I agree with coryblick about the sugar pill script, though; I think it offered far too much encouragement in favor of the pill, and glossed over the part about no medicine at all.

A clinician telling a patient, particularly a vulnerable psychiatric patient, that he thinks a pill will help is often persuasion enough. That script opened with the premise of “doing something” to relieve symptoms, and also mashed the “helping” of placebos in with the “helping” of tranquilizers. And the “no medicine at all”, if it wasn’t missed entirely by the patients, might have implied some sort of “all natural” remedy. Which, as y’all know, has quite the appeal.

Also, not everyone understands that “sugar pill” means “fake pill”. Non-clinically oriented people hear and use colloquialisms like “salt tablets” and “water pills” without understanding what exactly that means; I imagine the patients could have thought perhaps there was some therapeutic quality to sugar in pill form.

I’d like to see that same study repeated with a script that’s not so wheedle-y. I have a feeling the results would be similar, but of course there’s no way to know unless one is using *good* science.

I’ve noted that the people I know who use or advocate scientifically implausible forms of alternative medicine are rather quick to resort to the “well, even if it doesn’t really work, why would that matter as long as people feel better?” The fact that any perceived benefit is only a superficial, temporary boost, and normal improvements are misinterpreted or falsely ascribed to the phony remedy, doesn’t seem to bother them — as long as someone, somewhere, feels better and is happy.

They tell me “if you think you feel better, then you DO feel better.” It doesn’t matter if anything they say about the process or science behind it is actually true. There are a lot of different ways to say that something is true — it can be true “for that person.” In which case, it “worked.” So they figured they’re covered either way.

I consider that a form of bullshittery hiding behind a short-sighted but genuine concern for people and a smug and rather self-righteous sense of being “flexible.”

Regarding placebo:

While the sugar pill may be inert, the interaction was not.

“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.”

This can provide expectation of a positive outcome.

There has to be more to it than this. Clearly something “clicks” between the public and those offering them dubious medicines. I suspect that they can collude in a state of half-belief, a kind of adult make-believe if you like, enabling “Well it just MIGHT be true — let’s assume so while we find out if it will help me with this unresolved medical problem.” The promoters keep kidding themselves because it is their living, and it is quite cool to be seen as a “healer”, and the patient because they want to feel better.

This helps explain Wally Samson’s discovery of the disconnection between the use of vitamins and people’s stated beliefs when asked to think in “science mode” — also the resistance of alt.med beliefs to rational argument — the slightest doubt serves to sustain such a collusion. .

There has to be more to it than this. Clearly something “clicks” between the public and those offering them dubious medicines. I suspect that there can be the collusion in a state of half-belief, a kind of adult make-believe if you like, enabling “Well it MIGHT be true — let’s assume so while we find out if it will help me with this unresolved medical problem..” The promoters are kidding themselves because it is their living, the patient because they want to feel better.

There has to be more to it than this. Clearly something “clicks” between the public and those offering them dubious medicines.

I suspect there is the collusion in a kind of half-belief, an adult make-believe if you like, that enables “well, it might be true — let’s assume so while we see if it will help this otherwise unresolved medical need”. The promoter half-believes because it is his living, the patient because they want to feel better.

An element of make-believe would help explain Wally Sampson’s observations concerning usage vs belief with vitamins.

Well, at least it’s good advice, even if the rationale is nonsense.

Certainly there are flat out con artists working in SCAM, particularly in the area of selling products. The same can be said for those whose main motivation is to continually increase profits through selling medicine (whether it’s private clinics, Big Pharma or just an individual doctor who cares more about payments on his BMW than his patient). Plastic surgery is an obvious area of medicine where there is a huge amount of quackery (and it exploits many of the same fears to sell itself). Both active and passive denial are prevalent in medicine too, which further weakens the framing of all people who practice alt med as being corrupt. I don’t see how demonizing people for being human does more than alienate people who don’t assume themselves to be better than other people.

It seems to me that many, many people engage in some amount of denial at the jobs – most people’s jobs just don’t have the same kind of practical and ethical responsibilities practicing medicine does (nor the kind of power or authority often). All of us engage in some form of denial vis a vis how we live in North America, though I’m sure we all have very tidy little rationalisations for why we’re not in denial but our neighbor is.

The placebo chapter was interesting yet it might have benefited from a discussion of the Cochrane review that found that there is little evidence to support ‘a large effect for the placebo response’.

Might I say that as long as you have nutritionists flaunting their Clayton College of Natural Health PhD’s being interviewed with approbation in the NYT (Jonny Bowman’s work triggered a busy discussion), the wonders of Drs Mercola and Weil, the fearless work of Mike Adams, Hulda Clark et al, and the unforgettable “more fluid concept of evidence” being promoted in your leading medical schools by Dr Katz at Yale – we in the Old Country can not hold a candle to the woo entrepreneurship of the US.

You might find the following informative, or perhaps simply enjoyable. Colin Blakemore’s amused derision is especially worthwhile.

http://uk.youtube.com/watch?v=M5rH7kDcFpc

Anyway, you should really pick up a copy of Bad Science to make yourself feel a tiny bit better about US healthcare.

I’ve always thought the prevalence of woo in Britain was a result of good healthcare being available to all. Unlike the US you do not have to pay money for treatment (minor prescription charges aside) so those who turn to alt-med do so because they have had a bad experience or are unhappy with the realistic suggestions of evidence based healthcare so spend their money on extraordinary claims because they feel evidence based medicine cannot help. In the US for most people there is a choice between paying for evidence based healthcare or paying for alternative medicine, in the UK you get one for free and the other is often a luxury. It’s a case of having your cake and eating it.
Besides in the US you have a much bigger problem with drug companies making extravagant advertising claims, such direct to consumer advertising is forbidden in the UK – which gives an opening for alternative medicine advertising which is allowed provided it does not make medical claims (although the definition of a medical claim is blurred).

Apparently, the school curriculum in Britain encourages children to “massage their carotid arteries through their rib cage” to enhance oxygenation to the brain.

This isn’t strictly true, schools and local authorities have autonomy in funding decisions, the Brain Gym stuff wasn’t part of the curriculum, it was the results of a dubious sales pitch claiming to improve teaching outcomes for a small part of the school’s budget. That’s not to say that alternative nonsense is not on the curriculum, it is for quite a few subjects, and more so in the adult education sector.

Bad Science is indeed a good read!

Two minor corrections, the BrainGym section is not on the UK school cirriculum (we’re not that bad!), but more that school governors have lacked critical skills when Brain Gym have come round each school touting their unique brand of pseudoscience.

After Goldacre wrote a number of columns about it, it got discussed in Parliament, to which the minister replied “We do not provide guidance or advice to schools on the use of Brain Gym”, which was an opportunity missed.

Secondly, I think it was the Scottish Executive (rather than the British government) who dallied with McKeith, but I think even that was eventually dismissed.

Cheers

T

Additionally, it was not the British Government, but the Scottish Government (Scotland being one of the 3 nations that makes up the island of Great Britain and one of the 4 consituent countries of the United Kingdom for accuracy freaks) that *suggested* asking McKeith for assistance – and even then it was only a few Members of the Scottish Parliament – by no means a policy.

Not that we have any reason to be complacent, after all – we have Prince Charles, – but it not like any of our candidates for governmental high office believe in witchcraft or anything…..