A couple of weeks ago, I made the observation that there seems to have been a–shall we say?–realignment in one of the central arguments that proponents of “complementary and alternative medicine” (CAM) and “integrative medicine” (IM) make. Back in the day (say, a few years ago), such CAM practitioners and apologists used to try very, very hard to argue that their modalities had actual efficacy, that they had actual, measurable effects that made them medicine rather than woo. Never mind that even back then they had been trying for at least a couple of decades to come up with preclinical and clinical evidence that various magical CAM modalities worked, without any appreciable success. Worse for them, it’s only gotten worse over the last few years. As I’ve documented here and elsewhere, the larger and better-designed the scientific study, the more likely it is that a CAM modality will show no efficacy detectably different than placebo effects. When we test a drug or medical device, finding no difference between the treatment arm and placebo arm leads us to conclude that the drug or device (or whatever intervention) does not work; i.e., does not have effects detectably different from nonspecific effects. When CAM practitioners find no difference between the treatment arm and placebo arm, they conclude that their treatment has promise. I love the double standard, don’t you?
In any case, as more and more evidence comes in failing to find CAM modalities to be any more efficacious than placebo, the inevitable conclusion is that most of CAM is placebo medicine. Given that placebo effects have not been shown to have any detectable effect on the actual pathophysiology of disease, that they are variable, unreliable, and generally weak, and that invoking them requires deceiving the patient, it is considered at best ethically dubious and at worst completely unethical to treat patients with placeboes. They are not particularly effective, and a practitioner must, in essence, lie to his or her patient. Paternalism, although by no means gone in medicine, is soooo 1950s; it’s slowly disappearing, and the disapproval of using placebo medicine is one part of that decline–except in CAM, apparently.
In any case, as I pointed out a couple of weeks ago, when faced with more and more evidence that the vast majority of CAM is placebo medicine, what do CAM pracitioners do? Do they do what a science-based practitioner would do, at least eventually, and give it up? Of course not! Instead, they double down and embrace the “placeboness” of their treatments by invoking the “powerful placebo” and claiming that they are “harnessing the power of placebo” to produce “powerful mind-body healing,” of course!
I thought I was done with this topic, at least for a while, but then I found a post in–where else?–that wretched hive of scum and quackery, The Huffington Post by someone named Robert Schiffman, who is apparently a journalist and wants to tell us How the Placebo Effect Proves That God Exists.
Now, I’ve seen some over-the-top CAM apologetics invoking the “power” of placebo to provide “mind-body” healing, but this was a new high (or low, depending upon your point of view). Schiffman first complains that people didn’t listen to him when he tried to argue in previous post that prayer and spirituality are correlated with better health. That in and of itself would be a topic for a post, given that I haven’t addressed that issue in a long, long, time, but for the moment I’m interested in his argument that the placebo effect somehow proves the existence of God. For the moment, it suffices to say that the evidence that prayer somehow results in greater health is does not mean what Schiffman thinks it means. In other words, it doesn’t show what Schiffman thinks it does; certainly it doesn’t show that prayer heals. Maybe I’ll elaborate next week if the mood takes me. Given that Schiffman argues in his previous article that the “jury is out” regarding whether intercessory prayer works, we know right away that he can’t be the greatest synthesizer of scientific
For now, here’s Schiffman’s, in which he concedes:
The research which correlates spiritual practices with health benefits does not ascribe these benefits to the intervention of a supernatural being. It does not prove that the God who people are praying to actually exists. It merely establishes that those who pray and meditate tend to be statistically healthier than those who don’t– end of story. And as for the placebo effect, you will get no argument from me there either. It is when people say “just a placebo effect” that my hackles rise.
But then he argues:
The placebo effect is arguably the most underrated discovery of modern medicine. Replace “just the placebo effect” with “the amazing placebo effect,” “the mind boggling placebo effect.” To my way of thinking, the very existence of this mysterious effect proves that God exists. That’s right, you can find evidence for the foundational truths taught by religion in virtually every double blind medical research study!
This clearly takes the promotion of placebo effects to an all new level, far beyond anything I’ve ever seen before. Placebo is evidence that God exists? Seriously?
First, however, Schiffman has to do some fancy footwork about just what he means by “God.” He’s quick to point out that what he means by “God” is not what a lot of “religious folks” mean when they refer to “God.” He also concedes that what he means by “God” might or might not be the “God you believe in” or “disbelieve in.” Schiffman doesn’t view God as some white-bearded dude in the sky or the “reclusive author of just one immemorial bestseller, the Hebrew Bible,” or the father of “just one son” (a.k.a. Jesus Christ). Instead, he does a bit of metaphorical hand waving, declaring God to be “so vast and all encompassing that we cannot limit it in the usual ways.” In other words, Schiffman is starting to sound more and more like a Deist, or maybe Deepak Chopra. The Chopra connection becomes even more obvious when he writes:
But I am not saying that you and I in our egocentric and separate selves are God. It is rather the other way around — when we drop the elaborate pretense and disguise of being these limited and conditioned entities, we discover that we are not separate or apart from anything. We are part and parcel of all that exists.
This sounds to me very much like Deepak Chopra’s “universal consciousness” woo, in which we are all somehow mystically connected by some sort of life force driven by Chopra’s misunderstanding of quantum physics and genetics. But, I wondered, what does any of this have to do with placebo effects and, even if any of this had anything to do with placebo effects, how does it “prove” that God exists? To Schiffman, it seems that it has something to do with mystics proclaiming themselves “one with God” or some such twaddle. As I read this, I was still trying to figure out just what the hell Schiffman was talking about and how any of this has anything to do with placebo effects. I bet you’re wondering, too.
So, I’ll end the suspense. Unfortunately, the payoff isn’t as interesting or brilliant as one might have hoped:
Which brings us back to the placebo effect. It is mysterious, right? We don’t know how it happens. A person was sick and they take a sugar pill and next thing you know — voila — they are healthy. To call this “the placebo effect” is to dress up our ignorance in words. What has actually happened is nothing short of a miracle. Science has got no explanation for it– something immaterial (a thought?) has impacted something material (our body) in a way which utterly defies logic.
Oh, no. I think I know where this is going. Unfortunately, where I think this is going and where it is going are pretty darned close:
And that is what prayer is all about. Prayer is based upon the conviction that the immaterial is more powerful than matter itself. Whether we call this immaterial force “God,” “the ground of our being,” “Spirit,” or “higher consciousness” doesn’t matter. The point is– there is an uncanny power (which all of us without exception have got access to) which performs miracles. The sick can be cured, the broken can feel whole again.
Yes, you read it right.
Let me get this straight. Because we don’t understand placebo effects and science has “no explanation” for them, placebo effects must be a miracle. And, apparently, because prayer is all about the conviction that the immaterial is more powerful than matter, it’s about miracles too. It so obviously follows that because we don’t well understand either prayer or placebo, they must be the same thing and the existence of placebo effects must be proof positive of the existence of God?
Or did I miss something here?
Of course, this is all Schiffman means to ask rhetorically, “Do we need any other proof for the existence of God?” My first retort was, “Well, yeah! Yeah we do! A hell of a lot of other proof!” My second thought was that Schiffman really doesn’t understand placebo effects. He seems to think they’re faith healing, given that he seems to think that a sick person taking a sugar pill will make a sick person healthy again (presumably only if you believe, given that expectancy effects are such an important part of placebo effects). They’re not. As I’ve explained time and time again, placebo effects are a name that encompasses a complex set of phenomenon that include observer effects, experimental bias in clinical trials, expectancy effects (wherein patients who expect to get better actually do feel better), the Hawthorne effect (in which the simple act of observation affects the outcome), and artifacts of the clinical trial process. Placebo effects are only commonly observed for subjective outcomes; they do not detectably affect the pathophysiology of disease. In other words, if Schiffman’s view of what placebo effects were correct, we would expect that placebos might shrink tumors, reverse atherosclerotic damage to coronary blood vessels, or even reverse diseases like multiple sclerosis. They do not.
Ironically enough, it’s not uncommon to see CAM apologists making similar arguments, only without the God angle. They’ll portray placebo as “powerful” or “near miraculous” mind-body healing, the difference being that instead of invoking a supernatural God they invoke a supernatural ability of the body to heal itself. Indeed, that’s just one reason why I tend to view CAM as far more religious–excuse me, spiritual–than it is scientific. If it weren’t, it wouldn’t be CAM. It would be medicine.