Drinking a trendy CBD drink got me thinking about placebos today. The word placebo has a negative connotation but I don’t think it necessarily should. Some people believe that CBD is a wonder drug that can cure cancer. It’s clearly not. But the lesser claims, like reducing anxiety, seem more plausible. There is however no scientific evidence that CBD does anything besides treating some cases of epilepsy, the indication that led CBD’s rapid rise. Part of that is because it’s difficult to study CBD due its classification as a Schedule I drug, so it’s equally as true that it hasn’t been disproven that CBD has other cognitive effects. But given the breadth and magnitude of claims of its effects, it’s worth wondering: is it all just a placebo? Maybe more importantly, does it matter?
My answers, which I’ll explain, are maybe, and no. With so many reports from users claiming that CBD reduces their anxiety, it is plausible that is has some kind of calming or soothing effect. Then again, thoughtful and well-informed people believe that Vitamin C helps them get over colds despite tenuous evidence for that the preponderance of evidence suggesting it has no benefit greater than…wait for it…a placebo. Many people also claim to have seen ghosts. It’s clear that we can’t perfectly trust our own perceptions on these matters because we’re biased towards experiences that we’re primed for by expectations. This is the generally accepted model for how the placebo effect works. What we believe informs our real perceptions and feelings. I think that’s pretty awesome.
I’m certainly not the first to note that the placebos can be used positively. After all, if telling someone that something that one knows to not do not anything in particular does a particular thing makes that particular thing happen for that person because they believed it would, then that thing actually did that thing. I apologize if you have to read that sentence several times, but I promise it makes sense. A placebo can therefore be a real treatment when no other options exist. Or maybe it can be a treatment when other options exist as well, perhaps not within the strict dogma of medical practice norms, but more generally when someone is looking to improve or change rather than cure. Perhaps we should actively try to create more placebos.
Most placebos that I can think of are essentially accidents or mistakes. For one reason or another someone believed that something worked. They might have also been trying to make a buck, and in some cases might have been straight fraudulent, but for the most part it seems reasonable to assume that supplements and therapies, like the now seemingly barbaric medical practices of blood-letting or the still popular notion that alcohol is a great medication for nearly anything, began with some good intention and belief. The scientific method may later demonstrate that these practices have no statistically significant effect over a placebo, but by then the flywheel of belief that alters perception is in motion.
When these practices don’t necessarily cause any harm, we tend to be okay with it, in a wink-wink, nod-nod sort of way. This is why the Tooth Fairy still exists. But it’s remarkable that these belief systems that have a real, positive impact through the placebo effect are almost exclusively the products of mistakes. To put it another way, would we be okay with it if from the get-go we knew that a thing had no scientific effect, but only a placebo effect? We’d call that a lie. Perhaps we should think a bit differently about what is good and bad.
We have set ourselves a trap in becoming so beholden to the scientific method and empirical notions of objectivity. We want science to fix our problems and give ourselves the answers. We prefer pills to therapy. This line of thinking externalizes all of our problems. And to be sure, some problems needs to be fixed externally.
We can’t fix the environment with hope and a sawed off digit can’t be sewed back on through meditation. Steve Jobs might have beat cancer, or at least lived longer, had he not eschewed western empirical medical practices for traditional eastern spiritual practices. But we should not think that all problems must be solved in the empirically derived way because the empirically derived way ignores the effect that human beliefs have on real outcomes. We shouldn’t be so averse to all that might seem ‘false,’ particularly when those ‘false’ beliefs may benefit us in real ways.
As of late, I’ve been considering the impact of beliefs on cognition more generally and placebos fit squarely into this line of thinking. From tantras to mantras, we broadly accept the value of actively indoctrinating ourselves with certain ideas and beliefs to alter our perceptions for our own betterment. In a way, it’s like giving oneself a placebo.
To give oneself a placebo seems like a contradiction, and is. In theory, the placebo effect should only work if you don’t know that something is a placebo. And in general, it’s probably true that knowing something is a placebo will diminish or entirely eliminate the placebo effect. But it’s also true that the mere exposure to an idea makes us more likely to perceive that idea as real. Case in point: I still take Emergen-C sometimes when I’m sick, despite ‘believing’ that it doesn’t do anything, and it makes me feel better. And maybe that’s all that should matter.
I’m thinking about how to apply this. I’m certainly not suggesting peddling sugar pills as a cure for anything. But maybe we emphasize the importance of starting with belief in a method or practice and its potential for creating outcomes. We also need to remember that objectivity is imperfect.
It may be that there is objectivity at all, which I actually believe philosophically if not practically. In the social sciences we have seen clearly that one can distort reason to find any desired outcome. Particularly in the case of societal design, we shouldn’t be averse to planting the seeds of ideas that can make people happier, even if they may be based in what some would assert are ‘false’ premises, taking the greatness of a nation as a simple example.
We tend to think of placebos as being bad but but if they have placebo effect then they aren’t all bad. There is no shame in embracing the real benefits of fake things. We would perhaps be better off thinking of placebos as neither good nor bad, but rather as tools. Potentially, as very powerful tools. We shouldn’t just accept placebos in the world because someone naively believed something that was false. Instead, we should consider how to actively influence our beliefs and those of others, to the desired ends.