I was going to devote today’s crawl to a recent study purporting to cast doubts on Libet’s notorious “no free-will” paper from the eighties— kinda pointless attacking that old study when more rigorous and recent studies have been so much more compelling on the same subject, and besides free will isn’t the same thing as conscious will so it’s kind of a non-issue, I was going to say— but I’d rather read the source material before shooting my mouth off and my University of Toronto library card expired a few days ago, so I can’t get into Brain or Nature Neuroscience until/unless it gets renewed.
So instead I’m going to dust off this story from last month (thanks to Alistair Blachford for the link.) Some of you may have read “Hillcrest v. Velikovsky”, my Law & Order take on placebos and religious faith that appeared in Nature last year. (If you haven’t, I’ve just uploaded it to my Backlist page, so go check it out. It’s only a thousand words.) It cites a case study (yes, even my short stories come with bibliographies on occasion) showing that placebos actually work better if you pay more for them. And now comes this Wired story, claiming that some drugs approved by the FDA in days past would not be approved if submitted now, because while they easily surpassed the placebo control in days gone by, they no longer do so today.
Let me put that another way: placebos are getting stronger over time.
The article summons several explanations for this result, all variants of the same mind-over-matter theme: decades of advertising have strengthened public belief in the miracle of modern pharmaceuticals; more sophisticated manipulation techniques (e.g., delivering antidepressants in cheery yellow jackets, stimulants in vibrant red) increases subliminal confidence in the delivery platform regardless of the drug being delivered; drug trials have been physically relocated to countries in which the population has different cultural expectations. But the mechanism underlying all these effects is simple enough. Belief and expectation, like any other perceived experience, are neurochemical— and those particular chemicals have a downstream impact on the brain’s dopamine and opioid production centers. All that placebos really do is trigger the brain’s own pain-management systems.
In fact, they seem to be doing it so well that Big Pharma is finding it increasingly difficult to come up with exogenous drugs that do it better. It’s really killing their bottom line. The less we hurt, the more Merck and Eli Lilly do.
Here’s a question the Wired article didn’t ask: do you think those guys are going to sit still for that?
Because when you come right down to it, you don’t need a bright yellow pill or a soothing blue one to manage your own brain chemistry. There are other ways of doing that. Meditation. Biofeedback. Things that you don’t necessarily stick in a pill that can be patented, packaged, and sold at exorbitant prices to senior citizens who don’t think they can get it up any other way. Now, as it turns out, there is a way— always has been— and whoever comes up with an effective meditation regime that allows us to manage our own internal pharmacopoeias is gonna make a killing at Pfizer’s expense.
So let’s take a good look at the war industrial health-care is currently waging against conventional reform. And let’s also look back at that other war, the so-called “War on Drugs”, while keeping in mind that opiates are already illegal. Now ask yourself how long it’s going to be before some pharma sock puppet like John Thune or Mike Ross wonders if it really makes a difference whether those “illegal drugs” are being mass-produced in your own head or a poppy field somewhere in Afghanistan?
Here’s my prediction: start running the clock when placebo-response mental exercises first take off. I say a year, tops, before such exercises become— literally— thoughtcrimes.