Friday 17 December 2010

The Placebo effect has become a gross and common error


The idea, to which I have at times subscribed and for which I have argued, that medicine pre-about 1900 was merely a matter of elaborate placebo effects - is a gross error, and a near-universal one among intellectuals.


In fact, for a medical treatment to be merely a placebo effect is exceedingly rare. Most treatments have an effect, and if a treatment is being freely chosen (if) then it is likely that in some way and in some people the effect is having some benefits.

(Of course the treatment may benefit other people rather than the patient - as when neuroleptics/ antipsychotics make crazy (or supposedly-crazy) people into docile anhedonic Zombies by inducing Parkinson's disease. This doesn't help the patient, but can be useful for other people. It is, at least, not a placebo effect.)


Unless, that is, we believe that modern methods of treatment evaluation have transcended those of the past.

A proposition for which there is essentially zero positive evidence and a vast mass of negative evidence: those with eyes to see can observe that medical progress first stalled then went into reverse.

That is, the discovery of effective new treatments - obvious, in-your-face breakthroughs like antibiotics, steroids, hormone treatment - got slower, then stopped.

And now the trend is to eliminate effective treatments.

The 'evidence' against this common sense observation comes from precisely the evaluation methodologies whose validity is being questioned.


Anyone who knows how modern medicines are developed and launched - the endemic dishonesty, careerism and politicization, the narrowness of 'evidence' evaluated, the inappropriateness of evaluation methods - will realize that the methods are grossly inferior to the 'common sense' evaluations of the past.

(Surgery and anesthetics are in a different situation from medicine - I am unsure of the balance of progress here; but major technical breakthroughs were occurring at least up to the development of endoscopic surgery a few decades ago.)


To believe that past medicine was merely an elaborate placebo is to believe that everyone in the past was an idiot - specifically that everyone in the past was either an idiotic victim (patients) or an evil and exploitative idiot (doctors).

That there were situations in which medicine was ineffective or harmful is not in doubt - but the further inference that all medical interventions were ineffective or harmful is an unjustifiable induction.

So when we look back on the methods used, it is quite wrong to assume that they were at best useless and more often harmful, or to assume that their usefulness can be explained purely by the power of suggestion.

This is, indeed, the same habitual style of thinking which gives us political correctness; with its regular transcendental inversions: the previously immoral becoming first neutral then morally approved; the previously ugly or neutral becoming redefined as 'art' - and so on.

This is possible and habitual become we have come to believe that everyone in the past were evil idiots and ignorant dupes, so that thousands of years of human experience can be - must be - wiped clean; and a fresh start made on the basis of radical doubt.


This matter of evaluating truth is indeed a core factor in political correctness; and in the decline of the West.

The insight that humans may be mistaken in their evaluations is sophomoric, if indeed it rises to that level.

But this 'insight' that individual judgment may be wrong has been used as an excuse (not a reason) to develop vast edifices of pseudo-technical evaluation to replace potentially-flawed individual judgment.

Now we have vast edifices of pseudo-technical - but actually arbitrary - evaluation which provide mandatory regulations for imposition upon medicine: especially government departments such as the FDA in the US, NICE and the Cochrane Collaboration in the UK,and many others.

All of these operate on the false logic that because individual judgment may be wrong, and because people in the past were sometimes wrong; their procedures are always right - or, at least, set a limit upon error. Yet they do not even do this.


Elaborate but arbitrary bureaucratic systems of medical evaluation run by officials making decisions for other people actually enable error to be unbounded and everlasting; whereas individual judgments of many people who take the personal consequences of their personal decisions are subject to corrective feedback.

A bureaucracy which deems that neuroleptic drugs are a necessary treatment for psychotic  people can continue to damage their lives without limit; psychiatric judgment of the same is subject - at least - to the feedback of observing the lives destroyed; people who take these drugs are well aware of the problems.

Similarly for forbidden treatments. Heroin is illegal in the USA, and those people suffering agonizing pain which is sub-optimally treated are the ones who pay the price for this example of bureaucratic take-over. So in the USA heroin is available (illegally) for anybody and everybody except the people who most need it (people in hospital with extreme pain). And this situation has been operative for many decades with no sign of corrective feedback.


Why does our culture assume that official bureaucracies are intrinsically better at making decisions than individual human beings?

Why does our culture assume that the evaluation of medical treatments is best done by elaborate procedures administered by regulatory bureaucracies?

And, further, that the choice of medical procedures is best done by elaborate procedures administered by regulatory bureaucracies?


These are all the same phenomena at different levels: this assumption is close to being the core of political correctness, and (at a certain level of analysis) is a major factor in the decline of the West.

Indeed, the decline of the West is itself something that - according to mainstream culture - can be allowed to exist only if and when recognized by elaborate procedures administered by regulatory bureaucracies.

Indeed the anti-humanity of modernity, of political correctness, is itself regarded as untrue unless and until validated by elaborate procedures administered by regulatory bureaucracies.


As I keep saying (Ho Hum!) - political correctness cannot reform itself; it is disproof proof, it is invulnerable to contradictory evidence on principle as well as in practice.



dearieme said...

Your heroin point and your memory hole point below: I believe I remember from my childhood that my father explained some point in a 'tec story by remarking that we (in Britain) dealt with drug addiction in a sensible, intelligent way, whereas the Americans didn't. Whatever happened to our old way, and why?

Bruce Charlton said...

@dearieme - The big change came about after Thalidomide - which was used as a rationale for bureaucratization.

As usual with governments, the answer bore no relation to the problem - and once begun, the regulatory juggernaut proved unstoppable.

We still have major drug marketing abuses going on and growing; but nowadays we don't have any breakthrough drugs (well, maybe one or two a decade, at about a hundredfold greater cost and delay).

And we still have problems with drug misuse (leading to violence, accidents, diseases, poverty, unwanted sex and pregnancy, assorted other social immoralities, economic consequences etc): alcohol problems are now greater in the UK and Ireland than anywhere else in the civilized world, but alcohol 'doesn't count' as a drug.

CorkyAgain said...


This is totally off-topic, but in all the times I've seen your comments on this and other blogs, it never occurred to me that you might be pronouncing your handle as "dearie me".

I've been reading it as if it were French, "dearie em".

dearieme said...

We are a family - dearieme, dearieshe and deariewee.