Myth making, science style

One of the great things about myth making is that the ‘belief’ that supports the myth is rarely ever explicitly stated, certainly not in the myth, but usually not in the wider culture.  Anthropologist, at least of my ilk, are about investigating the assumptions, not to somehow ‘reveal’ the truth or the Marxist “consciousness raising,” but to understand how these assumptions drive cultural economics, in the sense of power and resistance, status and symbolic capital, and other stuff (more technical language).  

Because I traffic in ‘normal science,’ I am often involved in designing and running clinical research (sausage making with statistics).  One of the critical notions is that there is a ‘gold standard’ way to design trials, which usually means that there are two matched groups (cohorts), who either get a therapy or intervention that is supposed to work (active) or one that is indistinguishable for the first, but doesn’t work  (placebo).  And neither the patient NOR the clinician know which group they are in.  The so-called ‘double-blind (patient and clinician do not know which group they are in), randomized (meaning patients are assigned randomly), placebo-controlled (working and non-working intervention) trial (RCT, for short).

Because all of that is horribly boring, I’ll pick out my favorite part, the....Placebo.  

Lots of people have written, blogged and tweeted about the topic.  Part of why it is a great myth is that lots of folks know what a placebo is:

1. (pharmacology) A dummy medicine containing no active ingredients; an inert treatment.
2. (by extension) Anything of no real benefit which nevertheless makes people feel better

Huh?  How can a placebo have no REAL benefit, yet make people feel (do, act, etc.,) better?  Ain’t that a benefit?  And if so, where does it come from?  Hmmmm.

This is the way myths are constructed.  Let’s say we are a pharma company and we need to demonstrate the effectiveness of a drug.  So we give some folks the drug and some folks a pill that is identical, but no drug is in it.  We have already decided, before we even start, that the ‘drug’ is the meaningful part of this experiment, and the rest or it (just a ‘pill’) is meaningless.  

That is exactly the point.  We agree to pretend that the ‘pill’ itself either doesn’t have meaning or is less meaning full than the ‘drug.’  But why?  Find a pill. Look at it.  From my perspective the pill is a ‘sign,’ a physicality that has meaning.  Some of the meaning is highly specific, that if it is ricin, for example, it will cause very specific effects cellular that might  will kill me.  But other kinds of meaning are included within a ‘pill’ as well.  There is the whole notion, that goes back eons, of a ‘transformative substance,’ meaning ingesting something can ‘change’ you (think about religious acts, for instance).  There is transactional meaning, that the ‘substance’ comes from someone (an MD) of higher ‘status’ than the receiver, so it has some transactional value, and the larger social milieu of how ‘treatment,’ ‘medication,’ and other ‘signs’ are indications of our social status.  This semiotic web is too complex to dissect (but can be modeled, a tale for another day). But we give highest value to the ‘biochemical’ aspects of the drug, e.g., those above the ‘placebo’ (or should we say ‘meaning’) effect.  The common thinking (both scientific and lay) is that the ‘placebo’ effect is in the mind and the ‘drug’ effect is actually biochemical.  Pure crack smoking, from a scientific perspective.  Yes, I said scientific perspective.  What it the ‘mind’ but an emergent property of the biochemistry of the brain (I personally don’t localize the mind in the brain as the body is a continuous, complex and iterative process, but most folks do).  So if the ‘placebo’ effects the biochemistry of the brain in such as was as to produce a positive effect, what’s the difference between the placebo and the ‘intended’ effect?  They are both biochemical outcomes of pharmacotherapy.  Why is one ‘better’ than the other?  Wait a minute, one effect, the drug effect, is patentable, commercial and monetized.  The placebo is not.  

Myth making, profit-style.