Thursday, March 27, 2008

The value of pseudo-scientific douche-bags

It is common for skeptics to rail against the ridiculous nonsense of credulous pseudo-scientific crackpottery. I've done it myself.

But in this article I'm going to take a different position. I'm going to do something I thought I'd never do. I'm going to talk about a positive benefit of such nonsense.

I'm restricting myself to medical flim-flammery - for example homeopathy and some of the other -pathy's and their related delusions.

Scientific medicine, and in particular so called "evidence-based" medicine, in spite of its tremendous and growing success, has a problem.

The problem is that in order to be regarded as effective, a treatment must be demonstrably better than a placebo. In some cases - with certain illnesses, or with certain patients, there are no more effective treatments than placebo. And don't let us short-sell it - sometimes well-done placebo treatments can be surprisingly effective. The problem is, an evidence-based medical practitioner cannot really use a placebo to full effectiveness.

Firstly, there's an ethical issue with prescribing a treatment that you know contains no active ingredient, but let's allow that we happily step around that. Our medical practitioner still knows they're prescribing a placebo. This - almost necessarily - reduces its effectiveness. At least in double blind clinical trials, the patient might be getting an effective treatment. But if you know it's just water (or sugar-pills, or whatever), that will impact the way that you treat the patient, and consciously or not, that is likely to impede the effectiveness of the treatment. One possible solution would be to get all our medical practitioners to spend years practicing the art of deceit - they can be trained by the best actors, politicians, used car salespersons and prosperity-Gospel TV-preachers into being able to convincingly appear like they fully believe their treatment will work. Even then, we'd have to hope that's enough.

But there's another way. We can get people who are naturally more convincing - because they actually do believe in the effectiveness of the treatment. And if that helps the patient believe, we may be able to take more complete advantage of the placebo effect.

That is, I'd like to consider the possibility of the established medical fraternity co-opting the alternative medicine crowd (at least where the treatements are clearly harmless, like homeopathy) in order to take the fullest possible advantage of the placebo effect when it's the most effective treatment available.

So I think it's at least possible that the homeopathological liars and their kooky friends actually have some potential value after all. All we need now is a study to see whether alternative medicine's ernest belief in their placebos is more effective than mainstream medicine's skeptical placebo. Frankly, I would actually be somewhat surprised if it wasn't at least slightly better.

If it proves to be so, it might then be possible to begin studying the characteristics of the most effective placebos for various ailments, in order to scientifically design much better placebo treatments (and, if they help, recruit some true believers to administer them).

But in the meantime, maybe we should keep around a few of the less harmful alternative medicine types, because they might just have the best placebos available to us, and we would be churlish to ignore a good placebo.

No comments: