There was a fascinating article in Wired Magazine in August about the increasing potency of placebo.
On the face of it, that sounds like mad chatter: a pill that is little more than sugar increasing in efficacy? With no pharmacologically provable mode of action or reason why?
Physician: steel thyself. Drugs are not your only tools any more.
We could easily adduce philosopho-quackery commentary along similar lines to the author's conclusion, namely that: 'the brain is really clever' and 'we don't understand it all, Horatio'.
But that only adds fuel to the fire of pseudo-science, and as anyone with a Hotmail account will know, there are all too many opportunities to increase your penis size with a blue diamond pill made out of bits of dandelion and alsatian. Or worse.
At least, that was the reason I fled Hotmail for Gmail.
I digress. Because the thought I wanted to ponder in this post was not precisely about the above phenomenon, but about the moral conundrum of offering someone with a life-threatening condition a sugar pill.
Even in the face of (apparently) more placebo peculiarities like this one, when you're dealing with illnesses as serious as cancer there will still be a statistically significant number of people who will think they're being given a pill that could make them better, only for it (up until recently) to do bugger all.
The moral conundrum is made more difficult still when you compare people's willingness to take part in trials where placebos are given. This article, on a sample of women asked to be recruited to an HRT trial, suggests that - at least in situations that are not immediately life-threatening - willingness does indeed drop.
This is not just because of perceived risk to self, either, but also the sense that the altruistic and research purpose of the trial would somehow be less.
And all this is, to my mind at least, understandable. I just don't comprehend the fact that most trials are against placebo rather than an existing competitor drug - where you would at least have some hope of being treated.
It's not even as if proving yourself against sugar pills is as easy as it once was...
3rd March 2010 ADDITION: a interesting post on other Placebo morality issues - http://www.kevinmd.com/blog/2010/03/placebo-effect-ethics-medical-treatment.html
