Physician, Heal Thyself.

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.

Any takers?

This entry was written by Peter Watts , posted on Saturday September 26 2009at 09:09 am , filed under biotech, neuro . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

20 Responses to “Physician, Heal Thyself.”

  1. Tell me this leads to a story about renegade monks with OCD who live by Benedict’s Rede or the Eightfold Path without technically believing a word of it.

  2. That’t would be too much. Anyway, how do you prosecute a throught-crime if we don’t have reliable mind-reading machines?

    BTW: here’s my prediction: in 15 years, you’ll be feeling sort of ashamed you’ve been had by the AGW disaster crowd. Probably for purely human reasons, as belief in AGW is part of the decadent western Zeitgeist, to which you undoubtedly subscribe. (and don’t get me started on American exceptionalists either. Europeans seem to have a deathwish, exceptionalists are just plain demented)..

    The wired article seems very.. improbable to me. Why the hell should placebo effect be getting stronger? Sort of like hearing certain people have learned to fly by trying to hit the ground and missing.

    :D Perhaps the effect’s getting stronger because we now place more value on lies and illusions..

  3. Nah. The training system will come out on a video game console, like an extension to Nintendo’s Wii Fit or their proposed Vitality Sensor, and who’s going to go after Nintendo as a drug pusher?

  4. Peter stated: “…drug trials have been physically relocated to countries in which the population has different cultural expectations.”

    Hmm, why yes, just recently we saw Thailand-USA doing a joint new HIV-drug/placebo trial testing to prevent HIV. It is said to be a “promising start” and seems to be making head-way.

    Speaking of blue pills and not getting it up, I am quite tired of all of the erectile dysfunction commericals with men going on and on about how “see-all-us”, “la-vee-tra” and vi-ah-grow” make things good and hard “when the moment is right”. I don’t even have cable, and I sorta get only one supposedly free tv station, but boy, or should I say man, so many commercials about erection pharmaceuticals…

    I believe, or is it hope, that more human beings realize that they are not really living and taking control of their health by popping a cornucopia assortment of multicolored plasticy pills just to get through each and every day. I have a couple of friends that take something for just about everything. Unfortunately, some of the “medicine” does not work, and they have to find something else to swallow.

    What about indigenous medicinal practices? Seems that the big billions and billions of dollars-making pharmaceuticals companies have managed to weasel the indigenous traditional medicinal knowledge from people in various locales (Hoodia from Africa, Acai from Brazil), as well as popular culture elevating new plant-based pharamceuticals under the guise of health food and nutritional supplements.

    Anyone ordering something like a Jamba-juice gets a free boost in their high-caloric drink. What exactly is in that fem-boost really…how do I know it is not some silly placebo utilized to fake-make me feel more “femininely boosted”?

    Lately, I have been buying Odawella and Naked Juice Drinks, and trying Sobe-Life Water. Luckily, at the moment, I take absolutely nothing, yet. I live in a place where ice (meth) and pakalolo (stupid weed) (marijuana), are still a problem. But there is a strong cultural influence for people to be healthy “naturally”. Behavioral modifications such as eating healthy, nutrient-packed and unprocessed food, exercising a lot, minimizing stress and taking care of one’s self makes more sense than living via pills.

  5. It takes too much work to learn meditation right now; the closest thing you’ll find to a commercial product these days is a widget like the StressEraser. I agree: it’ll take a commercial biofeedback sensor (like some of the ones coming up for various game systems) and then an effective game to make use of it. Then you’ll see litigation springing up to try and control it. Knowing the exercises will never be thoughtcrimes as long as you need to put in years of training; they’ll just try to control the shortcuts that make them accessible to most of the population.

  6. Troll Orc said:

    Anyway, how do you prosecute a throught-crime if we don’t have reliable mind-reading machines?

    Dude, you’re not keeping up with the literature. We’ve had proof of principle for over a year now — and while the current state of the art is pretty crude, it doesn’t take sophisticated mind-reading tech to measure elevated glucose metabolism in the dopamine generators. Hell, invest half the effort that Pharma put into promoting cures for “sweaty hand syndrome” and you’ll probably have a working buzz-box in half a decade.

    BTW: here’s my prediction: in 15 years, you’ll be feeling sort of ashamed you’ve been had by the AGW disaster crowd.

    Actually, as a biologist, I’m more likely to be had by the myriad species whose ranges are climbing up mountains and degrees of latitude. Which leaves melting glaciers free to mislead the geologists, and the increasing amplitude of extreme weather events free to mislead the climatologists.

    Probably for purely human reasons, as belief in AGW is part of the decadent western Zeitgeist, to which you undoubtedly subscribe. (and don’t get me started on American exceptionalists either. Europeans seem to have a deathwish, exceptionalists are just plain demented)..

    Putting aside for the moment the fact that I’m neither European or American— and even putting aside your sadly misguided perspective on the science of climate change— this is relevant to the use of placebos in drug studies how, exactly?

    The wired article seems very.. improbable to me. Why the hell should placebo effect be getting stronger?

    Forget keeping up with the literature; you’re not even reading the crawl posts all the way through. I guess a short attention span is another part of that decadent western Zeitgeist you’re so fond of…


    Rob Slater said:

    Nah. The training system will come out on a video game console, like an extension to Nintendo’s Wii Fit or their proposed Vitality Sensor, and who’s going to go after Nintendo as a drug pusher?

    And then Max Kaehn agreed, adding:

    Knowing the exercises will never be thoughtcrimes as long as you need to put in years of training; they’ll just try to control the shortcuts that make them accessible to most of the population.

    A game platform. Of course. Brilliant. Thank you.
    But I have to disagree with Rob: politicians have been going after video games for years (they got a real boost after Columbine); and embedded Satanic lyrics in rock albums before that, and fucking comic books before that. Do you really think they wouldn’t jump on the opiate angle to take down something like Grand Theft Auto, for example?

  7. Orc stated: “Why the hell should placebo effect be getting stronger?”

    (From the 8/24/09 Wired Article)
    “One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug.”

    “These new findings tell us that the body’s response to certain types of medication is in constant flux, affected by expectations of treatment, conditioning, beliefs, and social cues.”

    Seems to be a bit of the “monkey see monkey do” syndrome, and we as human beings are primates afterall.

    More importantly, and significant, as I have found after reading the whole Wired Article on the “placebo effect”, is just as I had wondered, and suspected, there is a connection between the issue of placebogenicity and Peter Watts:

    “…one way that placebo aids recovery is by hacking the mind’s ability to predict the future.”

    As we can see, the connection is to Peter’s last book, therefore placebos are like scramblers…

  8. @ Keanani

    You could even attach this to the Watt’s earlier post on wiring mass empathy into people to feel what others feel. It’d be neat to see whether a sick person could get healed by seeing another person getting “healed”, or if the healthy person would become sick.

  9. [Editorial intrusion: what follows is my response to a comment which, you may notice, no longer exists on the crawl for reasons which will soon become obvious.]

    orc
    once again graced us with:

    .. elevated glucose levels in dopamine generators, hey, can’t that occur naturally? People are pretty diverse, I think such a detector would have many false positives, neuroscience being pretty murky.

    Doesn’t seem to have stopped the gait-recognition and facial-morphometrics crowd from jumping on the bandwagon. Better to put a few innocents in jail than threaten our hard-won liberties, and all that.

    Where’s the money in banning it?

    By eliminating the biofeedback option, you force people back into the arms of Big Pharma.

    And who could it harm?

    It’s not about harming people. It’s about harming profits. Do try to keep up.

    Making a few models and then twiddling with them to make them predict today from past data does not guarantee the model is working.

    Just as well the current scientific consensus isn’t founded on anything so rickety then, isn’t it?

    Apparently Japanese people working at the so called Earth simulator system there compared AGW consensus to ‘ancient astrology’,,,

    http://www.theregister.co.uk/2009/02/25/jstor_climate_report_translation/page2.html

    My guess is people who actually work with numerical modeling of earth processes may be more competent at assessing those blasted models. More than, say, the mid-list sf writer/marine biologist :)…

    Oh, definitely. But not more competent than 90+ percent of recognized experts on the subject. Or to put it another way: you’ve got one article from a software website with a buzzard on its masthead. I’ve got mountains of data reported from top-line journals like Science and Nature (which, btw, rebutted that whole “climate change has stopped” claim before it was even publicized).

    I win.

    My attention span isn’t that great(enough to study engineering.. but only so-so…. and I should thank EU for banning the proper medication.. ),

    Okay, that explains some stuff…

    …but I’ve read the Wired article and your crawl post in their entirety, but found no good reason for placebo effect apparently getting stronger.

    Paragraph 4 of my posting, summarizing paragraph 43-on in the original Wired article.

    @why I brought up AGW
    We all believe crazy things, I mean, thinking that big pharma might go after meditation seems pretty paranoid…

    My first reaction is to remind that you that this is the blog of a science fiction author: one point of the exercise is to take current trends and push them to extremes, and I made it pretty clear I was looking at this in terms of story potential. But my more considered response is to remember Paul Krugman telling us at Worldcon that “you can never be cynical enough”. He mused that if anyone had told him a year ago that people would seriously claim that Obama Wanted to Kill Old People, he’d never have believed it.

    The bottom line, in retrospect, may be that my ruminations of banning biofeedback may not be paranoid enough.

    @You’re not American or European? As if Canada was any different. More socialist, more do-goody than USA. (giving asylum to fucking gypsies… :D Proper treatment of those involves either labor camps or boarding schools or bullet to back of the head, depending on which of their neighbours you ask)—

    Aaaaaannnd that’s the last we’re going to hear from our dearly departed friend orc, only the second person ever to be banned from this ‘crawl for being an unmitigated twat. I’m generally pretty tolerant of the mitigated ones, but that last bit crosses a line I’d just as soon not be associated with…

  10. I think he was trolling you. Which, if true, is equally good grounds for good riddance.

  11. butbutbut .. trolls are bigger than orcs. right?

  12. Someone would have to demonstrate the ability to do it before they bother to ban it (unless it is a convenient straw man for something else).

    Personally, I wish the techniques were clear on how to do something like this.

  13. That last bit by Orc made me remember Monty Python’s The Meaning of Life in which they ask Maria The Cleaning Woman for her version of the meaning of life.

    It would be amusing to see how they’d be throwing the baby out with the bath water, banning all those snake oils being peddled right now. Imagine a Big Pharma vs. Scientology. I put my money on Big Pharma. They have a much greater market share and you don’t have to be a lunatic in order to follow their teachings.

    Of course there are people who are quite angry at that wired article. Sciency people:
    http://scienceblogs.com/gregladen/2009/09/what_is_the_placebo_effect_and.php
    http://scienceblogs.com/whitecoatunderground/2009/09/placebo_is_not_what_you_think.php

    That’s a lot to read and my concentration is even worse than Orc’s.

  14. From the OA:

    The success of those ads in selling blockbuster drugs like antidepressants and statins also pushed trials offshore as therapeutic virgins—potential volunteers who were not already medicated with one or another drug—became harder to find. The contractors that manage trials for Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient’s hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. “The quality of care that placebo patients get in trials is far superior to the best insurance you get in America,” says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. “It’s basically luxury care.”

    So, it may not actually be placebo getting stronger, but other reasons…
    I mean, placebo effect is there, but any variations in it are purely cultural, and no doubt not universal. The so-called nocebo effect is well known too. There has been a case of a policeman who was mortally afraid of being shot dying from shock after being shot into an arm with a . 22LR cartridge. People have had to fire more than one into their head to commit suicide sucessfully.

    @consensus:
    .. my older relatives here think that it is quite possible that a lot of scientists are self-censoring. That was common here, if you wanted to be published, you were supposed to not upset the marxist-leninst apple-cart. Are you more or less likely to get funding if your research is challenging or if it supports the established line..

    I mean, coming from someone who left research for precisely those reasons, I would think you would give them at least some benefit of doubt..

    @Ban:
    .. well, I am not pro genocide, but I suspect a lot of my compatriots would not mind if the so called “brown-czech” people vanished like smoke from a chimney. That is not twattish, just real. Are we not supposed to be more likely to dislike people who do us ill and look different? You yourself posted a link to a study on that here…

  15. Grisnakh: my older relatives here think that it is quite possible that a lot of scientists are self-censoring. ….Are you more or less likely to get funding if your research is challenging or if it supports the established line.

    Both of my siblings are researchers, and tell me you follow the grant money. The impression I get is that you have to have one toe out ahead of the current thinking, but you still have to convince the interests with the grant money to fork over. It does strain the theoretical construct of free scientific inquiry a little, because at least in the US, about half the grant money is from the government.

    If the voters decided that developing a slice of bread that always landed butterside up was the most urgent scientific question of the day, you can bet there would be an explosion of grants and then labs devoted to developing that slice. Actually, the grants and hence the science is driven by what frightens the voters, so I guess fear of butter on the linoleum would have to be more widespread?

    I suspect a lot of my compatriots would not mind if the so called “brown-czech” people vanished like smoke from a chimney. That is not twattish, just real. Are we not supposed to be more likely to dislike people who do us ill and look different?

    Hm, well, maybe, but codes of civilized behavior insist we treat others equally and respectfully regardless of skin color.

    Since you included, either on purpose or subconsciously, a reference to crematoria in your description, I will also go all crazy and mention that Christianity also disagrees. It not only asks that you refrain from treating browner Czechs badly, it suggests that you recognize them as your brothers, and treat them as well as you would like to be treated.

    If your compatriots subscribe either to civilization or Christianity, they might want to get with the program?

  16. Oops. final html code missing. Pretend the last 3 paragraphs are not italicized.

  17. Slightly on a tangent, but whilst I share the overall paranoia of the post, I think there is a big overestimate of the survival rate of pharmaceutical companies.

    In fact, I’d say that the past 10 years showed how business models and entire clusters of companies can suddenly die or become orders of magnitude less powerful or relevant.

    In fact conglomerates like Merck etc. are too big to behave all that smart. And they are taking significant financial hits already with the generics market booming at all once.

    I’d say in a few years we’ll download drugs (well, perhaps production processes and manufacture automagically at home…)!

  18. [...] Peter Watts wonders what the drug companies are going to do about the apparent increased effectiveness of placebos. [...]

  19. [...] Watts comes up with a super-punchy Shock material. In this one, he notes that placebos are getting stronger over time. And that the logical conclusion is the prohibition of modes of thought that heal one’s body. [...]

  20. [...] Watts comes up with a super-punchy Shock material. In this one, he notes that placebos are getting stronger over time. And that the logical conclusion is the prohibition of modes of thought that heal one’s body. [...]