Waterville, County Kerry, Ireland We're sitting around a peat fire, while rain batters the windows of the cottage and a howling gale blows in from the Atlantic. Five of us are here for a workshop on the placebo effect, Anne Harrington (historian of science), Howard Fields (neurobiologist), Dan Moerman (anthropologist), Fabrizio Benedetti (neurphysiologist), myself (psychologist). It's the latest in as series of interdisciplinary workshops under the auspices of the Harvard Mind Brain Behaviour Initiative. We've set ourselves the goal of writing a joint paper by the end of the summer "How to think well about the placebo effect". We've decided to organise it around Niko Tinbergen's four "Whys?": proximate causation, developmental history, biological function, evolutionary history. My
own interest is especially in the question of evolutionary design.
When a person recovers from illness as a result of placebo treatment,
it must of course be his own healing system that is doing the job.
Placebo cure is self-cure. But if the capacity for self-cure
is latent, then why is it not used immediately? If a person can get
better by his own efforts, why doesn't he just get on with it as soon
as he gets sickwithout having to wait, as it were, for outside
permission? Why should the mind be allowed to influence the
body in this waywhen the net result is, if anything,
to put a brake on healing? Sometimes,
for example, it would have been best for a sick person to get well
as rapidly as possible, throwing off defences such as pain and mounting
a full-scale immune response; but at other times it might have been
more prudent to remain unwell and out of action and to conserve resources
for later use. As a general rule (and of crucial importance for the
story of placebos): the brighter the prospects for a rapid recovery,
the less to be gained from playing safe and remaining sick.
At least this is the story I've been pushing! Are my colleagues convinced? It's such a different way of thinking for themespecially the two neuroscientiststhat I'm afraid they haven't yet taken it on board. Max Planck said "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it." I like my friends in this group much too much to hope that this is true.
Nick |