One More Time – The Placebo Effect

Way back in early 2012, I first brought up the placebo effect – the tendency of the body to heal itself when belief in the cure is strong. How it works is still a mystery but that it does work is indisputable.

The example I used over 6 years ago was a $30 performance wristband, one endorsed by famous athletes and touted to improve athletic performance. In a test people were given the advertised wristband and exposed to some physical performance and balance tests. The before and after results showed some improvement. Then they were given a similar-looking one-dollar replacement band and told it was also special, performance on physical and balance tests improved comparably. Conclusion: it wasn’t the band at all; it was the perception that they were getting some extra, outside help – mind over matter.

Since then I have mentioned the placebo effect in essays warning about vitamins, acupuncture, forest bathing, chiropractic, healing crystals, gluten-free diets, cryotherapy, homeopathy, ear candling, essential oils and a few other subjects. (Wow, that’s a lot of toes to step on in only six and a half years!)

The point is not to make people angry and defensive, but to make them aware of the difference between science and marketing, and how the placebo effect can lead to an erroneous conclusion that a treatment really works.

When a cure is proposed, competent scientists will split a relatively large group in two, randomly assigning one to test the treatment while giving the other a placebo. Both groups usually show some improvement due to the placebo effect. To validate the treatment however, the improvement of the treated group must be significantly better than that of the control group. Otherwise they declare the treatment “no better than a placebo,” that is, no better than no medicine at all.

The placebo effect explains many of the endorsements we hear from celebrities, friends and neighbors. They sincerely (and enthusiastically) believe whatever they are recommending has beneficial effects, but with no scientific evidence it may be “no better than a placebo.” When you buy one of these products, the money spent is money wasted. That’s why the small print in ads, where they explain how the FDA has not approved their magic formula, they often add something like “results will vary.”

That takes us to a health story from England where the BBC reported a pure placebo experiment. With help from University of Oxford, they tried to see if they could “cure real back pain with fake pills.”

One hundred people with severe back pain were asked to participate in a study of a powerful new painkiller. What they didn’t know is that everyone would be given realistic looking pills that were really placebos, “capsules containing nothing but ground rice.”

The blue-and-white-striped pills “came in bottles, carefully labeled, warning of potential side effects and sternly reminding patients to keep out of the hands of children” to further the impression that this was powerful stuff.

Three weeks later researchers found “nearly half of our volunteers reported a medically significant improvement in their back pain” and that those who spent a little more time with a doctor merely discussing the pills were more likely to improve. In one case, a man went off his morphine but continues to take the ground-rice pills.

Placebo effect is not a trick that works only on the gullible. Taking a placebo can cause the body to release endorphins, natural painkillers. And sometimes subjects improve even when they know they are taking a placebo.

But that doesn’t mean the gullible aren’t tricked. In the earlier case of wristbands, even after the people learned that there was no difference and the improvement in both cases was psychological, they still wanted to buy the $30-wristband over the equally effective $1 bands. It’s like when people think the same wine tastes better when the bottle has a higher price tag. 

It does no good to understand science when critical thinking fails to kick in.

Questioning Ancient Wisdom

It’s hard to say how some subjects creep into daily conversation, but I have heard in the past and again recently about the practice of ear candling as a safe remedy for ears plugged with wax.  The theory is that putting a special candle in your ear and lighting it will draw the wax out.  It is also promoted as a remedy for earaches.

It may sound a little strange, but many people believe in it.  These candles and kits are available at national pharmacies and discount stores as well as specialty shops.  The Internet provides instructions on how to make your own ear candles.

A website dedicated to the practice warns not to trust the critics and skeptics.  According to them it is a “therapeutic relaxation technique similar to acupressure, acupuncture, and aromatherapy” highly recommended to those “within the Holistic and Natural Health Community.”  The practice dates back “many thousands of years and has been found in nearly every culture since the beginning of civilization” with “archeological evidence of stone pottery cones in antiquity” for this purpose.  In addition, it boasts that “humans have been coning or candling for eons.”  

The website goes on to defend the practice against its critics saying that it is misunderstood as are many other “Alternative lifestyle practices” that have been “passed down through the generations” and praises it as another rediscovery of “ancient wisdom” as we “attempt to remain connected to the teachings of our past civilizations.”  It goes on to question and criticize the findings of the FDA that there is “no valid scientific evidence to support the safety or effectiveness of these devices for any medical claims or benefits.”

Well, it seems the FDA is not alone.  They are even milder in their criticism of ear candling than many others.  WebMD quotes Jennifer Smullen, instructor of otology and laryngology at Massachusetts Eye and Ear Infirmary in Boston.  "You can actually lose your hearing from ear candling.  I've had to treat bad consequences of ear candling, including burns in the ear canal and on the eardrum."

Audiology.org notes the large number of websites on the subject.  “Many present reasonable and rational information warning those contemplating this activity of nonexistent benefits in tandem with significant potential for serious injury. The medical literature has clearly demonstrated ear candling has often caused serious injury without evidence of benefit (Zackaria and Aymat, 2009).”  [Emphasis added.]  They conclude: “Ear candling is dangerous (even when used as directed by the manufacturer) and serves no legitimate purpose and there is no scientific evidence showing effectiveness for use.”

The Mayo Clinic weighs in with further warnings.  “Research shows, however, that ear candling is ineffective at removing earwax. In fact, the technique can actually push earwax deeper into the ear canal. Ear candling can also lead to: Deposits of candle wax in the ear canal; Burns to the face, hair, scalp, ear canal, eardrum and middle ear; and Puncture of the eardrum.” 

Finally, a highly recognized ENT physician put together this YouTube video to demonstrate that ear candling, when used to remove earwax does exactly the opposite of what it is purported to do.  The ear candle is placed in an empty glass and lit.  Instead of creating a vacuum to draw the wax out of the ear, deposits of soot and wax from the candle form in the glass and on the inside of the tube.  Adding more debris to the ear canal can be dangerous, but the deposits inside the tube give the false impression that wax was drawn out from the ear.

Here again we find trigger words: ancient wisdom, holistic, natural health, alternative, reconnects with the past, and belief.  These are sure ways to win over many who inclined not to be skeptical.  These words sound nice and gentle and friendly, almost magical.  Science is so impersonal and objective.  All it takes is a recommendation from a neighbor, relative or a social media contact, who says they tried it and it worked.  That really means they didn’t hurt themselves and experienced subjective feelings of improvement, possibly driven by the Placebo Effect.  At this some people are willing to throw out the research and warnings from professionals, or more likely, not do simple Internet research on their own to confirm safety and effectiveness.  They trust unqualified promoters of so-called ancient wisdom more that the doctors.  (Do they only reject the use of leaches because it can’t be traced to the Orient?)

I’m not trying to be a party pooper and condemn everything alternative and natural.  I’m just asking that we raise our standards.  Require proof beyond the sample size of one or two and the feel-good hype associated with these products and practices.  In so many cases, these are just more examples of “snake oil” that do nothing but enrich the promoters while diverting money from practical uses like debt reductions and saving for retirement, while in worst cases endangering the patient.