Placebo and Phlogiston

by Mike Sententia on April 24, 2012

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There’s been an idea in the back of my thoughts lately: The placebo effect is a lot like Phlogiston*. This post is me exploring that half-formed idea.

*Phlogiston is a discredited 17th-century model of fire, saying it was caused by phlogiston. But there were no predictions: You discovered something contained phlogiston when you saw it burning, and saying “X contains phlogiston” only told you that it would burn. It has become a shorthand for a non-scientific model that only explains after the fact. More on wikipedia.

First, I’m not decrying the placebo effect in general. It is well-established that people sometimes get better, and that their expectation of getting better can trigger a perceived improvement, and sometimes an actual, objective improvement. Placebo is real.

But… One of my exercises for myself, to learn to explain my magick well, is to try and explain my results away as placebo. And here’s what I find:

  • Sometimes, placebo makes the person get better for a short time.
  • Sometimes, it makes them get better for a long time.
  • Sometimes, it causes no result.
  • And there’s no pattern to it. (Aside from the actual magick techniques I used, which, if we’re assuming it’s all placebo, shouldn’t matter.)

Now, I’m not saying this model of placebo is wrong, but it sure feels like explaining away, rather than explaining. Really, it feels a lot like Phlogiston: Once you tell me the results, I can say, “Yes, placebo did that,” but it has zero predictive power.

So, what would a predictive model of placebo look like? It would have odds. It would say, “For condition X, with a highly-believable placebo, Y% of people should feel better due to placebo, and Z% of those should have lasting results.” It would tell you how much the believability of the placebo matters: A doctor from Harvard vs the local community college, or energy healing on a believer vs a skeptic. In short, it would tell you how to design an effective placebo, or how to behave to minimize the probability of placebo. It would say a lot more than, “Sometimes, people just randomly feel better.”

Is anyone aware of research like that? It seems really useful for doing small-scale experiments when you can’t do a randomized controlled trial. Thanks!

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{ 5 comments… read them below or add one }

Ona April 24, 2012 at 12:19 PM

If I recall correctly, studies show just being in the presence of someone wearing a doctor’s coat is enough to make some people feel better, heal, get better. Stress is a huge factor in illness (from “psychosomatic” stuff to lowering immune system strength).

On a more anecdotal/personal level, a neighbor who is a firefighter said there is always a rush of emergency calls on Thanksgiving. After a few years he realized some of them were the same lonely elderly people every time. At least at the hospital they got a warm meal and some affection. So the firefighters started inviting those people to the firehouse for Thanksgiving dinner every year. No more “heart attacks” from the lonely old folks.

In any case, back to your question: my own personal feeling is that it doesn’t really matter what the mechanism is that makes a technique work, if it works with some consistency. We usually just get ourselves into another version of “phlogiston” if we try to come up with some pseudoscience to explain magickal things. I think it’s okay not to have an explanation.

Is there any way to test whether your healing works: a) with some consistency in similar situations b) even if the recipient doesn’t know they are receiving it?

Just some ponders.

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Mike Sententia April 25, 2012 at 11:03 AM

Thanks Ona. I didn’t realize it was as simple as wearing a lab coat to calm someone down, that’s pretty crazy. And the firemen story is neat.

Does the mechanism matter? If we just want to get the same results we’re getting so far, then no, it probably doesn’t. But if we want to push the limits of what we can do, then understanding the underlying mechanism can help us see better techniques. That’s why I’m working toward these explanations. (And I think the reason some other mages are, too.)

And I’ll ponder those tests. Thanks!

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Ananael Qaa April 24, 2012 at 4:16 PM

The difficulty of predicting the degree of the placebo effect for particular medical trials is precisely why scientists set up controlled experiments. The effectiveness of a drug is rated in terms of its effectiveness relative to a placebo treatment administered to a randomly allocated control group drawn from the same sample as the experimental group. Then you rate the effective treatment rate in the experimental group (E) versus the effective treatment rate in the placebo group (P). Regardless of what the overall placebo effect is for a particular set of trials, E – P should yield a positive result, the higher the better. So you don’t need to know the exact value of the placebo effect to conduct meaningful drug or in your case healing trials.

Back in the late 1980’s and early 1990’s, though, there was some work of this sort done by practitioners of an interdisciplinary field that was dubbed psychoneuroimmunology.

http://en.wikipedia.org/wiki/Psychoneuroimmunology

Their working hypothesis was that the placebo effect was caused by increased immune system function that in turn could be related to particular brain functions that were influenced by states of consciousness. A lot of what we know now about the effects of stress and depression on illness came out of that research, but as it turns out response to placebo varies a lot by individual so it may be impossible to come up with a general statement of how strong the effect should be.

http://en.wikipedia.org/wiki/Placebo#Mechanism_of_the_effect

According to that article, placebo effects are thought to occur in approximately 35% of people, though the degree of the effect in each case can vary widely.

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Mike Sententia April 25, 2012 at 11:07 AM

Very cool. I should have known that wikipedia had everything I needed to know :)

Reading those, it seems like we know a lot more about when placebo works than I thought. In particular, it was interesting that, if the person finds out they got a placebo, it stops working. In the past, I’ve always told people that this was a technique I was developing, so it might not work, because I wanted to get honest feedback. (Make it socially acceptable to say that it didn’t work and you get more honest feedback.) But it seems like that would also reduce the placebo effect. Maybe I should try doing a healing, then telling the person I really didn’t do anything, and see if they still get the benefit.

Thanks!

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Andrew April 25, 2012 at 2:07 PM

A lot of the placebo effect has to do with how effective the patient thinks it is going to be. For instance they have found that red and yellow pills give a stronger placebo effect, and that smaller pills are more effective than bigger ones. Also that the more painful the shot the greater the placebo effect. But it is all tied into how the effect is described and how nasty the side effects you tell them are. The idea being that it seems like it should be very effective.

Part of the problem with placebos as a theory is that you can’t easily create controls to test for. I have heard that those who are highly suggestible (along hypnotic lines) tend to give greater placebos, so that might be a place to start.

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