Is there Ever a reason for placebo use?

Updated 10.22.2014; reformatted 9.19.2015
So a brief respite from the ongoing mea culpa over not doing adequate due diligence before touting the nutritional advice of Yale's Dr. Katz and the whole Evolution of Medicine crowd. To be fair, his nutrition advice is excellent, but I can't shake the suspicion that David Gorsk's contention that the science based nutrition stuff is the equivalent of "the camel's nose under the edge of the tent" is correct.

And yet.

What about people like my father?

My father suffered and died from Progressive Supranuclear Palsy (PSP). PSP is very rare, and thus attracts little interest from researchers. That's starting to change a bit, but the change comes too late for my father who died in November 2012. PSP is an awful disease, as the name would suggest progressive in nature. There are no drugs specifically targeting PSP, what patients are given are drugs for Parkinson's or Alzheimer's. It's a very depressing situation. Among the issues that developed as his disease progressed was difficulty sleeping. To combat this, he prescribed Ambien, which beyond being potentially addictive and/or interacting with the other drugs he was taking, never seemed to work.

Like many elderly, the Ambien was added to an already extensive chemical cocktail (of real f*cking medicine as the Sci Babe would say) that he was prescribed by various doctors to take each day. Could drug interaction be why the Ambien did nothing? It's impossible to say. Most of prescribed drugs seemed to be ineffective, (not surprising given they weren't developed for PSP) though getting him off any drug, once prescribed, was never an easy task.

So my thought experiment for the day is, what if we'd tried some placebo option? It may not have worked— because in order for ANY placebo to work the person taking it has to BELIEVE that it will work.

Please note what I'm NOT saying.

In posing the question above, I am NOT saying that a placebo (homeopathic or otherwise) is the best choice or should ever by the first choice. And homeopathic placebos can do real harm. Here is an old list of patients who died after replacing medicines with homeopathic placebo remedies. I'm sure if I searched I could find more recent examples, but I'm not suggesting that ANY of my father's drugs for his disease should have been replaced with a placebo. But trouble sleeping was NOT part of my dad's disease. And adding that extra drug to his already sizable cocktail didn't help him sleep and may have affected the action of the other drugs (he was on so many it was impossible to isolate precisely which interaction caused the issue. We just stopped the Ambien.) In such a case, is a placebo sleep aid really the worst option?

Gamergate gives me the answer?

Well, not Gamergate per se, I think Gamergate is an extended online tantrum by a bunch of anonymous idiots. I think this Chris Kluwe essay says all that needs to be said; be warned, Kluwe liberally uses profanity and gamer jargon. But in Frederik deBoer's Gamergate coverage, I may have found the reason medicine cannot for any reason allow or acknowledge placebos.

The analogy deBoer uses is the effort to increase Fathers' Rights, which gets almost uniformly associated with the anti-feminist Men's Rights movement. deBoer's friend is struggling to gain custody to his daughter over her alcoholic mother and has found that in 2014, courts still presumptively favor awarding custody to the mother. In trying to find kindred spirits with whom to build a movement to give Fathers equally standing in child custody cases, the friend looked online, only to find that any discussion of fathers' rights was confused immediately with the misogyny of the Men's rights. So confused, that most people stop listening when the words "Fathers' Rights" are mentioned.

deBoer's further point is that the misogyny and nastiness found in Gamergate (#gamergate on Twitter if you really want to be sickened) completely overwhelms any legitimate ethical concerns that some gamers have. Unless and until the two streams are completely separated, the taint of the one ruins the other.

Yes, it is unfortunate to define any group by the actions of its worst members, and there are times in life, particularly when it comes to political struggles, that you have to hold your nose and align with people you can't stand. But this isn't one of those times, and too many people who complain about how #gamergate is discussed in the media refuse to be frank about how rife with ugliness the phenomenon is.

That's the problem with placebos and medicine. David Gorski, has said numerous times something along the lines of mixing a cow patty with ground beef doesn't produce a better burger. Placebos aren't medicine, and acknowledging they might sometimes be useful in specific cases would pollute the message that real medicine is what matters. That makes sense to me.

And yet. had I known about the sugar pills for sleep, I might have given him some to try if I could get him to think it would work (as belief is important with placebos). With no risk of drug interaction and a small placebo sized chance of success? After all, he wasn't sleeping taking the Ambien (a real drug that he believed should work). I'm still left thinking, why not?

As this was only a thought experiment, it ends here. I doubt this will be my final words on this topic.

Would I take a placebo?

It seemed remiss not address whether I myself would take a placebo. If I knew it was one, (ie if I knew it was a homeopathic or alternative treatment rather than an actual drug) the answer is NO. I have no illusions about homeopathy, it's complete and total bunk. Using nutrition (food choices) to affect bodily changes, on the other hand, I would (and do) do, at least if there is real science supporting the hypothesis.

So why consider an option (even if it's only hypothetical) for my father that I would never choose for myself? Desperation is the answer if I'm honest. Lack of sleep directly affected his well being and medicine didn't have an answer for him. A no risk option with at least a small possibility of success looks tempting in the face of a high risk option proven to be ineffective.

More background sources on homeopathy.

I am still learning about homeopathy, which has a lengthy history despite my being completely unaware of its existence until recently. Eventually I should collect all these links into a single background page, but for now I will simply list them as sources at the end. As always, if a specific point or fact is drawn from a source, an inline link will be created.

A history of homeopathy, written from a skeptical physician's stand point. Homeopathy is legal, and has been since 1938, thanks to a sympathetic lawmaker who led the drive to get it legally recognized. The Food and Drug administration (FDA) doesn't regulate homeopathy in the same way as drugs because placebos aren't drugs.

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