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Fabrizio Benedetti asks: “Does placebo research boost pseudoscience?”

Professor Fabrizio Benedetti is the most famous and almost certainly also the most influential researcher investigating the physiology of placebo effects. In a recent commentary, he asks whether placebo research is fueling quackery, as quacks co-opt its results. The answer to that question is certainly yes. A better question is: How do supporters of science counter the placebo narrative promoted by quacks, in which placebos represent the “power of the mind to heal the body”?

Fabrizio Benedetti is professor of physiology and neuroscience at the University of Turin Medical School in Turin in Italy, who is best known as a researcher studying placebo effects. In fact, arguably Benedetti is the most famous and influential researcher focusing on placebo studies. Just to give you an idea, let’s note that, for example, Harriet Hall discussed an interview on placebos that Benedetti did, with a followup on the ethical issues that the use of placeboes engenders as well as the misinterpretation of his research by a journalist. His work has been used by purveyors of pseudoscientific medicine for at least as long as I can remember writing about pseudoscientific medicine, which means close to two decades. So it was with great interest that I was made aware by multiple people of a commentary written by Benedetti in Clinical Pharmacology & Therapeutics entitled “The Dangerous Side of Placebo Research: Is Hard Science Boosting Pseudoscience?” In it, Benedetti laments something that we’ve been lamenting ever since this blog started, namely how quacks are co-opting placebo research to justify their quackery. While I was happy to see a someone as renowned as Benedetti finally notice this and become disturbed enough about it to use his considerable cachet to publicize this problem, on the other hand I can’t help but be a bit frustrated that it’s taken him this long to speak out this way on the record in the peer-reviewed medical literature. (He’s also published in a quack acupuncture journal; he is not entirely innocent of himself promoting what Steve Novella has described as the placebo narrative.)

Of course, over the years, I’ve described how quacks co-opt studies on placebo effects to justify their quackery. Indeed, I’ve observed many times that, as more and more rigorous scientific studies have shown that, for example, homeopathy has no effects distinguishable from nonspecific placebo effects, some homeopaths have switched from arguing that homeopathy has actual physiological effects that positively impact disease and its symptoms to arguing that the mechanism through which homeopathy “works” are placebo effects, which are rebranded in quack parlance as “powerful mind-body” effects or the power of positive thinking. Of course, as you will see and as Benedetti emphasizes, placeboes do not heal and do not produce more than transient effects on symptoms without affecting the overall course of the illness. They can’t cure cancer and do not affect the respiratory pathology of asthma. Worse, there is no such thing as placebo effects without deception, as we have repeated here many times, the attempts of acupuncture maven Ted Kaptchuk to “prove” otherwise notwithstanding, making the ethics of placebo use highly problematic at best. We also like to emphasize, as Benedetti himself does, that there is no single “placebo” effect, but rather placebo effects, which range from expectancy effects, to observation and reporting effects, to observer bias, and several others, making the whole topic very complex and often misunderstood.

Also, Benedetti gets on my nerves a little bit in that he makes placebo research sound far more wonderful and promising than it is. We see this in his introduction, where he goes on and on about how the “hard science” is validating placebo effects, even citing two of Kaptchuk’s articles on “open label placeboes without deception” favorably. I must admit that I did a little facepalm when I perused the reference list and saw that. However, he starts to right himself soon enough:

Although this is wonderful news for science, this may not be the case for society. The number of nonmedical organizations and healers that rely on this hard science, and actually justify their odd and bizarre procedures, has increased over the past few years. The main claim is that any procedure boosting patients’ expectations, which represent the main mediator of placebo effects, is acceptable because it can activate the same biochemical pathways and neural networks that have been made credible by hard science. Our department has witnessed an alarming increase in proposals from quacks and charlatans who devised new placebos which, they aver, may have powerful effects on those mechanisms so much emphasized by hard science (Figure 1). The first bunch of proposals our department received started in 1999, and they amount to 298 until the end of 2018, with an increase over time. In Figure 1, the sharp increase in 2009 is attributable to an article that appeared in the New England Journal of Medicine,9 asserting that ours was the foremost laboratory in the world studying placebos, which I believe may have had a great impact on the quackery community. It can be seen that a second sharp increase occurred in 2015, which can be attributed to the publication of this information in Wikipedia,10 which surely spread these concepts in the layman.

New England Journal of Medicine

And here’s the figure:

Placebo increase

Benedetti appears to be correct. There was a big increase in proposals to him in 2009, which does correspond to the publication of his NEJM article. I suppose it could have been something else but it seems reasonable enough that the increase of his fame as the premier placebo researcher in the world as the result of a publication in such a high impact journal would lead to quacks contacting him. He’s also correct. Quacks are glomming on to every new scientific finding with respect to placeboes and placebo effects:

The crucial point here is that when hard science started investigating placebo effects, it unconsciously produced a shift in quackery thinking. In fact, charlatans are becoming more and more aware that their bizarre interventions could work through a placebo effect. Indeed, whereas hard science has so far denied any scientific basis for nonconventional therapies, now the very same hard science certifies that the placebo effect has scientific grounds. Therefore, quacks are no longer interested in showing that their pseudo-interventions work; rather, they justify their use on the basis of the possibility that these bizarre interventions may induce strong placebo effects.

Which is what we’ve been saying for years, as I pointed out above. Indeed, sometimes the claims for placebo effects can include amusing hyperbole, such as when Robert Schiffman wrote, apparently with a straight face, that placebo effects are not only scientific, but they’re proof that God exists. I can’t resist quoting this little snippet from his article:

The placebo effect is arguably the most underrated discovery of modern medicine. Replace “just the placebo effect” with “the amazing placebo effect,” “the mind boggling placebo effect.” To my way of thinking, the very existence of this mysterious effect proves that God exists. That’s right, you can find evidence for the foundational truths taught by religion in virtually every double blind medical research study!

Then of course, there’s Deepak Chopra, who is all over placebo effects as “evidence” of “powerful mind-body healing” or “how the mind can heal the body“:

The placebo effect is real medicine, because it triggers the body’s healing system. One could argue that this is the best medicine, in fact, since: a. drugs do not trigger the healing system and b. the placebo effect has no side effects. Staying well means that the body is taking care of itself – and you – through a feedback loop of chemical messages. Circulating throughout the bloodstream, lymphatic system, and central nervous system, chemical messages are crucial to the healing system, because they keep every cell in communication with every other.

Then there’s Joe Mercola:

Your beliefs are energy fields, and they are working to promote either health or disease in your body right now. Which one is up to you. When it comes to the ability of your mind to heal you, there are NO limitations. The sky is the limit.

And Andre Evans:

In clinical studies where patients are given placebos, they often will respond positively to them due to the expectation that they are receiving some form of beneficial medicine. Although not talking about placebo sugar pills specifically, this kind of self-treatment can be seen in one case where a woman’s own thoughts made her lose nearly 112 pounds.

Evans concludes:

If you believe that your illness is getting worse, it will probably get worse. If you believe that your treatment is helping you, you could actually cause massive self-healing to occur. Assuming a disposition will automatically prejudice your mind, and therefore cause your body to react either positively or negatively.

I’ve likened this view of placebo effects to the New Age belief system known as The Secret, which posits that if you only want something badly enough the universe will manifest it to you and it can be yours. Indeed, placebo effects are a major aspect of what I like to call the central dogma of alternative/complementary/integrative medicine, in essence, that wishing makes it so. It’s therefore no surprise to those of us who have followed the topics of quackery, CAM, and integrative medicine over the years that quacks immediately embrace any placebo research that they can portray as “proving” the power of the mind to heal the body and that whatever woo they are peddling “works” through placebo effects.

Benedetti notes with alarm the number of conditions for which quacks are advocating placebo medicine, including cancer, infectious diseases, central nervous system disorders like Alzheimer’s and Parkinson’s diseases, infertility (and to prevent pregnancy), and more. Here’s where we get to the meat of Benedetti’s article, in which he asks several questions and tries to answer them, including:

  1. What is the ethical limit to hand out placebos and to increase expectations?
  2. Can we accept every means available, whether a sugar pill or a bizarre concoction?
  3. What about those patients who trust bizarre rituals but not conventional drugs?
  4. Should their expectation-related brain mechanisms be activated by means of odd rituals?

Here’s the money paragraph:

Although a definitive solution to these ethical issues is surely difficult to find, I believe that at least two aspects need to be considered in depth:education and communication. We need to educate and communicate with patients and health professionals in order to make them better understand the placebo phenomenon and the related problems. A first point that should be emphasized is that placebos do not cure, but rather, they may sometimes improve quality of life. There is plenty of confusion on this point, and unfortunately, many claim that they can cure virtually all illnesses with placebos. Hard science tells us that placebos can reduce symptoms such as pain and muscle rigidity in Parkinson’s disease, yet the progression of the disease is not affected; for example, in Parkinson’s disease, neurons keep degenerating even though some symptoms can be reduced for a short time.4 The second point is related to the first. The type of disease is crucial, and we need to make people understand that pain is different from cancer and that anxiety differs from infectious diseases. The psychological component of some illnesses can indeed be modulated by placebos, but placebos cannot stop cancer growth, nor can they kill the bacteria of pneumonia. The third point is related to the difference between real placebo effects and spontaneous remissions. So far, hard science has studied the placebo effect within a time span of hours/days, thereby limiting our knowledge to short-lasting effects. Consequently, long-lasting effects can be often attributed to spontaneous remissions.

I’m not sure exactly what Benedetti meant by that last part about spontaneous remissions. The first time I read this, I thought that he was implying that placebo effects could cause spontaneous remissions, but a reread suggests that he meant that fortunate patients who chose quackery and were fortunate enough to have a spontaneous remission misattribute their good outcome to placebo effects. Of course, although I haven’t seen an example of a patient attributing remission of cancer to placebo effects, I certainly have seen (and documented) many cases of patients who underwent both conventional therapy and alternative medical treatments for, say, cancer and did well attribute their good fortune to the alternative medicine rather than the conventional “cut, burn, poison” (as quacks like to call it) therapy.

Benedetti is, of course, correct that placebos, as far as the “hard science” shows, do not heal or cure. Indeed, as we have argued, it’s certainly highly debatable whether they have any clinically meaningful effect at all. In clinical trials, after all, a placebo is nothing more than an inert treatment that serves as a surrogate for all the other confounding factors in patient treatments that can affect results: natural history of disease, physician and patient bias, regression to the mean, Hawthorne effect (observer bias), and more. It has even been argued that placebo effects are primarily an artifact of the clinical trial process. Indeed, a 2010 Cochrane review on placebo effects for all interventions notes that placebo effects vary from large to non-existent, even in well-conducted clinical trials and that these variations were partly explained by variations in how trials were conducted, the type of placebo used, and whether patients were informed that the trial involved placebo. The review also noted that it is “difficult to distinguish patient-reported effects of placebo from biased reporting”. Overall, the authors did not find that placebo interventions had important clinical effects in general. Similarly, in 2001, an analysis of clinical trials published in the New England Journal of Medicine comparing placebo with no treatment found “little evidence that placebos have powerful clinical effects” and had “no significant effects on objective or binary outcomes”. Basically, the preponderance of science suggests that placebo effects are probably mostly illusory, artifacts of clinical study design. I can’t help but note that even Benedetti himself does not advocate the use of placeboes in clinical practice yet, having stated that they are useful to study in clinical trials but that there are too many practical and ethical issues in clinical practice.

Still, it’s hard to disagree with Benedetti’s conclusion:

Overall, today the placebo phenomenon still remains a paradox and an effect not easy to handle. Besides the recent findings of hard science, many ethical concerns limit the implications and applications. We certainly need to pursue further research in this direction, yet the possible dangers of misuse and abuse should always be kept in mind. Unfortunately, quackery has today one more weapon on its side, which is paradoxically represented by the hard science–supported placebo mechanisms. This new “scientific quackery” can do a lot of damage; thus, we must be very cautious and vigilant as to how the findings of hard science are exploited. The study of the biology of these vulnerable aspects of mankind may unravel new mechanisms of how our brain works, but it may have a profound negative impact on our society as well. We cannot accept a world where expectations can be enhanced with any means and by anybody. This is a perspective that would surely be worrisome and dangerous. I believe that some reflections are necessary in order to avoid a regression of medicine to past times, in which quackery and shamanism were dominant. Unfortunately, the new knowledge about placebos by hard science is now backfiring on it. What we need to do is to stop for a while and reflect on what we are doing and how we want to move forward. A crucial question to answer is, Does placebo research boost pseudoscience?

The answer to that last question is certainly yes. I don’t need to “reflect” upon anything to know that, as I’ve been reflecting on placebo research for close to 15 years now. I would also point out that medicine is already, in at least one aspect, regressing to “past times, in which quackery and shamanism were dominant”. True, quackery and shamanism are not (yet) dominant again, but there is a whole specialty, “integrative medicine” or “integrative health,” that, while claiming to be evidence-based, nonetheless “integrates” pseudoscience and quackery such as acupuncture, “energy healing,” naturopathy, and even homeopathy, among many other forms of unscientific and pseudoscientific practices into its armamentarium of treatments, along with evidence-based lifestyle interventions, such as nutrition, exercise, and the like, thus making the quackery indistinguishable to the lay person from sensible, evidence-based recommendations. Worse, this specialty is becoming increasingly “respectable”, with institutes, divisions, and departments of integrative health popping up like kudzu in academic medical centers.

Of course, if an area of science increases our understanding of a scientific phenomenon and has arguably beneficial practical uses, it should be pursued. A lot of science can be misused (e.g., nuclear power, the scientific understanding of which is also used to create incredibly destructive weapons). The question to ask, I would argue, is not “Does placebo research boost pseudoscience?” The answer to that question is self-evidently yes. Rather, we should ask, “How can we mitigate the boosting of pseudoscience that placebo research inevitably produces?” Benedetti has some ideas on that topic, correctly pointing out that communication with patients is key, noting that “not only should we discuss and consider the positive effects of placebos and the impact they may have in clinical trials and medical practice, but we should also pay much of our attention to the negative counterpart, that is, the misuse and abuse by quacks, charlatans, shamans, and nonmedical organizations”.

I’ve been doing that for nearly 15 years, and welcome Prof. Benedetti to the effort.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

58 replies on “Fabrizio Benedetti asks: “Does placebo research boost pseudoscience?””

Benedetti: ”The crucial point here is that when hard science started investigating placebo effects, it unconsciously produced a shift in quackery thinking.”

Benedetti’s article also refers to ”the recent findings of hard science” concerning placebos. It sounds like he’s patting himself on the back for being the pioneer in investigation of the placebo effect, while failing to acknowledge a great deal of work by investigators who came before him.

“Hard science” was studying the placebo effect at least as far back as 1955, when Henry Beecher’s paper “The Powerful Placebo” was published, reviewing 26 relevant studies.

http://jamanetwork.com/journals/jama/article-abstract/303530

As far as suggestions for countering quacks’ use of the placebo effect (ain’t that a shaman?), I’d suggest more emphasis on the temporary as well as undependable nature of placebo effect, noting that many patients continually switch to new, briefly effective placebos after the old ones fail, while ignoring therapies that perform better and actually affect the course of their disease.

Promoting as effective a therapy that has only placebo effects is contrary to principles of informed consent and patient autonomy. Also, conducting placebo-controlled studies of placebo-based treatments is inherently biased as the results strongly depend on what type of placebo control the study uses. Embracing deliberate use of placebos means embracing bias, misinformation, fraud, and paternalism. Lie down with dogs, get up with fleas.

Sorry, dogs, I meant no offense.

@Greg

You confuse “contrarian” with nutter and “choir” with rational thinkers. You cannot seriously think that anyone here is going to click on a Natural News link?

BUT we do click on these links!
Mostly to scoff or see how they are distorting reality in- hopefully- new ways because they tend to get repetitious. For example, anti-vaxxers compare vaccination to the Holocaust, slavery/ racism and rape and PRN compares Wikipedia to the Inquisition, Blacklisting, the Gulag Archipelago and most recently, to Devil’s Island, making woo-meisters so many Dreyfuses ( see PRN today and latest news and articles).
They can be very creative as we see in their confabulatory accounts of scientific ideas, history and data.

He’s as creative and predictable as a 6-year old with a book of knock-knock jokes, except the 6 year old is probably cute and will grow out of the knock-knock jokes by the end of the week.

MuTaTo is a game played on a grid using the letters from the classical Greek alphabet instead of Xes and Os.
Spicing things up? Cat litter is not a condiment*.
As to Natural News, I am guessing that they use “natural” in the sense that it’s used in the expression “natural child” as a euphemism for bastard.

*I was going to use a ruder term than cat litter but changed my mind..

Or maybe they use “natural” in its archaic meaning of “one born without the usual powers of reason and understanding” (from Merriam-Webster).

Interestingly irrelevant – by the way, I’m not feeling ‘charged’ am I therefore not part of the choir or am I just immune from your placebo effect?

C’mon, drug dealers! Hear me out. Yeah – I called you drug dealers — you are! What! – you say you’re making people better and healthier? Well drug dealers say the same thing! Anyway, regardless of whether you agree with Adam’s hypothesis that pharma isn’t interested in curing cancer, he does raise some startling numbers. Cancer rates have gotten ridiculously worse over time, where now 1 in 3 women and 1 in 2 men are expected to get the diseases over the course of their life. Where is the alarm and accountability?! It’s the same with kids’ health, The CDC just recently released figures confirming that 1 in 6 kids have a developmental disability. I repeat! – that’s 1 in 6 US kids with a serious disability that the CDC is still treating as a head scratching mystery, not sure why the numbers keep increasing. Again – why are heads not rolling?! What other industry except the medical one would anyone accept such abject failures and incompetence? Orac is foaming at the mouth about placebos and pseudoscience? I am sorry, that’s like a bus company watching its vehicles careen off a cliff over and over again, and complaining that the seatbelts on the vehicles of the other bus line are suspect.

–What if Orac’s minions are “drug dealers” ( really, supporters of the use of meds)? Perhaps they’re allowing people with serious conditions to live longer. Suppose your mother had diabetes like mine and your father developed heart failure at age 80 like mine- meds gave them collectively several decades of life. I didn’t lose my mother when I was in secondary school; my father lived really well until the last three months of his life despite extremely advanced age- longer than any man in either family going back over a century and a half.
— Aren’t cancer rates related to increased longevity generally over the past century- if you live longer you may get cancer? And better diagnosis? How many older men die of other causes with prostate cancer at age 80+ ? An older Irish couple I know both have skin cancer: they are included in those figures although they have very minor cases.
— “One in six” is how we measure things which I needn’t even explain: if you take one particluar SD it will always be one sixth because mathematics! SRSLY

Since Greg accuses us maybe he wants to divert attention from his own activities: for whom does he work ?
Perhaps he wants children to be unvaccinated and either wind in hospitals or be treated at home with supplements, herbal medicines and homeopathy by their parents, similarly adults with serious illnesses. Hospital corporations, vitamins, botanicals and homeopathy are BIG Businesses and rake in plenty of money across the globe. Natural health advocates like those I survey ( Mikey, Gary and Joe) also scare people away from SBM and rx meds: maybe Greg works for them: two of them have published reams of articles accusing Orac & Co of all manner of criminality so Greg might just be taking marching orders from them who each earn millions of dollars annually and live in luxurious estates visible on the internet to anyone who looks.

Dangerous One, so in the same vein you’re agreeing with ‘antivaxxers’ that disease mortality plummeted drastically before the introduction of vaccines.

Cancer is an illness, that is also connected with aging, so when people live longer, they are more likely to get cancer. Because science has advanced, more people can be cured.
‘ Antivaxxers’ state that disease mortality has plummeted, before the introduction of vaccines, to argue that vaccines don’t help with preventing vaccine preventable illnesses. This is wrong, because the mortality might have dropped, before the introduction of vaccines, but it’s not about how many children die, but about how many people get the disease and the drop in children getting a vaccine preventable disease is the result of vaccines. That is why in areas where less children are vaccinated, more children get vaccine proventable diseases. For instance in a certain area in the Netherlands, where people are opposed to vaccinating, because of religious reasons, there was a polio epedemic in 1971.

Cancer is an illness, that is also connected with aging, so when people live longer, they are more likely to get cancer. Because science has advanced, more people can be cured.

Is there a problem here with this argument? Are people really leaving longer or is it just a case that improved infant mortality leads to more people reaching their 70s, 80s and 90s. What is the implication of this?

Consider we have a population sample size of 10 individuals. Let’s say back 150 years ago due to high childhood mortality rates only five of those individuals would make it into their 70s, 80s or 90s, and we also had 1 of those 5 getting a cancer. Let’s say current day with improved childhood mortality we now have all 10 individuals reaching their 70s, 80s and 90s, and it also turns out that 2 of those individuals will get a cancer. Now — is it fair to say overtime more people are getting cancers because they are living longer and cancer is connected to aging?

Yes it is. The probability of ‘getting cancer’ is the same, given that you survived. The number who get cancer increases. It’s all about the priors baby.

Very astute Steve. I will concede the error. I meant to have it that 3 out of the 10 would develop cancer. Of course then the rate would change, and that’s exactly what we’re seeing now. Cancer rates are getting worse and this is not consistent with the longevity argument.

You’d have a reasonably hard time finding people in their 70s, 80s and 90s back in the 1860s. Must be that modern medical care industry trying to reduce the worlds population, causing all the problems we see today.

1860’s isnt ancient times. Life expectancy has been studied for this time period. Life expectancy at birth was pretty low. Around 40 to 50 as far as I can find (in the US). Hence, reasonably hard to find people over 70. Not impossible. At the present time its around 80.

AND speaking of placebos/ maybe OT but it’s a slow day…

@ highwire talk with Del Bigtree : latest episode lots of woo but at 42 minutes in to 1:11 a holistic vet, Dr Dym, who is
— mostly anti-vax ( vax causes chronic illness)
— raw, clean foods not the bad stuff you buy
— a homeopath
— not fond of flea meds
— energy medicine provider
— supplements cure
— against neutering males
— anec-data
Even the poor doggos and kittehs ( or their parents) are victims of pseudoscience

Isn’t Del harming enough children but cats and dogs TOO now?

It bugs the dickens out of me that the local fancy pet food store (where I purchase Her Majesty’s duck and pheasant low-carb dry food) is always pushing CBD stuff for dogs and cats. One of these days I’m going to be rude and ask for citations on safety, given that plain weed is bad for dogs and makes them sick.

As for the holistic vet who isn’t into flea medication, I bet their life is very itchy.

Right. Even Del says he uses flea drops because the amount of fleas in Malibu is astonishing although he knows that it may shorten the dogs’ lives while the vet says you need to balance their energies more and they won’t attract fleas!

We raw fed our dogs for quite a long time. Chunks of beef, chicken etc. Our terrier has a much healthier bowel on the decent tinned meat and a dry food that he gets now.

I’ve had vets ask if we want to try a homeopathic remedy. Once.

It’s ironic that we urge humans to eat less meat and more Beyond Burgers and Incredible Whoppers, but if you listen to the dog food makers our dogs need an exclusive meat diet..
Dogs’ ability to eat and survive on plant foods is why they were able to spread to nearly every environment on six continents.
Our cairn terrier has reached fourteen years while barely losing a step on ‘traditional’ commercial dog foods. She also loves green beans and broccoli and usually manages to cadge some whenever we have them. She is a silent but sad-eyed partner in every orange we eat, and has just discovered the tomatos in the garden.
We considered getting a Roomba, but we already have a self-propelled floor cleaner.

Ugh, I wish I believed in hell so that I could rest easy that people who foist bullshite on pets would end up there.

“Does placebo research boost pseudoscience?”
I’m going to go Windrivenish on this, and say “no.” Sure, “quacks co-opt studies on placebo effects to justify their quackery,” and distort legitimate science findings into fun-house mirror versions that suit their woo – e.g. the twisting of placebo effects into “how the mind can heal the body“ woo. But the thing is, they do that with EVERYTHING. As I’ve noted here any number of times, they do the same trip on concepts from the humanities – co-opt, misuse, redefine, scamify…. They’re good at the whole co-opting thing, too, to the point where they can swing the general public perception and use of certain concepts and terms to their BS-versions. The one I’m thinking about specifically is “wellness”, which IIRC was mostly a valid idea say 20 years ago, and now seems the semiotic property of Goop and its ilk. Anyway, Wind would say that actual scientific research just produces objective knowledge of the physical world, and if humans muck up how that knowledge is used, that’s not the fault of science. I don’t actually agree as a general principle, but I’ll go with that in regards to woo exploitation. Which is not to relieve this Benedetti dude beyond critique. Maybe he talks or writes about placebo research in ways that are far more open to woo-optation than they could be, but that’s a separate thing that whether or not the research is any good, or worthwhile for legit purposes, etc. (Neither of which I’m knowledgeable enough to judge…)

The ethics of placebo use in medicine I agree is a grey area at best. That didn’t stop me from taking advantage of it on a few occasions, usually to hold the line until something more effective than Berocca C came up from the pharmacy.
There are just times when you have to grit your teeth and scrape the bottom of the barrel.

Orac…pseudoscience is boring! Real science is interesting. Flu science and flu propaganda are intriguing.

Speaking of flu, “Flu season” is almost here. Reading about egg free options like FLUBLOK, which uses fall army worm ovaries for cell cultures. Ew. There is also FLUCELVAX that utilizes dog kidneys. Yuck. Both brought to you by stinky SANOFI PASTEUR. Hmmm? Worms or dogs? Maybe risk the egg and have the epi pen at the ready? https://www.npr.org/sections/health-shots/2013/01/18/169695011/a-worms-ovary-cells-become-a-flu-vaccine-machine

And then there is this brought to you by SANOFI PASTEUR :
https://en.wikipedia.org/wiki/Dengvaxia_controversy

Believe it or not, I knew people who sampled two of these delicacies: my late uncle had the cheese in Italy and a school friend’s father, uncle, cousin and brother regularly had the sheep’s head ( and they weren’t Italian- which is the usual source of that around here- but mostly German).

Because I’ve long been an aficionado of Chinese food, I would run across interesting dishes – one place in NYC’s Chinatown had a huge list of intestines done spicy, other innards, sea cucumbers ( really not attractive looking), beef penis and the highly touted “Big Leg” ( but who knows of what ). Recently, at a hipster ramen place ( which looked like a setting from Twin Peaks) I had octopus dumplings which were sort of black and gelatinous. And not bad. I also had the “thousand year old” eggs at an artsy soiree- also gelatinous and sort of grey- black IIRC.

@squirrelelite – Yucky indeed! I have only tried octopus. Too chewy and too intelligent. I have family and friends who have eaten the maggot laced pecorino and sheep’s head. Former coworkers raved and bragged about balut. As for the rest of the “delicacies”, ahem…no thank you. However, gimme a baguette coupled with a ripe, runny and stinky camembert and I’m in heaven! And then there is pate, oysters on the half shell, sea urchin, toro sushi, any kind of sushi, eel over rice – all sound really good right now. Damn, I’m hungry.

So you’re not against all cell culture, just some of it?
Yes, the life sciences can be gross, but then again, life can be gross.

Fall army worm ovaries sound like a great virus growing medium. Insect cells are well characterized and sufficiently different from humans that you get to skip a lot of cross-reactivity concerns. But that makes them not great for making other things.

Speaking of placebos: what’s up with the claim that artificially-sweetened, non-carbonated beverages (that contain zero sugar, carbs, calories, or caffiene), have negative health impacts?

That strikes me as a placebo effect and I’m highly skeptical. It reminds me of “foodie” wooey-woo claims about “evil chemicals” vs. “natural foods.” (The only plausible mechanism I can see is if people “make up” for the “lost” calories of the zero-calorie beverages by over-eating something else in their diets. If that’s correct, then don’t waste your time reading the rest of this;-)

One of two things is true: Hypothesis 1) The artificial sweetener has a chemical effect on the body, due only to the chemistry, or Hypothesis 2) the taste of sweetness has an effect on the body due to subjective experience it produces. I’ll assert that (2) is essentially a placebo claim, on the basis that strong belief (the conventional placebo effect) is approximately equivalent to subjective experience (see also research on the effects of beliefs on perception, e.g. witness bias, etc. etc.).

This should be testable, assuming that the negative health impact is reflected in any sort of test result that is obtainable within a few hours following drinking such a beverage.

Group A, control: drinks a glass of water.

Group B, baseline test: drinks a glass of artificially sweetened non-carbonated beverage.

Group C, control: takes capsules containing an inert substance that has zero calories. (No chemistry, no subjective experience.)

Group D, test: takes capsules containing a quantity of artificial sweetener. (Chemistry without subjective experience.)

Group E, test: swishes artificially-sweetened beverage in mouth, then rinses mouth out with water and takes a drink of water. (Subjective experience without ingestion, thus without chemistry, and we can discount absorption through the tissues in the mouth.)

Group F, control: swishes water in mouth, then rinses mouth out with water and takes a drink of water. (No chemistry, no subjective experience.)

— If the measure of health impact is valid we should expect to see a significant difference in response between groups A and B.

— If the effect of the sweeteners is chemical, we would expect to see Groups B and D have significantly higher responses on the measure of health impact than any other groups.

— If the effect of the sweeteners is subjective/experiential (essentially placebo), we would expect Groups B and E would have significantly higher responses on the measure of health impact than any other groups.

Just for fun, throw in a group G, who are given hypnosis and then while in the altered state of consciousness, given a glass of water to drink and told it is an artificially-sweetened beverage. If the placebo hypothesis is true, then members of group G who report tasting the sweetened beverage should score significantly higher on the measure of health impact, than members of group G who report tasting the beverage as water. (How else are we going to produce an experimental situation where belief produces subjective experience?)

And/or are there any respectable peer-reviewed findings now, that describe an actual mechanism whereby the artificial sweeteners produce the claimed health impacts? (Aside from “compensatory over-eating” to make up for the “lost calories.”)

HI Narad –

I’ve heard two claims made. One is that carbonated artificially-sweetened beverages (sugar-free sodas) are comparably harmful to carbonated sugar-sweetened beverages (regular sodas). The other claim is that non-carbonated beverages follow the same pattern, where artificially-sweetened ones are comparably harmful to sugar-sweetened ones. To my mind those are wild claims because they assert that a chemical that has zero calories triggers effects comparable to those of sugars that contain plenty of rapidly-deployed calories.

I didn’t mention the issue of carbonation when I came up with the experimental design in my previous comment. Perhaps an error of a-priori thinking there (dismissing it as irrelevant), or perhaps I was just seeking to keep the comment length “too long” instead of “ridiculously too long”;-)

We could just duplicate all of those experimental groups (A) through (G) for carbonated beverages, and then compare each carbonated group to its corresponding non-carbonated group, as well as run the rest of the comparisons. And yes we could play the “fishing for significant differences” game, just to see what comes out, and then run a subsequent project on the less-plausible ones to see if they hold up.

There’s another way to go after this, which is to measure blood glucose levels in three groups of subjects:

A) plain water, B) sugar-sweetened beverage, C) artificially-sweetened beverage, and then duplicate those groups for carbonated and non-carbonated.

I would be rather surprised to see a placebo-like effect where C produces comparable effects on blood glucose levels to B with or without carbonation of either.

But if C does produce results comparable to B, then administer the artificial sweetener in capsule form so the subjects can’t taste the difference between a test capsule and a control capsule.

I’m not in any position to do any of this (I’m in technology). But I’m in the San Francisco Bay Area, where the “foodie” culture frequently gets into magical thinking, such as about “vibes” and “energy” and so on, and of course “natural good / artificial bad / chemicals evil.” So when people who identify with that “tribe” make claims about “artificial sweeteners,” I want to know: is there any empirical basis or is it more wooey “chemicals evil” BS?

And if there is any empirical basis, is it chemistry or subjective experience aka placebo effect?

I seriously doubt there’s any “there” there at all, except for the possibility that people who drink “diet” beverages could be using them as an excuse for pigging-out on something else. So, design an experiment, maybe find out that someone has already done something similar, or get someone interested in doing it, and then see what the actual facts are.

I’d bet that Big Soda would even pay for this because they could promote the results as showing that diet sodas are “good for you” as long as you don’t “compensate” by pigging-out on something else.

Or alternately we discover that “tastes” are what cause health problems, and “wishing makes it so.” That would be one heck of an alt-universe, and probably one where homeoquacky also works. Not to mention “biopulsar ayurvedic energetic screening”!;-)

Thanks – GS.

“And/or are there any respectable peer-reviewed findings now, that describe an actual mechanism whereby the artificial sweeteners produce the claimed health impacts?”
Observed effects are mixed, but there is some evidence that artificial sweeteners cause changes in gut flora that may lead to elevated blood sugar,
Also, there is the cephalic phase of insulin production, triggered by the smell, taste, or sight of foods before they are actually eaten. One study, at least, has shown that sucralose taken orally raised insulin levels, but when injected directly into the stomach did not.
For more, search on: “effect of artificial sweeteners on insulin production in humans”.

@Dangerous Bacon – Ha, ha! Got me! I am not down on science. I said science is interesting.

Your moniker…what’s the deal? Is bacon dangerous because…

a) you love it so much you can’t control yourself.

b) nitrates and nitrites are known to cause cancer and you’re too cheap to buy the high quality bacon.

c) raises your b/p, causes you to retain water, get bloated, and gain weight.

d) stinks up the house.

e) religious reasons.

OldRockin Dave-is there any experimental evidence that dogs can healthily survive on plant foods? Not just able to
eat them but survive solely on plant material.

I’m not aware of any research but my daughter has made me aware that there are vegan dog foods. They can be just as good as meat-based diets, but on looking into it, it seems that doing a vegan diet for dogs needs closer attention to the dogs’ health. Most of the dog treats we give are grain-based, and they are eaten as avidly as the marrow snacks.
A major reason for their spread is that dogs in the wild or belonging to pre-scientific societies can scrape through shortages of game for an extended period as a stopgap. I have been told but have not verified that French toast can work as an emergency dog food. The other side of that coin is that herbivorous animals occasionally have been observed eating eggs, insects, or even small game when it’s easy to obtain.
Just as a personal, not really relevant, note, if you can tolerate loud and frequent barking, cairn terriers are great pets.

ORD,

Do you have any opinion regarding great danes? are they quiet and calm? Asking for myself.

Alain

ORD-I have had wonderful dogs over a roughly 40 year period. All different with their own unique ‘mannerisms’. I think strict vegan diets are misguided if the animal is omnivorous or carnivorous. There is a vitamin B12 lack unless some unwashed raw food is eaten that by accident has some invertebrate contamination by excretion or say spiders webs which purportedly have some B12.

@ JustaTech – Uh…you know insulin is required by our body to function properly. Vaccines are not required to live and are given as a preventative measure. Poor comparison.

I was just using it as an example of a medicine that is made in cell culture that you might find “icky”. Lots of people don’t know where insulin comes from, or where it used to come from, which is why I asked.

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