The Ethics of Placebos
An analysis of over 4000 wines entered in 13 U.S. wine competitions shows little concordance among the venues in awarding Gold medals. ... An analysis of the number of Gold medals received in multiple competitions indicates that the probability of winning a Gold medal at one competition is stochastically independent of the probability of receiving a Gold at another competition …
For the 375 wines entered in five competitions, one would expect by chance alone (for p = 0.09), 234 wines receiving no Golds, 116 receiving a Gold in just one competition, 23 receiving Golds in two competitions, two receiving Golds in three competitions and no wine receiving Golds in more than three competitions. The observed frequencies closely mirror these numbers.
"The more I look at empirical studies such as this one," writes Felix Salmon, "the more I’m convinced that if you’re tasting blind, there’s no correlation between perceived quality and just about anything." Which isn't to say that people don't really prefer the high-quality wines when they order them: The placebo effect is real, and it's powerful. If you think a wine is tastier due to its prices, or a pill is a powerful antidote to your ailment, your experience is likely to match your expectations.
The ethics of this have always interested me. Take a gander at the graph atop this post. It's from a CBO paper that contains many more graphs like it, and it compares the relief patients felt after a surgery meant to relieve angina pain and a skin incision conducted while the patient was under anesthesia. Relief was effectively the same. The medical community responded by abandoning "internal mammary artery ligation," though you could argue that they should have responded by increasing the use of skin incisions. The pain relief, after all, was real, and significant, even if the surgery was fake.
There are no end of situations that might lend themselves to placebo treatments: patients demanding an antibiotic when they have the flu, or painkillers when they have nothing but unspecific aches. The placebo could do the patient some good and avoid them some potential bad (side-effects, antibiotic resistance, etc). This is, of course, unethical, not to mention an invitation to some serious lawsuits, not to mention ineffective once word gets out. But the evidence in favor of the placebo effect is really quite tremendous: It's hard not to wonder if there's not some way to marshal that cheap, safe power.
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