Is it okay to pay for a placebo?
No one’s stopping you … but maybe you shouldn’t. This came up on Threads this morning when someone asked:
“What role do you think placebo effects play in healthcare, and could they justify homeopathy’s existence?”
Not much, and not at all. The “power” of placebo has been exaggerated and hijacked to justify treatments with low or no other conceivable value, like homeopathy. Placebo is a perpetually abused topic, and I’ve been writing about it for many years. This morning I tuned up this part of my main placebo guide. Here’s how that section reads now…
Placebo for sale! Is it okay to pay for a placebo?
It seems to me that placebo treatments ought to be paid with a placebo payment.
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Even when people begin to accept that a treatment is probably bunk — homeopathy is a good example — they often still protest that they are happy to pay for a placebo. As long as it works, who cares how? And placebo can work! Right? Maybe! So why not? This is basically the medicinal version of Pascal’s wager: erring on the side of faith in dubious treatment instead of a dubious God. If that treatment turns out to be real, great! If not, no harm done, and perhaps there’s a little placebo consolation prize.
Except harm could be done, and the consolation prize is probably very small indeed. Remember, placebo is not actually spooky or potent! [As exhaustively documented in the rest of the article.]
I have no problem with people choosing to pay for a placebo with eyes open, aware of the nature of the choice. But … the wider your eyes get, the less likely you are to benefit from a placebo (despite the “open label” hype, see above). And there are clearly some strict limits on what placebo can do even at its best … and paying for things is never completely harmless, because that money could be used for other things … and trying to use a placebo gets a lot more problematic when something medically ominous pops up, which it often does as we age.
I have the least objection to paying for a placebo when we’re talking about treatments in the happier side of the grey zone: unknown efficacy but with higher plausibility and lower risks. I’ve tried many such treatments, knowing full well that any effect I enjoy is probably just regression to the mean… but it might be an actual effect, and I’m willing to pay something for that chance. I’m gambling on getting a genuine benefit, with the more remote possibility of a small placebo effect as a consolation prize. Or at least the comfort of being proactive!
But the plausibility has to be there for me to bust out my wallet.
And it ain’t there with homeopathy, but also lots of other things where many people are banking on getting at least a placebo.
There’s a weightier placebo update coming soon-ish. I’ve been missing something important, and it turns out the power of placebo power needs even more debunking than I’ve already given it…