Newsweek on the placebo effect

Here's another mainstream media take on placebos. Sharon Begley acknowledges from the outset how resistant both doctors and patients can be about the very concept of the placebo effect. Then she writes:

"But the fact remains that placebos are at least somewhat effective and sometimes very effective for some patients. Rather than railing against that finding or pretending it doesn't exist, what we should be doing is learning how brain activity that corresponds to the expectation of cure translates into clinical improvement."

I remain rather flabbergasted that so many people would rather ignore evidence that placebos often work than figure out what exactly is going on. How odd that the doctors who require clinical evidence before drawing conclusions on treatment will nevertheless overlook or disavow knowledge of clinical evidence that has proven, over and over, that placebos can and do work under many circumstances. So it's not clinical proof they really want; what they really want, like so many of us, is to have their own preconceived ideas to be continually affirmed.

Is depression caused by chemical imbalance? Um, maybe not.

"Biochemical roots of depression challenged," says the headline in an article on the Psych Central web site.

Ideally this should be a headline blazed across every mainstream web site and TV news show. This is a big big deal and it will probably get very little attention because marketplace economics are dead set against it.

Scientifically what's going on here is no new news at all. There has yet to be any conclusive, clinical proof that chemical imbalances "cause" depression. None. It was a theory that gained footing in the '60s but 40 years later, the Diagnostic and Statistical Manual of Mental Disorders, continues to tell us, in no uncertain terms, that the cause of depression and anxiety is "unknown."

Authors of a study quoted in the Psych Central article suggest that the media has played a large role in passing the chemical imbalance theory along as fact, fueled in large part by how apparently successful certain drugs were in alleviating depression.

Only--uh oh--it turns out the drugs don't work so well after all. Some recent studies have questioned how effective these drugs actually are. One study published last month suggests that most of the perceived effectiveness of several of the most common SSRIs (Selective Serotonin Reuptake Inhibitors, often prescribed for depression) is due to the placebo effect.

All of this, to me, relates to an incredible, largely unexamined bias in our day and age towards treating our bodies reductively, particularly when it comes to biochemistry and genetics. It's like every Valentine's Day when there are articles in the newspaper about the chemistry of love, quoting scientists talking about whichever chemicals that get secreted in the brain when we are in love. And the underlying presumption much of the time is that the chemical is somehow causing the feeling of love.

Western scientists truly have an irrational faith in the fact that the chemicals cause the emotions. That's how the "chemical imbalance causes depression" arose so naturally.

It rarely seems to occur to clinicians that the emotions may be causing the chemicals. That's because western scientists have such a hard time accepting the idea that the mind can impact the body so flagrantly. (Once again, I would ask: hasn't any of them ever blushed? Or seen someone blushing? Of course the mind can affect the body!)

And so with depression. No doubt a depressed individual does in fact have some chemical imbalances associated with that physical state. But all these years later there is no evidence to show that the imbalance comes first.

And here's the crazy dead-end of reductivist thinking anyway: even if the imbalance *did* come first, what then? We still wouldn't know what caused the imbalance. So the chemical imbalance theory is pointless before it even starts.

Yet it lives, and this small notice on a psychology web site is probably not enough to alert the world about how naked this particular emperor truly is.

Pain eased by more expensive pills--study

"New research shows that people who thought they were given a pricier painkiller reported less pain than those who believe they took the same drug at a discounted price."

Story on WebMD.

I also heard about this on NPR this morning, and the report there focused on the implications of the cost factor, as does this WebMD story. As one of the researchers asks, "How do we give people cheaper medication, or a generic, without them thinking it won't work?"

Two groups in the study were given sugar pills. One group was told the pills cost $2.50 each; the other was told they cost 10 cents each. Of those who took the "more expensive" pill, 85 percent experienced reduced pain when subsequently subject to an electric shock, while only 61 percent of those who took the "cheaper" pill felt their pain had been eased.

It seems to me there are many more important unanswered questions here than how do we give people cheaper drugs without undermining their effectiveness. Such as: why do we prescribe chemical substances at all when sugar pills often work just as well, as long as people think they're real drugs? Or, even: how is it that our bodies can heal themselves under the power of suggestion?