PLACEBO

I like to think of myself as a reasonably intelligent person. After all I have had a long life, following a Jesuit education, married for 60 years, five children and a career in high level finance. I am confident that my decisions and choices are well founded. But I am put on warning: people have an inbuilt tendency to overestimate their intelligence. Why not me? Or you?

I have been looking at the placebo effect. It is a valuable source of knowledge about the way the human mind works. It has the great advantage of enabling us to measure our possible confusions in a reasonably precise way. For example, the effectiveness of a drug for a particular condition can be measured by giving it to some patients while other patients are given a neutral substance instead. Clearly the effectiveness of the drug can be measured by the outcomes of the two groups. However, a number of the patients, who did not know that they had been given the neutral substance, also improved. This is put down to the placebo effect: thinking that you have, or may have had, the correct drug is enough to bring about a degree of recovery.

Perhaps even odder than that, there is evidence that for some conditions even telling the patient that the drug given is inert does not prevent an improvement. I can only suppose that going through the routines focuses the mind on the condition and in some way affects the brain. The patient’s basic temperament appears to be significant.

Other factors play their part. For instance, placebic injections are more effective than placebic pills. And blue pills are more effective than pink ones. Confidence in the medical team or an admired doctor also contribute. A most dramatic example is the potential effectiveness of sham stem cells injected into the brain in cases of
Parkinson’s disease.

Nor should we forget the “nocebo effect”. Here, for example, patients are told that a neutral cream may lead to more pain in some people. And so it does. You will understand how such phenomena can complicate medical conclusions.
Nor is this confined to medical issues. Athletes can improve their performance by false measurements of their timings, and insomniacs can brighten up when (fictional) tests show that that they had had better sleep than they thought. (You will find a thorough article on placebos on the British Psychological Society site at: p://tiny.cc/hzdc7y)

We are not thinking here merely of interesting facts: we are discovering how the human brain works. What we know, or what we decide, is the outcome of the combination between the action of our brains and our freewill. This column is not called Science and Faith for no reason. Every time we act, think or learn our brain changes. It carries our memories further back than we can actually remember, and even these may be distorted. The influence of our parents, other early carers and our siblings, is largely forgotten, but they travel with us into adulthood. I assume that I learnt my faith from my parents, and even now I can remember the answers in the Penny Catechism. Add to that all our experiences and decisions throughout life – each of them, and their consequences, have altered our brains, and so influence our decisions.

So much for freewill? I will certainly defend its existence – but I need to be careful. Most of the time, what are apparently free choices are in fact reactions furnished by my brain. They may well feel free but, unless I am aware of the likely influences playing their part, my freedom may be very limited. I am, as it happens, rather good at convincing myself that whatever I want to do can be justified in some way or another.

There is another side to this of course, how do we judge the actions of others? We might be thinking of gross activities such as murder, fraudulence, adultery or – if we are prepared to go that far – the abuse of the young. Naturally we judge them by our own standards, and that means that they can by no means be tolerated. But how about their standards? We know nothing of their experiences or the details of their brains. They should be punished of course – but perhaps not for their guilt, which we cannot measure, but because their punishment is an unpleasant experience which will be in their brains when faced by the next temptation. You may think I am going too far — but one day we will all be judged before the throne of God and I, at least, would prefer him to bear in mind all the subconscious weaknesses which have contributed to any sinful activities.

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About Quentin

Science Editor, Catholic Herald. Portrait © Jacqueline Alma
This entry was posted in Bio-ethics, Catholic Herald columns, Neuroscience, Quentin queries and tagged . Bookmark the permalink.

28 Responses to PLACEBO

  1. David Smith says:

    Quentin writes :

    // There is another side to this of course, how do we judge the actions of others? //

    Ah, the end of sin. And, I presume, the beginning of crime. God is gone, but the law lives forever.

    // So much for freewill? I will certainly defend its existence – but I need to be careful. Most of the time, what are apparently free choices are in fact reactions furnished by my brain. //

    So you defend free will but you do not believe in it.

  2. Nektarios says:

    Quentin

    I find the placebo effect is not that difficult to understand.
    If we can agree that we live in the past, that is out of memory. We have memories concerning the good doctor giving us pills or some other medicine that makes us better. If given a placebo we are duped into thinking from our memories that the good doctor is giving us the real medicine which in some cases seems to work, but it is simply memory at work in the brain which when working normally, the brain works as a whole with many different functions to perform and can do so simultaneously. Information coming in is also being assessed and acted upon by the memory.

  3. Alasdair says:

    In his feature “Thoughtlessly Thoughtless” in New Scientist, 13 Dec 2017, Graham Lawton says “Sloppy thinking is at the root of many modern ills. We delve into nine key ideas that come naturally to us to find out why they are often so misguided”.
    You won’t be surprised to hear that one of Lawton’s nine products of sloppy thinking is the notion of God. Cognitive scientists (unnamed) have said so. Atheism requires hard intellectual graft apparently, whereas religious belief is intuitive, and therefore it’s sloppy thinking which could have been eliminated by even a basic scientific education.
    This extraordinary assertion just keeps on coming up, apparently immune to all the evidence to the contrary. But then, why would a science journalist be interested in evidence?
    Quentin, you have consider the possibility that perhaps a Jesuit education encourages sloppy thinking!

  4. GD says:

    Yes, the unconscious does affect our choices more than we care to admit; can’t admit until brought into conscious awareness.
    But!! …. Does freewill need to be TOTALLY conscious to actually make a choice?

    If we can be aware of, and consciously believe, our will is partly unconscious, and honour that part by allowing it to inform our choices intuitively, we may well find our choices are closer to Truth.
    By not ‘definitively knowing’ JUST by conscious logical analysis, we needn’t define ‘freewill’ as needing to be TOTALLY conscious to be FREE.
    (Is there any credence at all for … ‘ah, moments’ … gut feeling … myth .. imagination .. dreams etc; ‘Soulful’ living?).

    Does the placebo effect deny freewill?
    The conscious belief that healing will occur, or NOT, is freely chosen. The fact that the drug/placebo administered has different actions on the ‘physical/chemical processes say’s nothing about the actual healing process, as BOTH produce healing or NOT, in some cases of each administration.
    Could it not be that it is the belief (conscious and/or unconscious ‘faith’?) that actually produces healing in BOTH cases?

    There was a placebo study done ( https://www.nejm.org/doi/full/10.1056/NEJMoa013259 ) on surgical knee operations – some were merely cut and sewn up again with no surgery done – with very significant results.

  5. David Smith says:

    GD writes:

    // There was a placebo study done ( https://www.nejm.org/doi/full/10.1056/NEJMoa013259 ) on surgical knee operations – some were merely cut and sewn up again with no surgery done – with very significant results. //

    Sham surgery. That sounds unethical.

  6. ignatius says:

    Free will for us humans can be compared to driving a car. As long a the car works we have complete freedom to move towards the object of our desire. But the application of our will is dependent on many factors, such as the steady firing of pistons, which we cannot affect at all. So for our human lives, our urges and desires originate from someplace within us that is almost never consciously fully determined, Man has a visceral life to which he is subject.
    So free will is a contingent property operating on a gradient.
    Placebo basically operates as a reaction, deep enough within our substructure, as to be beyond the reach of free will. For example if someone calls your name in the street you will automatically turn to respond. This tells us that voice quite naturally evokes a deep visceral response and so by extension that voice – commands, promises etc will produce some change in what we might deem our psycho emotional feedback systems.
    In my understanding it is a mistake to link placebo to free will because the former keys into mechanisms which are deeper and more primal than the consciously weighed and rationally considered decision making with which we normally associate freedom of choice.

  7. Iona says:

    David Smith: – if you look at the detail of the experiment you will see that all the patients were fully informed i.e. knew in advance that they might be receiving actual treatment or maybe just an incision and stitching up again; and they agreed to this. So, not unethical.

    • David Smith says:

      Iona writes:

      // So, not unethical. //

      I think I understand your position, Iona, but I disagree. Something about this experiment rings an ethical alarm bell in the back of my mind. It would take me more time to think through than I’m willing to give it now, but I hear it clearly.

      • milliganp says:

        Every time we inoculate against a major illness or administer drugs there is a finite possibility of side effects including, sometimes, severe ones. Even this simplest surgery can go wrong. All medical intervention has ethical dimensions but much progress involves intervening first and dealing with side effects later.

  8. Nektarios says:

    There are a lot of unethical behaviour going on in the medical and caring professions these days,
    unfortunately, there is no placebo effect for unethical behaviour.
    Neither is there any placebo effect for sin. Only one effect for sin works, that is our Lord’s shedding his blood. death, and resurrection. His sacrificial death for us works with God to forgive us all our sin and to bring us to glory to dwell with God forever.

    I am not sure I agree with you, Iona. As individuals, they would not know for sure if they got a proper op or a placebo op till afterwards. They might agree to a trial op program, otherwise, they would not have the op at all either way. This would be emotional blackmail and so unethical.

    • David Smith says:

      Nektarios writes:

      // There are a lot of unethical behaviour going on in the medical and caring professions these days //

      I agree. We’re not only a secular society, but also a utilitarian one, in which, it seems to me, professional rationalization often comes far too easily. Perhaps the most recent example of this in the news is the Chinese and Russian rush to “improve” human babies by altering their genetic makeup. Even professional objections to this seem tepid, based only on the fact that the experimenters did not go through official international channels before dong what they did.

      The law, in our culture, seems to have taken the place of the conscience. Once a law has been put into effect approving or disapproving something, the media – and, therefore, unfortunately, much of the public – take the position that any moral or ethical objections have been dealt with, and that, therefore, it’s the obligation of every individual conscience to fall in line. In fact, continuing resisters are publicly made outcast.

      • Nektarios says:

        David Smith
        Well said, David, I could not have put it better myself.
        Despite all the unethical behaviour going on in the medical, pharmaceutical and caring professions, Good practice does still prevail in some people. I was protected by the good Lord. Faced with a serious and lengthy op that might have at least left me paralysed and at worst, die on the operating table, the anaesthetist stopped the surgeon from going ahead with the said op.
        I have had over my three score years and ten, and though I still love life and living, my time is in the Lord’s hands.

  9. ignatius says:

    Nektarios,
    Read carefully the small print of the project and you will find no breach of ethics. Perhaps you do not believe that people have free will and are able to make decisions intelligently and rationally?

    • Nektarios says:

      Ignatius

      I was one who was called upon occasionally to advise at various times on medical ethics. I won’t discuss that here.
      If one says one has free will, to what extent is it free, influenced or conditioned by others or by one’s earthy fallen nature?
      There is the argument that we have free will to choose. To choose is to divide, that is I choose this, but not that, I like this, but not that, I want this, but not that. How free is our free will really?

  10. GD says:

    The placebo effect, is not just medical. Can be extended to political/social/religious manipulations propaganda & downright lies; it has ever been thus. (& now proven manipulation of the weather too, denied vehemently by the perpetrators for years until recently).
    All to often we don’t know what we are being ‘administered’ by ‘governmental authority’.
    So do we have a freely chosen vote for anything really, or is it ‘affected’? Is there any ‘democracy’ left? …. The solution in all cases … ‘Know Thyself’, and be careful what you wish/pray for.
    If enough of us were aware of our own motivations we could choose or not; or forge a completely new path … seems a little like the early disciples enlightened by the Spirit of Truth i think.
    May even be surprised at the ability to affect the outcome for the good; against all the odds.

  11. Ignatius says:

    The placebo experiment, as Iona states, was definitively an exercise in free choice. If anyone has actually bothered to read the small print this should be painfully obvious. On our Osteopathic Msc course we have to do literature reviews till blue in the face and devise research projects many of which require board approval. In my own experience as a Course tutor the ethics board are comprehensive to say the least and I cannot fault the set up of the placebo experiment. Yet there are concerns raised. The concerns are there probably because of the echoes from more barborous days and because there is a strain on our credulity as we try to fathom any condition under which we might ourselves participate in what might be called the mutilation of inncents. Yet there is no doubt that choice – and thus free willing- has taken place. Our discussion here on the topic of free will is floundering badly because we do not have a shared definition of the term itself.

  12. ignatius says:

    The interesting thing about Placebo is how well it chimes with Aquinas on ‘knowing’ To ‘know’ is not to simply have an abstract image in the mind but to join in a kind of embrace with the thing known. Quite clearly the ‘placebo’ effect demonstrates that the embrace of something ‘known’, be it idea or object, implies a relationship of change; as we read in the book of proverbs :
    “As a man thinks, so he is” ch 23:7

  13. ignatius says:

    Ooops..glitch ..to continue:
    Quentin sketches out the issues in his admirable text but the real connundrum lies between the lines:
    ” Every time we act, think or learn our brain changes. It carries our memories further back than we can actually remember, and even these may be distorted..”
    Here lies the nub of it. How,exactly does the brain ‘carry memories’? How is it possible for a structure of flesh to ‘live in the past’ when it is altogether present now. The gap between sense, idea,intellect and record is still one which perplexes both science and rational speculation. Current neurological thinking indicates that our ‘present’ is a very short period of time indeed, yet how is the past ‘stored’ in order that we may access it? Again an interesting and germane aspect to this thread.
    http://www.psychologytoday.com/us/blog/going-out…/how-long-does-the-present-last

    • Alan says:

      I cannot follow your link Ignatius. It shows as “page not found”. I think I found it through a search of the title though.

      “How is it possible for a structure of flesh to ‘live in the past’ when it is altogether present now.”

      It would be interesting to find out. Everything I see or hear brings me information about the past despite if being carried by some simple “structure of flesh”. The medium might not be that important … or much of a hurdle.

    • Nektarios says:

      Ignatius

      Isn’t it wonderful, we come across something, for now, we think we do not know the answer to. The way the brain functions has been divided up to component parts with its main functions. What we are not so sure about is how it relates to all the other component parts.
      The function of memory is due to the deluge of information the brain is taking in at any giving time, it is processed and deposited it the memory component of the brain.

      It is there for several reasons, the main one most closely in touch with our human nature. Memory is not only the sum total of all its experiences but other memories as well. Memories of our Native place in God, Our home in Heaven, though it is very difficult to access these memories.
      Memory also assists one to assess the present in light of the past. There is a very good reason for this, memory is part of the brain along with its other functions, is to protect the brain. To access the totality of our brain it needs to be quiet.
      Truly we are wonderfully made!

      • ignatius says:

        That’s Amazing Nektarios ..I didn’t know there was a little tin box in our heads with a sign written on it saying: ‘Put Memory Stuff Here’ …Strange though, I’ve seen a few dissected brains but never seen anything like that.
        Ah well. Just out of interest perhaps you could tell me..is this memory stuff a fluid? a gas maybe..? or is it solid? And how come this memory stuff doesn’t rot?

  14. Nektarios says:

    Ignatius

    As far as I am aware it is electromagnetic.

  15. David Smith says:

    Quentin wrote:

    // people have an inbuilt tendency to overestimate their intelligence. Why not me? Or you?

    I have been looking at the placebo effect. It is a valuable source of knowledge about the way the human mind works. //

    The placebo effect is just one tiny manifestation of our minds’ propensity for creating life stories that comfort and sustain us. We each of us write our own realities. Apparently, that’s an essential part of our programming: beginning as infants and continuing until we die, we do it to make coherent sense of the chaos in which we swim. And a natural part of the stories we tell ourselves seems to be the existence of a supernatural reality that answers the questions our poor creature imaginations can’t handle.

  16. GD says:

    Is it our mind that manifests free will (of any kind) or is it merely a receiver of a free ‘consciousness’ beyond our ‘rational knowing’?
    (Science is unable to prove/disprove one way or another – ‘consciousness’ can not be studied as ‘an object’ from within ‘consciousness’).
    Is there an inability to ‘know’ (‘know’as Ignatius gives Aquinas’ definition of the term) reality due to our ‘thinking’ we know ‘the facts’, when in truth facts are the ‘imaginations’ mistaken ‘memory’ of ‘reality’? (An ‘image’ a ‘reflection’?).

    And so are we incapable of following the dictum ‘know thyself’ until we embrace (‘know’) ‘consciousness’ prior to the mind’s (electrical) ‘gymnastics’?

    Does God create life, or does man manifest his life? I’d answer Both.
    But only one is reality, the other is ‘imagination’ manifested as real. …. ‘As man thinks so he is’ …. we can think factually … or ‘know’ consciously.

    And, as consciousness embraces all that is, we lose no thought process’ – rational, imaginative, memory fantasy – but can see (Aquinas’ ‘knowing’) them clearly for the reality they are; the place/use they have in reality; and come to ‘see’ the reality of consciousness, prior to thought (mind).
    Then we can choose freely one and/or the other …

    …… ‘Know thyself’. ……
    A life long (Eternal even) process of coming to ‘know’ our reality within consciousness?

    • GD says:

      adding … it’s a collective ‘coming to know’ … we all influence one another’s ‘awareness’ of, or lack of, ‘conscious knowing’.

    • Nektarios says:

      G.D.
      I can see some of the books you have read on the subject of consciousness. A very interesting and useful study in itself. But we need to first define it. Consciousness is the sum total of all that we are and all that has been and is.

      Of course, there have been many strands of esoteric knowledge on the subject of consciousness, but it seems such practitioners seem to lack the understanding such living would have who had their functioning and living out of that consciousness.
      From what I have seen and read most operate out of philosophy about consciousness.
      This indulgence in the esoteric aspects of consciousness is powerless.

      Living out of consciousness is to know how to live and how to act. For then we are entering into, or rather being on the threshold of the realm of the spiritual. One has to be spiritually alive to move any further forward.

  17. Ignatius says:

    “We each of us write our own realities”

    Karl Rahner is really worth pursuing on all of this. I’ve been working through ‘A Rahner Reader ‘ for about a year now and it is quite remarkable in scope. Basically a reworking of Aquinas. Rahner is of the impression that our basic identity is one of spirit. This explains rather a lot when you think about it and puts much of the problems of ‘memory’ ‘ The Past’ ‘The Present’ etc into a wider perspective. Well worth a read.

  18. GD says:

    Is it our mind that manifests free will (of any kind) or is it merely a receiver of a free ‘consciousness’ beyond our ‘rational knowing’?
    (Science is unable to prove/disprove one way or another – ‘consciousness’ can not be studied as ‘an object’ from within ‘consciousness’).
    Is there an inability to ‘know’ (‘know’as Ignatius gives Aquinas’ definition of the term) reality due to our ‘thinking’ we know ‘the facts’, when in truth facts are the ‘imaginations’ mistaken ‘memory’ of ‘reality’? (An ‘image’ a ‘reflection’?).

    And so are we incapable of following the dictum ‘know thyself’ until we embrace (‘know’) ‘consciousness’ prior to the mind’s (electrical) ‘gymnastics’?

    Does God create life, or does man manifest his life? I’d answer Both.
    But only one is reality, the other is ‘imagination’ manifested as real. …. ‘As man thinks so he is’ …. we can think factually … or ‘know’ consciously.

    And, as consciousness embraces all that is, we lose no thought process’ – rational, imaginative, memory fantasy – but can see (Aquinas’ ‘knowing’) them clearly for the reality they are; the place/use they have in reality; and come to ‘see’ the reality of consciousness, prior to thought (mind).
    Then we can choose freely one and/or the other …

    …… ‘Know thyself’. ……
    A life long (Eternal even) process of coming to ‘know’ our reality within consciousness?

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