The Elaborate Ritual Improving Medical Care
Category: Seeing Clearly Now
Over at Bad Science Ben Goldacre discusses the placebo effect.
Now as I have said so many times before, the placebo effect is not about a sugar pill, it's about the cultural meaning of a treatment, and our expectations: we know from research that two sugar pills are more effective than one, that a salt water injection is better for pain than a sugar pill, that colour and packaging have a beneficial effect, and so on. Interestingly, there has even been a trial on patients with arm pain specifically comparing a placebo pill against a placebo ritual involving a sham medical device, modeled on acupuncture, which found that the elaborate ritual was more effective than the simple sugar pill. "Placebo" is not a unitary phenomenon, there is not "one type of placebo".
Ben provides some of the results of a recent study of the benefits of acupuncture for patients with chronic back pain. From his point of view the study has more to say regarding the placebo effect than acupuncture per se.
Firstly, 27% of the medical treatment group improved: this is an impressive testament to the well known healing power of simply "being in a trial", since medical treatment hadn't helped these patients for the preceding 8 years. Meanwhile 47% of the acupuncture group improved, but the sting is this: 44% of the fake acupuncture group improved too. There was no statistically significant difference between proper, genuine ancient wisdom acupuncture, and fake, "bung a needle in, anywhere you fancy, with a bit of theatrical ceremony" acupuncture.
Ben got me to thinking. If an elaborate ritual can work for patients might it also work to improve the conduct of doctors? If we could devise an elaborate ritual with a significant cultural meaning could we use it to upgrade the quality of medical care dispensed by the medical profession?
Then, it struck me - we already have such a ritual. It is called the medical malpractice claim.
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