As part of the continuing decline of the New York Times, we have this new op-ed by Steve Petrow, a writer from North Carolina who, the paper says, “is a regular contributor to Well” (the paper’s health column). But this is more about woo than about health. Click the link below to read the piece.
Petrow’s point is apparently twofold: curative “placebo” effects can result from the use of talismans, amulets, or comforting objects like plush rabbit toys. Further, he says, these objects can soothe one and even make one optimistic. I’m prepared to accept the second claim but not fully the first.
Petrow was apparently cured of testicular cancer when, 34 years ago, he was diagnosed and also given a “velvety rabbit with big floppy ears” named “Fairy God Bunny”. He brought the rabbit to all his appointments and, sure enough, has been cancer-free for decades. Of course, testicular cancer is one of the most curable forms of the disease, and I doubt that a fluffy bunny could have helped him with mesothelioma or pancreatic cancer. Still, to be fair, Petrow adds that conventional medicine is also responsible for his cure, but the rabbit played a substantial role:
You’d expect me to be skeptical. I’d grown up in an age of science, when facts and data reigned supreme. I’d excelled at Manhattan’s Stuyvesant High School, famous for its geek curriculum. As a three-time visitor to the nearby 1964 World’s Fair, a paean to new technology, I’d drunk DuPont’s Kool-Aid: Better living through chemistry.
When I first got sick, I read every evidence-based, peer-reviewed study I could get my hands on, so I could make the best-informed treatment decisions. My odds of survival were actually pretty decent, but I found that data wasn’t enough. As a twentysomething, I simply couldn’t accept any chance of not making it to 30. Put simply: Science could not guarantee me a 100 percent successful outcome.
Enter the bunny. I needed another tool in my tool belt to improve my chances.
And I was not alone. Stuart Vyse, a psychologist and author of “Believing in Magic: The Psychology of Superstition,” told me that many people turn to “irrational beliefs” in times of dire need. Whenever medical science does not provide a cure, there’s going to be a “psychological gap, the need of something better,” he said. Enter superstition, magic, paranormal beliefs and religion.
“It’s not uncommon to be of two minds and to say, ‘I know this is crazy, but I’ll feel better if I do it anyway,’” Dr. Vyse said.
This bit is confusing at best. Was the effect purely psychological, making Petrow feel better, or did it help cure the cancer? Both are implied.
Five years after my diagnosis, my oncologist said I was cured. I believe science played the key role in that. But I also think the hope embodied in the bunny made a difference to my well-being, reducing anxiety and giving me more good days than bad.
Can I prove it? No. Does that mean it’s not true? No. As Dr. Kaptchuk told The New Yorker, “We need to stop pretending that it’s all about molecular biology. Serious illnesses are affected by aesthetics, by art, and by the moral questions that are negotiated by practitioners and patients.” All ways of saying, by luck or magic.
Sorry, but these things are neither luck nor magic: they are the effect of brain functions and their attendant physiological changes, on one’s feeling of well being or even on the progress of a disease. Using “luck” or “magic” implies that the numinous was involved.
Now I doubt that the plush bunny “improved his chances” (how could he tell?), but it could surely have made him feel better, as Stuart Vyse notes. But feeling more positive and having a higher rate of cure are two different things (though well being might affect disease). Petrow sort of recognizes the distinction, but the two effects are not the same, and are conflated in the article. After all, it is one thing to document the effect of amulets and other placebo objects on feelings of well being, another altogether to show that they increase cure rates. Petrow cites a physician who claims the latter (my emphasis):
Do I sound like a kook? I don’t think so, but no kook ever does.
Dr. Ted Kaptchuk, a Harvard physician, told a New Yorker writer several years ago that he’s always “believed there is an important component of medicine that involves suggestion, ritual and belief.” He added: “All ideas that make scientists scream.”
Dr. Kaptchuk is the chief of Harvard’s program in placebo studies and the therapeutic encounter, which is focused on studying the power of the mind to influence health outcomes. In that same interview, he noted that medicine has known for centuries that some people respond to the power of suggestion — but not why or how.
During his tenure at Harvard, Dr. Kaptchuk wrote in an email, “I haven’t been twiddling my thumbs.” He sent along a list of the more than a dozen studies he’s either led or participated in that show how placebos, rituals, beliefs and talismans play a role, albeit “modest,” when compared with surgery and medication.
When you’re in a fight for your life, “modest” is something to hang on to.
I’ll leave it to the readers to check out the list of Kaptchuk’s studies to show if they’re sound and, if so, how big that “modest” effect is. I’m prepared to believe that placebo effects can also increase cure rate, as we simply don’t understand the interaction between mind and body, and some experiments I know of show they can work. For example, a 2013 article in the New England Journal of Medicine showed that “sham surgery” for a meniscus tear in the knee, in which patients were not really operated on but thought they were, had the same outcome as real knee surgery. That’s remarkable. Here’s how the sham surgery proceeded:
For the sham surgery, a standard arthroscopic partial meniscectomy was simulated. To mimic the sensations and sounds of a true arthroscopic partial meniscectomy, the surgeon asked for all instruments, manipulated the knee as if an arthroscopic partial meniscectomy was being performed, pushed a mechanized shaver (without the blade) firmly against the patella (outside the knee), and used suction. The patient was also kept in the operating room for the amount of time required to perform an actual arthroscopic partial meniscectomy.
So there’s no harm in patients using amulets or plush bunnies to supplement their therapy. What is harmful is when these items are thought to be curative as well, especially if there are no controlled trials to show it. Remember that a Templeton-funded study of intercessory prayer on the outcomes of heart surgery, which surely involves a placebo effect since patients either knew they were prayed for or might be prayed for, showed no difference between those patients and those not prayed for. In that case, prayer was useless, though harmless (actually, prayer had a slight negative effect).
The downside of the Times article is that it doesn’t point out the many failed experiments in which even placebo effects were not useful, and it implies that there is “magic”, which is not really what is going on here. If there is any psychological or even curative effect of amulets and lucky objects, it it purely natural, not “magic.” In fact, I’m not sure why the Times published this rather than a more sober and less personal analysis of what we know about placebo effects, which would have been far more interesting. And shame on them for implying that anything beyond natural phenomena were involved.
h/t: Michael
Enter the Bunny. Wasn’t that a Bruce Lee movie?
Woo sells.
“All the woo that’s fit to print.”
That would be a blank page.
Maybe you’re on to a NYT parody editorial page.
The meniscectomy would be a terrible example on which to test a “placebo” effect. This procedure, in which damaged portions of the meniscus are removed, has long been controversial. Studies have shown that physical therapy, in most cases, has as good an outcome as the actual procedure. The quoted study may have been done with this same intent.) The outcome of the “placebo” study could have been predicted in advance.
The ethics of faking surgery on an unsuspecting patient are also questionable.
Without placebo surgery we’d still be transplanting adrenal tissue, and cultured dopamine neurons into the brains of patients with Parkinsonism.
Yeah. I did not know about the ineffectiveness of the surgery itself, but was wondering if this comparison merely showed that a torn meniscus will resolve itself, to whatever degree, and that the surgery did essentially nothing.
Reminds me of when ol’ Lonesome George Gobel said he musta been a helluva pilot stationed in Oklahoma during WW2, ’cause not a single Japanese plane ever made it past Tulsa.
LOL. I remember George Gobel, but not that joke.
I speculate Gobel told that joke more than once. On a 1969 Tonight Show video clip I saw him telling it while, unbeknownst to him but knownst [the cyberspelling fascist doesn’t recognize it as a word without the “un-“) to everyone else Dean Martin was using Gobel’s drink as an ashtray.
A magic fetish, coupled with the failure to understand that thoughts and mental states are physical phenomena.
What someone should ask these magic believers is what would they do if they suddenly discovered they had something like maybe an aortic aneurysm instead of cancer. Would they go for the stuffed animal for help on this one or look for a good thoracic surgeon. The convenience of the type of illness allows all that time to come up with the magic. There is no magic about open heart surgery.
I’d go for both surgery and the plush bunny before and after.
But then, if you had to choose, which would it be?
I’m insulted you had to ask. The surgery of course!
No insult intended. Just getting the priorities straight.
Paging Dr. Oz. Code woo.
Yes! If anyone, Oz could quickly turn a code woo into a code brown👺.
It would have been really good if the NYT published both this opinion piece AND an explanation of the science behind the placebo effect (what there is of it, anyway). I don’t see what goal was achieved by publishing the opinion piece alone. It can only support the woo industry which we should be fighting against. Or should we?
The placebo effect is certainly fascinating. It has been shown many times to be real. Given that, what is someone who has a life-threatening disease like cancer to do? Should one rush out and buy a plush bunny? If so, how big does it need to be? Does paying more for it increase its efficacy? Would a live cat do even better?
Perhaps Steven Petrow was worried that his cancer might return and he wrote his article attempting to wake up the placebo gods. If so, I wish him luck.
Someday we’ll find out how the placebo effect really works. Perhaps it will lead to a range of placebo drugs that will have to compete with sugar pills and plush bunnies.
We actually do have a pretty good handle on it, and it is extremely complicated – not likely possible to be handled by the NYT. The real bottom line is this:
Placebo effects are real and there are at least 3 separately identified effects (look up the work of Fabrizzio Benedetti):
https://sciencebasedmedicine.org/benedetti-on-placebos/
https://sciencebasedmedicine.org/followup-benedetti-on-placebo-ethics/
SBM also has a good set of articles on placebo:
https://sciencebasedmedicine.org/?s=placebo&category_name=&submit=Search
But the real point is that the vast majority of what people – including doctors and most scientists – call the “placebo effect” is describing the nature of study design and not some actual physiological effect. That is why Benedetti does very, very complicated experimental designs to get at the “real” placebo effects. And at the end of the day, those are not, to the best of our knowledge, currently exploitable in clinical practice (see the second Benedetti article I linked above). So there is no “power of placebo” to be exploited and literally everyone who tries to make any such argument is putting the cart before the horse and not even understanding what they are talking about in the first place.
https://sciencebasedmedicine.org/can-the-mind-really-heal-the-body/
Thanks a lot for this helpful post!
My pleasure!
I also wrote a much longer comment with multiple references from SBM about Kaptchuk specifically that I don’t see as having made it through. Hopefully the number of links didn’t manage to scuttle the comment, so hopefully it is just in some moderation limbo.
But the real thesis is that Kaptchuk’s research is bad and he is a fraud. SBM has a complete and very well done series on him specifically.
From a statistical point of view, the “null hypothesis” is that there is NO special efficacy of amulets, etc. until there is a strong statistical probability that there is.
Fascinating! I really appreciate these links.
Thanks – that’s really useful
— Frank Zappa, Cosmik Debris
Thanks for that. I could hear them playing as I read it.
Objective vs. subjective symptoms …
I think there are medical conditions that the brain can cure via belief, especially if bolstered by ritual. Not “woo”, just one way the brain works that we don’t understand.
My father told me of several ways warts were cured by ritual when he was a child. So, when my son was about 10 and developed warts on one arm, I tried one of them. I had him draw a picture of the arm with warts and then we burned the picture. He asked, “What if I don’t believe in it?”
I said, “That’s the cool thing — it works whether you believe in it or not.”
It worked. The warts went away within a few weeks.
I did not tell him it was “magic”. Neither of us believed in that. Just that it was a mysterious thing that could work — in a way we did not understand.
If you have never read the amazing story of Cabeza de Vaca, who was shipwrecked on the coast of what is now Texas not long after the conquest of Mexico, you should. He saved himself from cannibal Indians by using Catholic rituals he remembered to cure the Indians’ illnesses and make their wounds heal up. It worked so well that he not only saved himself and a companion but but became a renowned witch doctor among the Indians, whom he led in a procession of thousands across Texas and into Mexico. Eventually, he was able to rejoin his countrymen and returned to Spain.
I think it depends on the specific malady, the psychological nature of the victim and no doubt many other factors. But sometimes ritual does work to cure disease. It is just as rational, as “scientific” as any other form of cure but we don’t know the mechanism.
I suspect that if doctors were to add a layer of mysterious ritual, more costume, maybe some dance and chanting, to their work, they would significantly up their cure rate, especially in pediatrics. Assuming they could prevent being laughed out of the profession, of course.
You say “It worked.” But you don’t know that and can’t know it. Many warts go away by themselves. It is almost certain that these warts were going to vanish anyway and your trick was uninvolved.
Coorelation ≠ causation.
By “worked” Gary obviously means that the warts disappeared, which of course he can and did know.
On what basis do you say:
“It is almost certain that these warts were going to vanish anyway”?
If we know for a fact that the burning of the drawing had no effect, then you are of course correct. But you are begging the question. Whether or not the burning of the drawing had an effect is what is in dispute.
I made my statement based on information from The American Academy of Dermatology. I can be faulted for using the phrase “almost certainly” instead of “there’s a good chance”.
The main point is that there is no basis to conclude that “it worked”. Correlation (spelled corectly!) ≠ causation. The warts went away. Gary doesn’t want to use the word “magic”, preferring to say it was a “mysterious” thing that he didn’t understand. I’m not sure what the difference there is.
Annecdotes based on correlation are close to useless for attributing causation. If burning drawings of warts actually was a cure there would be no need for dermatologists to know anything about them.
You are certainly correct in stating that:
“Anecdotes based on correlation are close to useless for attributing causation.”
Clearly if the success rate of removing warts by burning drawings was 100% the wart removal aspect of dermatology would be out of business. But, speaking in more general terms, there is much evidence that the “placebo effect” exists. The open question is, how often does it actually occur? His son’s experience with the warts proves nothing, but the father’s conclusion is in harmony with what is known about the placebo effect: That OCCASIONALLY it does come into play.
IMO, the father’s conclusion is bunk. Self deception. Nothing more.
You may very well be correct. In your opinion does the “placebo effect” exist in any meaningful sense? If your answer is “no” then your opinion is counter to some serious research. If your answer is “yes” they why are you so sure that the father was deluded?
I’m unaware of any research that placebos have any affect on warts. If you know of some, please provide the reference.
Unless some evidence for this is provided, the reasonable person should conclude the father is deceiving himself.
Thing is, warts come and go apparently by themselves. Well, some warts do, anyway. And some warts are caused by viruses. Apparently some warts, being in the outer layer of skin, escape notice by the immune system.
I had a wart on one eyelid for a long time that was long and flat and almost invisible, but it bothered me. Eventually, just before Easter, it got very swollen inflamed and I made an urgent appointment with a dermatological(?) surgeon for right after Easter. Well, during Easter, it disappeared one night – I think it fell off. Just like that. Quite possibly at some point my immune system became aware of it (possibly even because I damaged the skin by rubbing it) and the inflammation was my immune system tearing into it.
Anyway, attributing wart behaviour to placebos, witches or lucky charms is strictly woo. Might as well try to credit them for the weather.
cr
Messi used an amulet in Argentina’s victory against Nigeria. Amulets apparently don’t work so well against France.
https://www.usatoday.com/story/sports/ftw/2018/06/27/lionel-messi-reveals-he-kept-good-luck-amulet-given-by-a-reporter/111179708/
Perhaps he should have taken it orally.
Or à la française; i.e., bottoms up.
The amulet musta cramped his style.
Curing cancer is not the only effect ascribed to magic. Magic can also cause earthquakes, according to certain analysts. The July 4 Jerusalem Post reports: “Shas MK Yinon Azoulai issued a tirade against progressive Jews from the Knesset plenum on Wednesday, and postulated that Reform and Conservative demands for egalitarian prayer rights at the Western Wall were responsible for the earthquake Israel experienced on Wednesday morning.”
So what you’re saying is sure we could allow woo-heads to try their talismans but because of the risks of the magic backfiring and causing an earthquake, it’s safer to just stick to muggle medicine?
To be fair, the author never outright claims that the amulet cured him, in fact he states clearly that science gets the credit.
The problem with the article is that his thesis is fuzzy. It’s unclear if he is implying some curative power to it, or if it just gave him emotional relief.
You are certainly correct in stating:
“It’s unclear if he is implying some curative power to it”
I suspect it is unclear because he does not know himself. If we assume that Gary believes that some sort of “placebo effect” exists – which many researchers do – then it is impossible for him or anyone else to determine what role if any it played in his cancer cure.
Knowing that superstition (juju) is rife in Nigeria, it may be that Messi’s possession of the amulet intimidated the Nigerians more.
Somehow this got posted to the wrong part of the message thread.
You don’t possess the right amulet.
“I’d excelled at Manhattan’s Stuyvesant High School, famous for its geek curriculum.”
As opposed to an “un-geek” curriculum?
I think we all can remember the efficacy of
favorite blankets and plush toys at various stages of life. Laughter works according to Norman Cousins. Anything that makes you feel better may be thought to work. Science and medicine doesn’t always work either.
When I had laparoscopic surgery for a Volvulus. The skill of the doctor repaired the Volvulus. I was given a teddy bear to hold against the site to counteract pain. I put a blue (my favorite color) bandanna around his neck and attached a small red heart. He may not have cured me, but he held me, helped me and was a constant reminder of the love of my family.
Placebo effect can undoubtedly influence mental state, and that in turn can have some effect on physical outcomes. Even a lucky charm, if it makes the wearer feel happier. Similarly, the sensation of pain (for moderate levels of pain) can be strongly mediated by the mind (I think that has been shown experimentally).
I’d say the knowledge that medically effective treatments and painkillers are available if needed would also have a similar beneficial effect without actually needing to be used.
Of course none of this is a substitute for actually using medically effective treatments where required.
cr
Extrapolation from personal experience – not scientific.
There can also be harm to your wallet. The $10 stuffy is only the start; the costs for your woo will increase the more you show a willingness to purchase it.
If anyone wants a comfort stuffy, I get it. What I’d say to them is: look, placebos are going to work equally well whether they’re given to you by a loved one for free or purchased for $100 from a doctor like Dr. Petrow. So don’t buy one. You don’t have to. If you’re seriously ill and want one, have a family member give you an heirloom stuffy. Uncle Bob’s doo-doo from 50 years ago will help cure your cancer just as well as Dr. Smith’s (or Gwyneth Paltrow’s) Woomatic stuffy (at only $99.99, it’s a bargain!), and you won’t be contributing to the propagation of bad science or the livelihoods of vultures that peddle nonsense to vulnerable sick people.
All of the benefit, none of the cost. So yes, work that placebo if you want. But no, don’t pay into the placebo industry. Because you don’t have to to access its ‘healing powers.’
Reblogged this on The Logical Place and commented:
Oh how the New York Times has fallen.
Woo doesn’t work for me. I have end-stage lung cancer and have been fortunate to have been treated with the latest immunotherapy drugs. Science is my saviour.