Lying, fake supplements, and the placebo effect

A somewhat outraged (but entirely justified) article by Timothy Egan in the Times reminded me of an interview I heard the other day on Fresh Air.

First, the Egan article: Mr. Egan is properly outraged at the New York Attorney General’s finding that dietary “supplements” sold by major retailers often contain none of the “active ingredient.” Sorry, the scare quotes are mine, not Mr. Egan’s, but I think they are entirely apt. Indeed, the fact that the “supplements” contains no active ingredient and people write testimonials to their efficacy hints that even dietary supplements that actually contain the active ingredient may be no more than placebos. Nobody knows, in part, because the dietary supplement industry in the US is virtually unregulated (see also the Times editorial here).

Which brings me to Fresh Air. Terry Gross interviewed Johns Hopkins neuroscientist David Linden, the author of a recent book on the science of touch. Fascinating interview, but then, at the 29-min mark, Ms. Gross asked Professor Linden about the placebo effect. He paused and then answered,

The general thing I take from this is that, in the end, the substrate is biology. When things work, whether they are drugs or the placebo effect or acupuncture or meditation or psychotherapy, they work because they are changing the functions of brain circuitry, and my feeling is that, if it works, it works, and it should be used. There is no reason to abandon something that works just because we don’t understand all the biological steps in the way it works. In truth, many of the most popular drugs in the armamentarium for neuropsychiatric disorders – we don’t understand how they work anyway. We don’t understand how antidepressants work. We don’t understand how lithium works for bipolar disorder. So if the placebo effect works, then let’s use it.

I cannot disagree that, if the placebo effect works, then we should use it. But how? Is it OK to lie to a patient and claim that some worthless herb is in fact a medication or that sticking needles here and there has some specific therapeutic effect? Or is there potentially a better way to harness the placebo effect and really make it work? Professor Linden may have been taken aback by the question, but I thought his response was a bit facile; I will be especially curious to read comments on how others, especially medical professionals, answer these questions.