Posted by: Ticktock | May 1, 2010

Placebo and Laughter

I was listening to Talk of the Nation the other day when I heard Ira Flato ask researcher Dr. Lee Berk whether or not Lee’s small study showing that laughter lowers stress hormones enough to reduce the incidence of heart attack might be explained by the placebo effect.

FLATOW: Mm-hmm. How do you know it’s not a placebo effect?

Dr. BERK: I’m going to use a term here – that’s what was thrown at Norman Cousins all the time. The reason he was told he got well was because of the placebo effect. I can assure you, with this phraseology, that placebo is not nothing. In other words, there is – that the placebo is a real phenomena. It is your own intrinsic pharmacology that’s responding. If I believe in a particular perspective, I will have some sort of response.

I taught my students, how do you think the body hangs together if it doesn’t talk to itself? So indeed, placebo in – relative to our belief systems, biotranslates. And indeed, that’s the tile of Norman’s last work – book that he wrote, “Head First: The Biology of Hope and the Healing Power of the Human Spirit.” So your beliefs elicit some translatable biology.

Hmm… this is the second time that I’ve heard a researcher on NPR toss placebo around as if it were a valid form of medicine. The exact same response was given by an acupuncture researcher when he was asked about placebo. Just because placebo is an actual biological response triggered by belief, doesn’t mean that it’s a valid form of treatment. The placebo response is the minimum amount of improvement we can expect from the belief in a treatment’s abilities alone. It shouldn’t be a standard of anything other than whether something doesn’t work.

Or maybe I’m wrong. What do you think? Am I missing Dr. Berk’s point?

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Responses

  1. Of course the placebo effect shouldn’t count when creating new treatments — it’s too hard to replicate. The right antibiotic will take away an infection whether or not you believe in it. A placebo doesn’t always work even if you DO believe it. I only wish someone could consistently train people to think away their diseases… it could be the most cost-effective, no side-effect-having cure-all the world has ever seen.

  2. The answer to the question of whether or not the placebo effect is “real” depends on what you mean by the question. When a patient reports an improvement in a subjective symptom, like pain or nausea, even thopguh they are getting a placebo treatment, there’s no way to argue that the improvement isn’t real.

    However, such effects have many characteristics hich argue against their being useful as clinical therapies:
    1. The response is usually small, often not clinically significant, and always much less than a truly effective therapy.
    2. Objective measures often don’t correlate with cubjective reports. Patients may say they feel less nauseated but vomit just as often. Or they may report less pain in their knee but measures of the amount of wieght they put on it when walking don’t change.
    3. Placebo effects don’t affect outcomes (such as length of survival in cancer patients or weight maintenance in chronic GI disease), only subjective symptoms.
    4. Placebos require health care providers to lie to their patients (unless, of course, they themselves believe in a bogus therapy, like homeopathy). This has serious consequences for the health of the doctor/patient relationship.

    Alternative medicine providers, unwilling to accept that their therapies don’t work, are forced by their cognitive dissonance to claim that “no better than placebo” actually means as good as the “natural” healing strength of belief and attitude, a mind-over-matter philosophy that fits nicely into their usual vitalist approach to medicine. Unfortunately, the little bit of “real” beefit in terms of subjective experience of symptoms liek pain and nausea doesn’t justify the whole package of nonsense that usually accompanies therapies that are no bettter than placebos. The harm done by erroneous beliefs about health and disease and by avoiding science-based medicine because of belief in faith-based medicine is far greater than any benefit of placebo.

  3. It really depends on the context (which I don’t currently have time to look through). Was he saying all this as part of a campaign to get laughter therapy added to standard medical treatment? Sounds like fun, but for that I would expect much more work to be done first.

    Maybe he was just saying, “Hey, check it out, here’s another reason to maintain an active social life.” In which case, great. After all, the placebo effect *is* a real effect, and if I can leverage it in my everyday life to improve my health, I’m gonna do it.

  4. I think its all just an issue of semantics.

    It’s very true that disorders that are related to stress and autonomic response (like heart attack) respond to non-pharmacologic interventions, like yoga, meditation, exercise, etc. You can also boost your immune system. But I don’t think that’s the same as saying placebo is a “treatment” – it’s really whatever intervention you do to get your stress levels down, whether that’s a change in outlook or something more concrete. But extending that to saying you can cure brain tumors with placebo because the body can talk to itself is pretty laughable.


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