stevenson in essence buys into this point. Rather than trying to argue for the “pwoerful placebo,” some like to put it, or The Secret, as I like to put it, she actually does her best to rubbish placebo effects as insignificant as an introduction to arguing that any condistions “cured” by alternative medicine couldn’t possibly have been cured by placebo effects. This is a straw man even bigger than the aforementioned straw man whose demolition with napalm-grade flaming stupid could be seen from space. That straw man is that skeptics dismiss “healing” by alternative practitioenrs as being due to placebo effects.

The second funny thing about this article is that Stevenson relies largely on Ted Kaptchuk, the Harvard high priest of acupuncture studies in quackademic medicine in the United States. Just type his name into the search box of this blog, and you’ll see that I’ve discussed him many times before in the context of how the results of his studies do not show what he concludes that they show or what they are claimed to show by advocates and the press. It thus amuses me greatly that both of the studies that Stevenson chooses to use to demonstrate her point are ones that I wrote. One I wrote about a couple of years ago—along with practically every skeptical blogging doc out there. Amazingly, Stevenson more or less correctly interprets the study:

The study used FEV1, Forced Expiratory Volume in 1 Second, to measure effectiveness. The graph on the left clearly shows that the drug placebo and sham acupuncture (another kind of placebo) had no curative effect, as they didn’t cause any change in FEV1. However, in the graph on the right, you can see that the subjects felt that both the drug placebo and sham acupuncture were nearly as effective as the actual drug, albuterol.

Two things are clearly demonstrated. One is that a patient’s sense of well-being can readily be skewed by belief. The other, though, is that placebos have absolutely no healing benefit.

It kind of creeps me out that that’s more or less what I concluded in my analysis of this particular study. She also discussed the infamous “placebos without deception” study by Kaptchuk that was sold as evidence that you don’t have to lie to patients in order to invoke placebo effects but, when examined more closely, shoed nothing of the sort. For a moment, I was wondering if I was losing my sanity. What kept me from getting too worried was the tone of the article, very confrontational to science-based medicine and skeptics. Also, the sarcasm. Given how good I’ve become at not-so-Respectful Insolence, I’m very much in tune with other people’s sarcasm, and Stevenson was being quite sarcastic. I knew there had to be a reason and that there would be a payoff, and I wasn’t wrong:

The claims by skeptics that the placebo effect can explain away any and all results of alternative medicine are pure bunk. They’re based on a false belief, the idea that the placebo effect is so powerful that it can cure. That is nothing but a myth. They can palliate—make people feel better—but never cure.

The placebo effect can be powerful in terms of people’s sense of health and welfare. However, no one is ever healed by a placebo. Therefore, when someone is actually cured by an alternative treatment, the false bravado of the skeptics, who invariably come streaming along shouting about the placebo effect, usually full of condescension and insults, is nothing more than that—hot air based on a belief that is founded only in myth.

The simple fact is that placebos cannot cure. So those claims of successful treatment for diseases that are not subjective—such as cancer, autism, mastitis in cattle, skin conditions, or any other—cannot be denied with that off-hand line, “But, my dear, it can easily be explained by the placebo effect.” No, it cannot.

And there’s the flaming straw man.

In fact, I challenge Heidi Stevenson to produce an example of a skeptic dismissing an “alternative” therapy story in which cancer, autism, mastitis in cattle (where did that one come from?), or skin conditions were “cured” by alternative medicine as being just due to placebo effects? Cancer is a very good example. Many are the times that I’ve spoken about alternative medicine “cancer cure” testimonials, going all the way back to the very beginning of this blog and continuing forward. What you’ll find are explanations of the potential for spontaneous remission, what the difference between adjuvant therapy and curative therapy is and how alternative cancer cure testimonials confuse them, and a variety of other explanations. One thing you will not find is me trying to dismiss these cancer cure testimonials as being due to placebo effects. Indeed, if I ever saw a skeptic trying to do that, that skeptic might well himself become the target of a little bit of not-so-Respectful Insolence. And he’d deserve it, too.

In a way, maybe Stevenson can be forgiven for thinking that the only arguments skeptics have against alternative medicine is to label it all as “placebo.” She is, as has been noted before, a homeopath, and if there is a form of “medicine” that is nothing more than pure placebo, it’s homeopathy. However, that doesn’t mean that pointing to placebo effects is the only weapon in the skeptical arsenal against the unscientific and pseudoscientific claims of alternative medicine. it is but one of many, and it’s generally only invoked—and correctly so—when claims about the ability of this quackery or that to relieve pain, anxiety, or other subjective symptoms. No one—and I mean no one—tries to dismiss alternative cancer cure testimonials, for example, as mere placebo effect. Ditto the issue of autism, the “cure” of which is generally discussed in terms of development (autism is a condition of developmental delay, not stasis) and not placebo effects. Improvements in skin conditions are usually explained by how such conditions often wax and wane.

In the end, I can’t help but wonder how Stevenson’s fellow quacks will react to her dismissing the ability of placebo effects to cure as a “myth.” Somehow I suspect they won’t be so happy. At least, Mike Adams won’t.