A Brief Reflection on the “Placebo Effect”

“Placebo effect” has become a term of tacit dismissal today. The word is largely invoked in a context that contrasts it with “active” or “effective” treatment, the implication being that the placebo effect exerts none of these influences. Of course, the claim is empirically false—as the existence of the term “placebo effect” in the first place testifies—but that does not prevent the belief from being widely held. As a result, “placebo” has come to acquire a derogatory connotation, signifying something like “a counterfeit” or “a sham” in contradistinction to an “authentic” treatment. The latter is referred to as a “drug.” Of course, insofar as a drug is meant to invoke a given physiological response, the claim that a substance which invoked a comparable response was nevertheless inauthentic makes no sense. Naturally, however, efficacy alone does not determine the conventional evaluation of the placebo effect against standard pharmaceutical interventions. Instead, the term “drug” also refers to a product that serves as the linchpin in the economic operations of pharmaceutical corporations and all of their offshoots and subsidiaries. Put another way, while the placebo effect and the pharmacological effect of a standard drug may be functionally equivalent, as a rule, they are never economically so. Thus, while a placebo may go toe-to-toe with a patented drug in terms of its margin of efficacy, it can never do this in terms of its profit margin.

The above may appear to present a serious criticism of Big Pharma and the for-profit model of medicine that it presides over like a beef farmer over his herd of cattle. But I believe the root of the problem lies deeper than this and the conventional medical industry is sustained by a deficiency in the theoretical underpinnings of modern medicine—no figs will grow from the roots of thistles. This is to say that the unfortunately widespread exploitation of patients’ health for profit is a contingent effect rather than a cause of our problematic relationship to medicine. 

Indeed, I think that this dismissal of the placebo effect indicates a fundamental absence of a bona fide theory of health. Conventional medicine has achieved extraordinary success in treating acute conditions of disease and injury, but it has accomplished this through a process of theoretical anatomization. The same approach that allowed Descartes to dissolve longstanding problems of synthetic geometry by transforming them into questions of analytic geometry also encouraged physicians to conceptualize the body in terms of its discrete elements. Unfortunately, just as it has become exceedingly difficult for us to conceive of mathematics without numbers (i.e. or qualitative mathematics), so the result of the anatomical approach to medicine is an increasing inability to conceptualize the organism as a whole. 

This inability is a significant one because wholeness is the fundamental level of organization at which health presents.* Thus, the greater our scientific education, the more challenged we find ourselves to recognize health as such whether in its presence or absence. As a consequence, “medicine as the profession of supporting health” can be surreptitiously replaced by “medicine as promoting a profit margin for shareholders” and the effect of this substitution can go largely unmarked because no one is prepared to notice it. Naturally, I have been speaking in statements that are more categorical and hyperbolic than the complexity of the situation might seem to warrant. At the same time, however, the purpose of this exposition has been to draw attention to a phenomenon that might otherwise go amiss. Galileo could magnify the moon (i.e. with a telescope) and Van Leeuwenhoek could magnify a drop of river-water (i.e. with a microscope) without either of them being accused of falsifying evidence. On top of this, each of these scientists had first to employ deliberate methods to isolate the phenomenon he wished to observe. In the same way, I have attempted to emphasize a specific social-scientific phenomenon for the sake of presenting it in greater clarity and if I have relied on rhetorical devices like flagrant hyperbole and figures of speech, I don’t think the argument should be dismissed on these grounds alone since these methods were arguably necessary to fully disclose the issue at hand in the first place.

Photo by Skyler Ewing on Pexels.com

* In fact, “whole,” “hale,” and “health” all stem from the same word in Old Anglo-Saxon (hælþ).

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