As part of the continuing decline of the New York Times, we have this new op-ed by Steve Petrow, a writer from North Carolina who, the paper says, “is a regular contributor to Well” (the paper’s health column). But this is more about woo than about health. Click the link below to read the piece.

Petrow’s point is apparently twofold: curative “placebo” effects can result from the use of talismans, amulets, or comforting objects like plush rabbit toys. Further, he says, these objects can soothe one and even make one optimistic. I’m prepared to accept the second claim but not fully the first.

Petrow was apparently cured of testicular cancer when, 34 years ago, he was diagnosed and also given a “velvety rabbit with big floppy ears” named “Fairy God Bunny”. He brought the rabbit to all his appointments and, sure enough, has been cancer-free for decades. Of course, testicular cancer is one of the most curable forms of the disease, and I doubt that a fluffy bunny could have helped him with mesothelioma or pancreatic cancer. Still, to be fair, Petrow adds that conventional medicine is also responsible for his cure, but the rabbit played a substantial role:

You’d expect me to be skeptical. I’d grown up in an age of science, when facts and data reigned supreme. I’d excelled at Manhattan’s Stuyvesant High School, famous for its geek curriculum. As a three-time visitor to the nearby 1964 World’s Fair, a paean to new technology, I’d drunk DuPont’s Kool-Aid: Better living through chemistry. When I first got sick, I read every evidence-based, peer-reviewed study I could get my hands on, so I could make the best-informed treatment decisions. My odds of survival were actually pretty decent, but I found that data wasn’t enough. As a twentysomething, I simply couldn’t accept any chance of not making it to 30. Put simply: Science could not guarantee me a 100 percent successful outcome.

Enter the bunny. I needed another tool in my tool belt to improve my chances. And I was not alone. Stuart Vyse, a psychologist and author of “Believing in Magic: The Psychology of Superstition,” told me that many people turn to “irrational beliefs” in times of dire need. Whenever medical science does not provide a cure, there’s going to be a “psychological gap, the need of something better,” he said. Enter superstition, magic, paranormal beliefs and religion. “It’s not uncommon to be of two minds and to say, ‘I know this is crazy, but I’ll feel better if I do it anyway,’” Dr. Vyse said. This bit is confusing at best. Was the effect purely psychological, making Petrow feel better, or did it help cure the cancer? Both are implied. Five years after my diagnosis, my oncologist said I was cured. I believe science played the key role in that. But I also think the hope embodied in the bunny made a difference to my well-being, reducing anxiety and giving me more good days than bad. Can I prove it? No. Does that mean it’s not true? No. As Dr. Kaptchuk told The New Yorker, “We need to stop pretending that it’s all about molecular biology. Serious illnesses are affected by aesthetics, by art, and by the moral questions that are negotiated by practitioners and patients.” All ways of saying, by luck or magic. Sorry, but these things are neither luck nor magic: they are the effect of brain functions and their attendant physiological changes, on one’s feeling of well being or even on the progress of a disease. Using “luck” or “magic” implies that the numinous was involved.

Now I doubt that the plush bunny “improved his chances” (how could he tell?), but it could surely have made him feel better, as Stuart Vyse notes. But feeling more positive and having a higher rate of cure are two different things (though well being might affect disease). Petrow sort of recognizes the distinction, but the two effects are not the same, and are conflated in the article. After all, it is one thing to document the effect of amulets and other placebo objects on feelings of well being, another altogether to show that they increase cure rates. Petrow cites a physician who claims the latter (my emphasis):

Do I sound like a kook? I don’t think so, but no kook ever does. Dr. Ted Kaptchuk, a Harvard physician, told a New Yorker writer several years ago that he’s always “believed there is an important component of medicine that involves suggestion, ritual and belief.” He added: “All ideas that make scientists scream.” Dr. Kaptchuk is the chief of Harvard’s program in placebo studies and the therapeutic encounter, which is focused on studying the power of the mind to influence health outcomes. In that same interview, he noted that medicine has known for centuries that some people respond to the power of suggestion — but not why or how. During his tenure at Harvard, Dr. Kaptchuk wrote in an email, “I haven’t been twiddling my thumbs.” He sent along a list of the more than a dozen studies he’s either led or participated in that show how placebos, rituals, beliefs and talismans play a role, albeit “modest,” when compared with surgery and medication. When you’re in a fight for your life, “modest” is something to hang on to.

I’ll leave it to the readers to check out the list of Kaptchuk’s studies to show if they’re sound and, if so, how big that “modest” effect is. I’m prepared to believe that placebo effects can also increase cure rate, as we simply don’t understand the interaction between mind and body, and some experiments I know of show they can work. For example, a 2013 article in the New England Journal of Medicine showed that “sham surgery” for a meniscus tear in the knee, in which patients were not really operated on but thought they were, had the same outcome as real knee surgery. That’s remarkable. Here’s how the sham surgery proceeded:

For the sham surgery, a standard arthroscopic partial meniscectomy was simulated. To mimic the sensations and sounds of a true arthroscopic partial meniscectomy, the surgeon asked for all instruments, manipulated the knee as if an arthroscopic partial meniscectomy was being performed, pushed a mechanized shaver (without the blade) firmly against the patella (outside the knee), and used suction. The patient was also kept in the operating room for the amount of time required to perform an actual arthroscopic partial meniscectomy.

So there’s no harm in patients using amulets or plush bunnies to supplement their therapy. What is harmful is when these items are thought to be curative as well, especially if there are no controlled trials to show it. Remember that a Templeton-funded study of intercessory prayer on the outcomes of heart surgery, which surely involves a placebo effect since patients either knew they were prayed for or might be prayed for, showed no difference between those patients and those not prayed for. In that case, prayer was useless, though harmless (actually, prayer had a slight negative effect).

The downside of the Times article is that it doesn’t point out the many failed experiments in which even placebo effects were not useful, and it implies that there is “magic”, which is not really what is going on here. If there is any psychological or even curative effect of amulets and lucky objects, it it purely natural, not “magic.” In fact, I’m not sure why the Times published this rather than a more sober and less personal analysis of what we know about placebo effects, which would have been far more interesting. And shame on them for implying that anything beyond natural phenomena were involved.

h/t: Michael