Placebos, Beliefs, and Cures

Recently, I came across several highly regarded studies that question the effectiveness of anti-depressant medications on all but the most severely depressed patients. According to these studies, mildly to moderately depressed people do about as well on placebos as they do on meds. One reason this is so may be that more than a few people in the placebo groups believe they are getting the real thing. Which reminds me of a story…

“Will” (not his real name), was struggling with a degenerative disorder. One of his physicians, “Steven,“ found a place for him in a study whose purpose was to gather further data on the effectiveness of a drug just approved by the Food and Drug Administration. The methodology of the study --- Will would not know whether he was receiving the drug or a placebo --- had him worried, and he sought my help in thinking through whether to participate.

Will’s dilemma was obvious and scary. In order to participate in the study he had to go off the drugs he was then taking and run the risk of making his condition even worse. But by not participating, he could be denying himself something that might make a more positive difference to his long-term health. It helped to learn that even if he were placed in the placebo group, the researchers would be monitoring his condition carefully enough to pull him out of the study were his condition to worsen significantly at any time. After giving Steven permission to talk with me, and several prayerful conversations between the three of us, Will decided to participate.

A month into the new regimen, Will bounded into my office with a broad grin on his face. He told me he had figured out that he was in the medication and not the placebo group, and that he was certain he would get better as a result. It seemed ingenious to me how Will had put two and two together on the subject: he researched other studies of typical side effects produced by the drug and realized that he was experiencing some of them himself, along with increasing relief from his degenerative condition.

But here is the complicator: Will received only placebos, never the drug being tested. I learned this from Steven, who came to me with this new information (I chose not to inquire how he gained access to it) and the difficulty it created for him not only as Will’s physician, but as a man of faith and moral integrity: It has to be Will’s belief in the drug that is making it work, Leroy. I have to tell him this, but I’m afraid that if I take away his faith in the thing, his illness will worsen all over again.

Steven eventually resolved his dilemma by invoking the “do no harm” principle. Since by that time there appeared to be no risk to Will for continuing with the research program, Steven delayed telling Will “the truth” until he completed it. Will’s response continues to interest me. You may be right that believing in the drug was what made what I took work, but I think something else was involved. Actually, somebody else. God must have wanted me to get better, and it didn’t matter to him what those guys gave me. As Steven later said to me, there was nowhere for him to go, scientifically, with the “God-thing” in that particular conversation, except to see it as yet another aspect of the potentially healing power of belief.

There is something to be said for Steven’s reaction. Believing in a God who heals is an important source of hope, even when we know that validating specific claims about divine healing is impossible empirically. Present-day brain-imaging technology is providing increasing support for the perspective that peoples’ hopes bring about measurable reactions in the brain. Someday it may be possible to connect those reactions more precisely with those produced both by specific drugs and by specific beliefs than we now can.

Clearly, it is too simplistic to conjecture that in order for anyone to get the most out of pharmacological interventions, they must believe that the interventions will work. Believing makes some things so, but not all things, and certainly not upon demand. Further, drugs sometimes seem to work even when there is massive doubt about whether they will. These same things can be said about prayer.

Nevertheless, in Will‘s case, it was at first a very specific belief --- that a very specific drug would bring about very specific consequences --- that played a major role in a very joyous outcome. But Will then moved to the view that divine healing actions pretty largely by-pass those of earthly healers. My own take is that God acted on Will’s behalf as God sometimes also acts on behalf of others, through the expertise of medical practitioners and researchers, and through the medicines and even the placebos of which they make timely and appropriate use.