Tuesday, February 9, 2016

Tricky, dangerous and valuable subject

It is that subject, again: placebos.  Could be a sugar pill that you tell me is a powerful drug.  Could be a fake hypodermic needle with no point that you use to trick me into believing I have been injected with a miracle drug.  Could be a real hypodermic that the nurse uses to inject me with something that may or may not be the drug, or any drug.  If I don't know which it is and the nurse doesn't know, we are in what is referred to as a "double-blind experiment."  Neither the patient nor the injector knows whether I got the tested drug or not in a double-blind experiment.

This whole business is tricky.  We are experimenting with the truth and trying to tease out what matters.  Much like a courtroom interrogation by an attorney, we are trying to improve our understanding. Our understanding is unlikely to ever be perfect and we know it.  We stand ready to revise our mental picture of what is going on.  But the road to more complete understanding is a tough one to travel.

I guess people often stand ready to take umbrage, be annoyed or angry, if we tell them their pain is "all in your head".  I haven't had a serious problem that anyone tried to dismiss with that phrase but I think I won't mind if I am told that my sore shoulder is all in my head.  My understanding is that it is.  My ability to feel pain, to receive signals from my shoulder nerves, to decode those signals and read them as pain - all that depends on my head.  Remove my head and it all stops.  So, yes, it is all in my head.  However, the question is how can I arrange things so that the pain signals stop and the shoulder is in good working order.

I love the fact that when you put on your white coat and soberly have me swallow this little blue pill, the pain stops.  I can think of other things you could put on (or take off) that might give me an even stronger effect.  But let's not get distracted.  If you have used others to establish that the blue pill was just sugar and if we all believe that sugar could not have a shoulder-healing power, we begin to explain my improvement using the word "placebo".  The improvement must have something to do with my mind and its connection to my shoulder.

This is tricky because the truth is elusive and too big.  It is dangerous because we are entering the area of scams and fakes, like Dr. Dulcamara, the "itinerant medicine man" from the 1832 opera, The Elixir of Love.  He could provide a liquid that would solve your problem but only he could do it.  Don't use anyone else's juice, just his, he tells us.  It is valuable because all sorts of benefits are sometimes possible using little blue sugar pills in the right way in the right setting.  Sometimes, we don't consider the mechanism behind what happens too mysterious.  When the little red-headed girl is in the stands, Charlie Brown is more nervous but also tries harder to be a good pitcher.  Is it reprehensible to get a different little red-headed girl, one who looks very much like Charlie's schoolmate, to sit in the stands for the big game?

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