MD, PhD, FMedSci, FSB, FRCP, FRCPEd

One argument I hear over and over again; it could be called ‘the fallacy of the benign placebo’ and goes like this:

  • Alright, I accept that the evidence for xy isn’t brilliant.
  • I might even accept it is a pure placebo therapy.
  • But that is not important.
  • What counts is that it helps suffering patients.
  • Who cares about the mechanism?
  • As long as a therapy can be shown to be helpful, we should use it!

I am sure you agree, this fallacy is extremely common. What is more, it is damn difficult to argue against. Whatever I used to counter, people would look at me in disbelief thinking: those scientists really sit in their ivory towers and haven’t got a clue about the real issues.

In my frustration of not getting through to many people, I have now thought of THE TELLING TALE OF THE PLACEBO BANKER.

Allow me to explain:

Imagine you are in real difficulties. You lost your job, your wife is ill, your children need feeding, the bills are stacking up – in a word, you need a loan to survive the next few months until things are sorted out.

Luckily, you know a very nice chap who is in charge of your local bank and who has a reputation of trying his utmost to help clients in need. So, you make an appointment and see him. He listens attentively and shows compassion for your situation. He gives you all the time to explain things in full detail and then re-assures you that there is hope: he will help you! At the end of the consultation you leave his office feeling well and optimistic. You even have in your hands a tidy amount of money that will get you through this bad patch. All is fine…because you have seen a real banker who knows his job in such situations consists mainly of two things:

  1. be kind, listen with empathy and give assurance that makes customers feel good,
  2. give the necessary credit.
The real banker is, of course, akin to the real physician who must:
  1. show compassion and empathy,
  2. prescribe an effective treatment.

Now, imagine you are in dire straights again. This time you go to a different banker, someone who has the reputation to be even kinder and more ‘holistic’. The consultation proceeds much as the last one. The banker listens, offers help and shows compassion. If anything, this new chap is even better at this task. He is more understanding than the last one, he even explains why you got into difficulties, and he has a full hour just to talk with you. Consequently, you feel really good about the whole thing, and you are happy as he gives you an envelope full of money that will assist you solving your current problems. You go home and feel great…until, three days later, you need to pay your first bill, open the envelope and discover that it contains plenty of notes, but they are all Monopoly money. You discover that you have become the victim of THE PLACEBO BANKER.

The placebo banker is, of course, akin to the placebo therapist who can do little more than:

  1. show compassion and empathy,
  2. dish out placebos.

I know, the analogy is not perfect but is explains the fallacy a bit, I hope.

Placebo therapist, such as homeopaths, energy healers, etc., give you their time, compassion, empathy – and that’s why their patients often feel better. They also give you their placebos which do very little and, if they do anything at all, the effect does neither last nor cure the disease. To argue that this limited effect justifies the quackery is like pretending THE PLACEBO BANKER does a good job.

Good banking consists of courteous behaviour and adequate financial assistance.

Good medicine consists of compassion and effective treatments.

If one of the two essential elements is missing, neither the banking nor the medicine can be good or ethical.

11 Responses to The telling tale of the ‘PLACEBO BANKER’

  • That is a horrible analogy. And there is NO medical procedure that does not also have negative consequences. Reiki and the like have far fewer negative consequences than say, aspirin, which has these not uncommon side effects: rash, gastrointestinal ulcerations, abdominal pain, upset stomach, heartburn, drowsiness, headache, cramping, nausea, gastritis, and bleeding. Aspirin has also killed people.

    Don’t you have anything more worthwhile to think about? Is this it? The rest of your life raggin on alternaitive medicine folks?

    • Dear JJ Flowers,
      It is a common claim that ‘reiki and the like’ have far fewer negative consequences’. This is not surprising, since ‘reiki and the like ‘, as you put it, are based on nonsense and flim flam, and have never been proved to have positive consequences either, beyond placebo. To call it a ‘horrible’ analogy seems to me to be a little-let’s say-overheated. And as I’ve said before-the destruction of the ideas of quackery like reiki and ‘reiki folks’ seems to me to be an utterly honourable way to spend one’s life.
      If you disagree-show us your reiki evidence. We’re open to persuasion, provided it’s based on science and logic and reason and evidence, and not – as with homeopathy- just the word ‘somehow’.

    • Reiki and the like rot the intellect and destroy the capacity for critical thought and honest self-correction; infectious cultural parasites that spread evangelically through populations, profiteering off rich and poor, neurotic well and desperately ill alike. Alt med has also killed people. And for what demonstrable benefit? Fellating egos and plundering wallets, and remarkably little else.

      Aspirin has a well understood risk-vs-benefit profile, with effective pain control and blood thinning properties that improve quality of life and manage serious medical conditions. It provides accurate dose control and far fewer side effects than chewing on its natural “herbal” equivalent, willow bark. Aspirin has helped save the lives of people at high risk of heart attack. Thus, on balance, its proven benefits outweigh its proven risks. Sure, it’d be great to have even safer and more effective alternatives, but I don’t see you or your lot doing anything to advance the knowledge and products of medical science so perhaps you ought to prescribe yourselves a big old cup of all-natural 100% holistic “Put Up or Shut Up” until you do.

      Oh, and Dr Ernst is a scientist who has devoted his life to studying, understanding, and determining the efficacy (or not) of a wide range of “alternative medicines”, so what do you suggest he’d be more qualified to critique? Ponies?

  • Where it starts to become really complicated is when somebody agrees. or partly agrees, with you, in that what’s working is merely a placebo effect, but still adheres to the belief in homeopathy , using the argument that whatever it is works for them and so what. How does the placebo effect not disappear as soon as it is shown for what it is?

  • I don’t think that this analogy will convince anyone who follows the – dubious – trail of arguments you laid out in the beginning of your post. They simply refuse to acknowledge that the comparison between placebo and monopoly money is accurate. They simply refuse to see that placebo effects are non-specific.

    And of course, whenever one points out examinations of the placebo effect indicating that it is mostly a subjective effect – such as an painkiller removing your pain but not mending your broken bones – the next question tends to be about which element of “Big Pharma” supposedly sponsored and fiddled with that research to have it fit their narrative.

    That’s usually the point where I give up, because there is no way to discuss something in earnest with someone deeply entrenched in conspiracy theories in order to avoid cognitive dissonance. They want to believe, and nothing you can say will keep them from doing so.

    As bad as that is – for the mislead individuals as for society as whole, considering the impact on children and people in need but also the finances of the health system – it’s not about a single argument, and most of these people are not accessible for arguments.

  • No, I don’t think this analogy works. I think what most people perceive would give you this banker analogy:

    There is the real banker and he is a pain in the ass to deal with. He has little time, is rude and meetings with him are generally painful. He will usually give you real money and that really helps, but sometimes he will flat out tell you that there is no hope for your situation (terminal illness). Or he might give you the wrong currency by mistake, causing you a lot of further problems (misdiagnosis, side effects). Or he might tell you that he has no idea which type of credit product is the right one for you and that you’ll have to try out several ones – all with a bothersome and painful process, strange side effects and more visits with this unpleasant guy.

    And then there is this homeopathic banker who is really likeable, who makes you feel good from minute one and promises you that he can help you in all situations, every time, all WILL be well, just trust him. Yes, he hands out only monopoly money, but he makes you feel so unbelievably good that in most (at least that’s what people believe) cases your confidence will be so improved that you’ll (trying to find some analogy for the placebo effect here) – I don’t know – unexpectedly get some extension from your creditors, land a new job right away, or similar. Somehow, by getting that monopoly money that uplifts your mood your situation fixes itself. And all this without having to deal with the unpleasant real banker and his painful processes. And it worked for your aunt, too, she also found a new job right away after stepping out of that guy’s office. And a friend of a friend’s nephew even won the lottery due to that monopoly money, I swear it’s true, heard it from a coworker just last week.

    That many people don’t find a new job and some even go bankrupt when a visit to the real banker might have been unpleasant but would have saved them with certainty is something you never hear about. And even if you do – there’s a lot of stories left over from not that long ago when bankers treated their customers even more rude, had the “god in white” attitude to the extreme, didn’t care, thought of customer’s opinions as of little importance or made huge mistakes and did unethical things (I’m thinking Contergan, or Tuskeegee, or Henrietta Lax, etc.). And hell, they change their opinion on what’s good for you every couple years anyway, so why would you trust them?

    That’s what I hear when I talk to my globuli popping friends and in a way I’m not all that surprised that they often prefer the monopoly money plus compassion combo to the real thing.

    • ttt-
      And yet, once you open the envelope and realise that the toy money is worthless, and you can’t spend it in a real shop, and the banker was just aggrandising himself at the expense of you and your bad circumstances, and you’re still in the mess you were before you visited him, and possibly worse, because the placebo effect has quickly worn off, and your creditors are now demanding interest-or in medical terms the the illness has progressed – and the Tax people for some reason don’t accept your banker’s pretend money or his maliciously playful attitude? In other words, as I asked before – how do people manage to hang on to the fantasy even when it’s been shown to be such?

      • The banker might tell you it’s your fault the creditors did not accept his perfectly valid monopoly money.

        Or you might not even identify it as monopoly money, and simply return to your banker to get more, to pay your creditors’ interest. Which is probably where the analogy breaks down even further, because even laymen are able to distinguish monopoly money from real money, while alternative medicine is pretty good at posing as real medicine.

        Humans have various strategies to avoid cognitive dissonance, one of them is simply ignoring conflicting information.

  • Well, the nasty side-effect of the real banker is of course, you have to pay the money back, with interest.

    But at least it helps you through rough times, something the Monopoly money isn’t able to do.

  • I have thought long and hard about this post. It makes a bold attempt to present a parallel to the situation with CAM, in an effort to explain the delusional thinking and credulity that lies behind so many purported ‘therapies’ that have no basis in science or reason, but which their adherents will defend till their gums bleed. The placebo banker’s weaknesses as an analogy have been pointed out in other comments: I don’t think Edzard Ernst imagined his metaphor was perfect, but it comes close to succeeding.

    Perhaps analogies to Big Snakeoil may be found in other, nonmedical areas of pseudoscience. I’m thinking in particular of dowsing and graphology. Both have been robustly shown not to work when appropriate controls are in place, yet believers continue to hire ‘dowsers’ to discover underground water, oil, and minerals, and many companies still use ‘graphologists’ to analyse the handwriting of job applicants.

    The ‘dowsers’ and ‘graphologists’ range from the self-deluded to the cynical money grabbers, as do practitioners of non-medicine; they are usually smooth-tongued charmers who offer their clients confident reassurance and empathy. They are not short of clients with positive anecdotes claiming success, even though what they offer performs no better than chance in properly conducted trials.

    Carl Sagan said it all: “Science is a way not to fool ourselves.” Such a shame how very many people are happy to fool themselves.

  • If I am right that placebo defined by Ernst is: if they do anything good at all, the effect does neither last nor cure the disease.“ To support his definition, he added : Good medicine consists of compassion and effective treatments.otherwise it can’t be medicine or ethical.

    despite this definition is far away from original concept of placebo, the new definition makes simple and good human sense, because not just physical issue but also mental one. The question is still remained who is judger to decide what is effective treatment. Patient? Doctor? professor?according to all of sorts RCTs is unclear and no good answer. Logically , if we do not know the real answer it will waste time to ask the Question. Therefore new definition can not work.

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