Bad Science by Ben Goldacre Page B

Quesalid, to his own surprise, perhaps, went on to have a long and productive career as a healer and shaman. The anthropologist Claude Lévi-Strauss, in his paper “The Sorcerer and His Magic,” doesn’t quite know what to make of it, “but it is evident that Quesalid carries on his craft conscientiously, takes pride in his achievements, and warmly defends the technique of the bloody down against all rival schools. He seems to have completely lost sight of the fallaciousness of the technique that he had so disparaged at the beginning.”
    Of course, it may not even be necessary to deceive your patient in order to maximize the placebo effect; a classic study from 1965—albeit small and without a control group—gives a small hint of what might be possible here. The researchers gave a pink placebo sugar pill three times a day to “neurotic” patients, with good effect, and the explanation given to the patients was startlingly clear about what was going on:
    A script was prepared and carefully enacted as follows: “Mr. Doe…we have a week between now and your next appointment, and we would like to do something to give you some relief from your symptoms. Many different kinds of tranquilizers and similar pills have been used for conditions such as yours, and many of them have helped. Many people with your kind of condition have also been helped by what are sometimes called ‘sugar pills,’ and we feel that a so-called sugar pill may help you, too. Do you know what a sugar pill is? A sugar pill is a pill with no medicine in it at all. I think this pill will help you as it has helped so many others. Are you willing to try this pill?”
The patient was then given a supply of placebo in the form of pink capsules contained in a small bottle with a label showing the name of the Johns Hopkins Hospital. He was instructed to take the capsules quite regularly, one capsule three times a day at each meal time.
     
    The patients improved considerably. I could go on, but this all sounds a bit wishy-washy. We all know that pain has a strong psychological component. What about the more robust stuff, something more counterintuitive, something more…sciencey?
    Dr. Stewart Wolf took the placebo effect to the limit. He took two women who were suffering with nausea and vomiting, one of them pregnant, and told them he had a treatment that would improve their symptoms. In fact, he passed a tube down into their stomachs (so that they wouldn’t taste the revolting bitterness) and administered ipecac, a drug that should actually induce nausea and vomiting.
    Not only did the patients’ symptoms improve, but their gastric contractions, which ipecac should worsen, were reduced . His results suggest—albeit it in a very small sample—that a drug could be made to have the opposite effect from what you would predict from the pharmacology, simply by manipulating people’s expectations. In this case, the placebo effect outgunned even the pharmacological influences.
    More than Molecules?
     
    So is there any research from the basic science of the laboratory bench to explain what’s happening when we take a placebo? Well, here and there, yes, although they’re not easy experiments to do. It’s been shown, for example, that the effects of a real drug in the body can sometimes be induced by the placebo “version,” not only in humans but also in animals. Most drugs for Parkinson’s disease work by increasing dopamine release; patients receiving a placebo treatment for Parkinson’s disease, for example, showed extra dopamine release in the brain.
    Zubieta (2005) showed that subjects who are subjected to pain and then given a placebo release more endorphins than people who got nothing. (I feel duty bound to mention that I’m a bit dubious about this study, because the people on placebo also endured more painful stimuli, another reason why they might have had higher endorphins; consider this a small window into the wonderful world of interpreting