Adventures in Ethics and Science

Dr. Free-Ride: Do you know what a placebo is?

Elder offspring: A placebo is something that you think works but doesn’t really work.


Dr. Free-Ride: Sometimes when people are not feeling well, like, if you’re sick and bed and want some medicine — you’ve asked me for medicine before when you were sick. Why do you ask for medicine?

Younger offspring: Because I think it will make me better.

Dr. Free-Ride: You think it will make you not sick anymore.

Younger offspring: Mmm-hmm.

Dr. Free-Ride: And sometimes you get the medicine and almost immediately you think maybe you feel better. Although I guess sometimes you say, “This medicine is not working well enough! Give me something else!”

Younger offspring: No I don’t.

Dr. Free-Ride: You don’t? Maybe I’m thinking of some other sick child. Remember that bug you had not too long ago that gave you a couple days when you couldn’t keep any food down?

Younger offspring: Don’t speak of it on the internet.

Elder offspring: Everyone vomits at least once in their life.

Dr. Free-Ride: Is that true?

Elder offspring: I think so.

Younger offspring: But still, don’t talk about me vomiting.

Dr. Free-Ride: OK. Hypothetically, if someone were sick in bed and the felt really bad because they’d been vomiting, and they needed to start feeling better so they could go back to school and soccer and all of that, and their mother offered them some food and said, “This is the food that I was always offered when I was sick as a child, and it helped me feel better,” … let’s say like a baked custard or something. Hypothetically, do you think that sick kid would feel better from eating those special foods?

Younger offspring: Yeah.

Dr. Free-Ride: Do you think they might even associate eating those special foods with feeling healthier?

Younger offspring: Yeah.

Dr. Free-Ride: When I’ve been sick, just thinking about baked custard can make me start to feel better, because it always seemed to help when I was recovering from a bug as a kid. And I’m not sure it’s actually because of the custard.

Elder offspring: Really?

Dr. Free-Ride: I think sometimes what makes people feel better isn’t so much about the particular medicine they’re taking or food they’re eating, but sometimes it’s because of what they expect to feel — maybe because of what someone has told them, or how they remember it from last time they were sick.

Elder offspring: What does this have to do with placebos?

Dr. Free-Ride: A good question! My hunch is that sometimes what makes you feel better is that a parent is taking care of you. They’re bringing you something and hoping that it will help you feel better, and they’re comforting you, and reassuring you that you won’t be sick forever. Sometimes just having that attention, I think, can help you feel better.

Elder offspring: And placebos?

Dr. Free-Ride: Maybe sometimes when people are given a medicine — or something they think is a medicine — what makes them feel better is that someone is taking care of them. Or do you think that’s just silly?

Younger offspring: I don’t know.

Dr. Free-Ride: Do you have any strategies for figuring out whether the thing you get that seems to be making you feel better actually is — whether it’s the food or the medicine that’s making you feel better or just the care and attention you’re getting along with the food or medicine?

Elder offspring: Give it to another sick person and be really mean to them.

Dr. Free-Ride: Be really mean to them?! My goodness! So, the same compound but different treatment from the caretaker bringing you the compound, huh?

Younger offspring: Yeah, to see if it’s mostly the attention that makes you feel better.

Dr. Free-Ride: So next time both of you are sick, I should do a little experiment where I flip a coin and I’m kind to one of you and mean to the other when I deliver the medicine or the special food?

Elder offspring: Oh yes!

Dr. Free-Ride: You have a lot of faith in the coin flip.

Elder offspring: I call tails.

Younger offspring: Do it on [Dr. Free-Ride’s better half]!

Dr. Free-Ride: You would have me experiment on your other parent?

Younger offspring: Yeah!

Dr. Free-Ride: That’s so mean!

Elder offspring: Unless [Dr. Free-Ride’s better half] gets lucky on the coin toss.

Dr. Free-Ride: How they actually test compounds that they think might be effective as medicines is they’ll have some of the patients get the pill that really has the medicine in it and others of the patients get a pill that looks just like the pill that has the medicine, only without the medicine in it. And actually the care providers that are giving them the pills don’t know which patients are getting the real medicine and which patients are getting the pills that don’t have medicine in them. So they give them all the same care and the same attention, and then they compare to see who felt better.

Elder offspring: Yeah, but we don’t have fake medicine.

Younger offspring: And you’re not a nurse.

Dr. Free-Ride: That’s true, I’m not. I’m not even a medical doctor who can prescribe medicines. I’m a doctor of philosophy. I can help you with your metaphysical problems, but not so much with your physical problems.

Elder offspring: I think detangler could be a placebo.

Younger offspring: Huh?

Elder offspring: Maybe it doesn’t actually help comb tangles out of hair any better than water.

Younger offspring: So we should have one person use detangler and another person use water and compare.

Elder offspring: I think we need to set up a spray bottle of water that smells like detangler so that the people being combed out don’t know whether they’re getting detangler or not and then compare.

Dr. Free-Ride: Awesome! I think we need to test that.

Younger offspring: Do it on [Dr. Free-Ride’s better half]!

Dr. Free-Ride: You know what, you’re a little too willing to subject your parents to experiments for the sake of science.

Comments

  1. #1 Catharine
    November 13, 2009

    Looks like the next conversation should address ethical concerns of using human subjects. For their generation, with genetics, synthetic biology and questions of “ownership” of genetic information, ethical questions related to scientific research are huge and entirely relevant. They aren’t too young to hear about the disparities in health care either, or even the Tuskegee study, which, believe it or not, some people defend to this day! Lovely, lovely young philosophers, I bow down respectfully to your excellent parenting. You should have had 16 kids!

  2. #2 Janet D. Stemwedel
    November 13, 2009

    You should have had 16 kids!

    No way, man! The quality of parenting in that case would be at least 8 times worse.

    Also, I hope you noticed that they identified nursing expertise as something important that I don’t bring to the table. Instead, they have to get by with a parent who’s just a philosopher.

  3. #3 $0.01
    November 13, 2009

    oh. my. god. EO is brilliant and could use her talents for good or evil, especially when it comes to marketing. EO knows the placebo effect of detangler– she could devise all sorts of useless but sellable products and take over the (gullible) world! Bwah-HAHAHAHAHA! Sign me to to invest!

  4. #4 Warren
    November 13, 2009

    Hmm. So you’ve deconstructed comfort foods, but it surprises you that your kids want to do experiments on you?

    Ah well. I suppose it’ll keep ’em out of trouble, relatively speaking.

  5. #5 Rick Pikul
    November 13, 2009

    YO has also figured something out: If someone isn’t there, they can’t object to being volunteered.

  6. #6 John
    November 13, 2009

    I liked the baked custard part, especially since the opposite is true for me. My parents always made me drink flat ginger ale if I was sick. Now, just the smell of ginger ale makes me think of vomit and turns my stomach.

  7. #7 David
    November 13, 2009

    “I’m a doctor of philosophy. I can help you with your metaphysical problems”

    I have existential angst. What would you prescribe, and how would I know it’s not just placebo effect?

  8. #8 Dario Ringach
    November 13, 2009

    I had a similar conversation with my kids… From then on, when they feel sick, I just offer them: “do you want some placebo?”

  9. #9 Catharine
    November 13, 2009

    No way, man! The quality of parenting in that case would be at least 8 times worse.

    Hmmm. Isn’t that a fallacy in the same way that saying that if eight people are in a room watching a child starve to death, they are each 1/8th guilty, while in fact the guilt of the eight people is *multiplied* exponentially?

    If you are an excellent parent to two children, wouldn’t your excellence increase with even more children to parent excellently?

    (That, too, is a fallacy to be sure. I’m just bullshitting you. ;-)

  10. #10 scotlyn
    November 14, 2009

    Very nice treatment of placebo effect, which focusses on the comfort factor, rather than the gullibility factor. It is interesting that no study has been able to define a personality type for “placebo responders” – that is to say many studies have, but the pooled results are mutually contradictory. I have often thought that people studying the “placebo response” (also demonstrated in a set of studies that did not use placebos as such, but found that post-op cancer patients required half the pain medication if they knew they were getting it) should focus on the comfort/reassurance aspect. The ability of stress hormones to suppress healing has been demonstrated. It should be easy to test hormonal stress levels on drug test subjects before and after receiving their test medications. I would predict that those who respond the best to placebos (and also, incidentally, to the test medication) will correspond with those who have had the greatest reduction in stress hormones, not necessarily those with the most “gullible” personality profiles per se. Doctors of all kinds whose manner, confidence, etc can reassure and comfort their patients are simply recruiting more of those patients’ native healing capacities into supporting their recoveries than those who do not, and no doctor should be ashamed of doing that.

  11. #11 Katherine
    November 26, 2009

    I will totally try to focus on the comfort aspect rather than the gullibility aspect next time I discuss placebo effects with people that think woo is a good idea, and see if they respond to it, or whether they still think I am accusing them of being gullible.

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