Why People Believe in Fake MedicineMorgan Levy, MD Levystien Productions Parker, ColoradoCopyright 2014 4,500 words
Fake medicine is a trillion dollar per year industry. Most people believe in some form of fake medicine and many people use fake medicine on a regular basis. Fake medicine is real, helpful, illogical, inaccurate and can be very, very dangerous.
That last line was seemingly contradictory but I hope that it grabbed your attention. My agenda in this essay is not to support or to bash alternative medicine. I am a neuropsychiatrist. My interest is in human behavior. I want to understand why humans behave the way that they do. I want to understand how the human brain works and how it thinks. I have found that the function of the human brain frequently seems contradictory.
You may feel that your brain is omnipotent and logical and that you are in total control but that is not the case. Human nature is a weird and confusing thing. I want to explain the fascinating story about how the human brain processes information relating to illness and medical treatment.
I will define what I mean by "fake medicine" and how our species thinks about it. We do a lot of thinking that actually helps and has resulted in our survival but in the modern world this thinking leads to behaviors that may be risky. Senseless illness and death is often the result. An underlying agenda of mine is to educate everyone about fake medicine so that we can all use it wisely.
Fake medicines are those that have no empirical evidence of efficacy. In other words, they don't do what they are claimed to do. They often don't have a rational mechanism of action. I call this entire category of medical therapies "Placebo Medicine." Other names for placebo medicine include alternative, complementary, naturopathic, homeopathic, chiropractic, integrative, and holistic medicine. Most humans believe that at least some of the medical therapies in these categories are everything they claim to be. These beliefs are not based on a logical assessment.
This begs the question, "Why do people believe?"
When I say, "Placebo Medicine," I am talking about an interesting phenomena that our brains do. There are many chemicals that are produced in the brain. They are called neurotransmitters. These chemicals effect every bodily system. You can cause these chemicals to be produced and to effect body systems without ingestion of any exogenous agent. If I call you an idiot, your brain produces adrenalin and this results in rapid heart rate, hair standing on end and fists clinching in preparation for combat. Similarly, I can use a number of non-pharmacologic or fake pharmacologic interventions to cause your brain to produce endorphins that reduce pain and nausea. This works by employing suggestion which is what physicians call the placebo effect.
Before we get back to the question, "Why do people believe?," lets further define what fake or placebo treatments are. Here is a list.
Acupuncture, Ayurvedic Medicine, Bach's Flower Remedies, Chelation therapy for coronary disease, Chiropractic, Crystal Therapy, Cupping, Ear Candling, EMDR, Faith Healing, Naturopathic Medicine, Ozone Therapy, Past Life Regression, Reflexology, Reiki, Trepanation, Urine Therapy, and Vitamin C that cures the common cold.
What do you think?
None of these treatments are what they claim to be. These are all examples of placebo medicine. The list is abbreviated, of course. If I wanted to I could have filled your entire hard drive with all the fake treatments that actually exist. You may be thinking, "But so many of them seeeeeem like they could be real." Right?
How can an average Joe figure out whether or not a treatment is real or fake?
Levystien's Top 10 Tell-tale Signs of Placebo Medicine:
1. The treatment is thousands of years old.
2. The ads rely heavily on individual testimonials.
3. A single therapy purports to treat most, if not all, conditions.
4. There is a secret formula.
5. It is a limited time offer.
6. There are claims of effectiveness without side effects.
7. There are claims that ridicule or denigrate traditional evidence based medicine.
8. There is no reliable information on effectiveness, efficacy, safety and/or cost.
9. The physician is not an MD or DO.
10. You must go to an exotic location for treatment.
11. There is pseudo medical language such as miraculous, amazing, natural, organic, detoxify, purify, revitalize, balance, rejuvenate, "unlock your bodies healing ability," and "stimulate your body's power to heal itself."
(Sorry about having 11 items on this list. I know that the human brain is programmed to love lists of 10, not 11.)
Does the list of tell-tale signs of placebo medicine inspire you to ask any questions? Perhaps you would like to ask, "Isn't it obvious which treatments make no sense?" Maybe you want to ask, "Why do we need a list at all?" One question that is obvious to me is, "Why would anyone think that ear candling or cupping or urine therapy would be medicinal?"
Lets proceed by asking the question like this:
"Why do the placebo treatments listed above seem so real?"
It has to do with how human brains are programmed and what kind of information humans are prepared to understand. Marketers know exactly what I am talking about. Anyone in the marketing profession will tell you to package your product in a way that the human brain will accept your message. They will tell you that presenting your product in the most logical way is not likely to work.
When I say that our brains are "programmed" I am using an analogy to the computer. The human brain is not exactly the same as a computer but it is close enough to use this analogy. I need an analogy if I am going to tell you about your own brain because Self Evaluation is not one of our default programs. To get around that fact I will use Storytelling which is one of our default programs. I am going to talk about how a computer understands and evaluates new information and relate that to how a human brain processes information.
Let's pretend that we are purchasing a computer. If you purchase a Mac, then you will need to purchase an operating system that is compatible with a Mac such as OS X. If you purchase a PC, then you will need to purchase a compatible operating system such as Windows 7.1. If you want a word processing program and you have a PC, then you should get Word or Notepad. If you have a Mac, then you should use Byword or iA writer. You can use Google Docs which is a free on-line program but the version that is formatted for your PC will not be compatible with a Mac and vice versa. You need to use programs that are compatible, speak the same language, and are designed for your system to understand.
Programs and operating systems evolve through upgrade after upgrade and you need to make sure that you have current editions that are compatible.
It is the same with the human brain. If you want someone to understand what you say, then you need to speak in the correct programming language. If you want someone to like what you say or to buy what you are selling, then you really need to speak in the correct programming language.This ad is totally illogical but it speaks a programming language that is compatible with my brain. I will buy Chanel.
Let's call the human brain "HB" and install an operating system called Homo sapiens 4.1. If you want to run a program in Homo sapiens 4.1, then it needs to be compatible. There are lots of compatible programs such as Religion, War, Sex, and Placebo Medicine. In this essay we will talk primarily about the program called Placebo Medicine.
Here are some add-ons and extensions that are commonly used together with Placebo Medicine:
1. Trusting traditional ways of doing things: TrustTradition
2. Being paranoid that others have secrets for survival that we need to know: ParaSecrets
3. Trusting members of your in-group: Trust NGrp
4. Distrusting members of an out-group: Distrust OGrp
5. Distrust of things made by unknown humans: DST UnkH
Go back and re-read Levystien's Top 10 Tell-tale Signs of Placebo Medicine. This list is about what is compatible with a human brain. You can almost hear the voice of a snake oil salesman saying these things. I saw an ad on television yesterday about a pair of copper woven gloves that will cure your arthritis. The ad was filled with items from this list.
I will now describe some of the more fundamental programs that were packaged in HB before it left the factory as well as some that were not. One that was not is Logic 2.0. You may think that others frequently lack this program but that YOU certainly have it. Well, you don't. Neither do I. I had to work really hard to be able to do it and there still may be things in this essay that are not logical. If you try to upload a program to Homo sapiens 4.1 that was designed to run in Logic 2.0 such as Relativity, Evolution, Global Warming, Macro-economics, Genetics, Stem Cell Research or Medicine you will encounter a compatibility issue.
There is a particular piece of system software that comes as a default on any new HB. It is called post hoc rationalization. This program is for evaluating new phenomena. Post hoc rationalization is a classic logical fallacy in which you make up a reason for an observation after the fact. We see something new and feel something in our gut and then make up a rationalization to explain what we saw. If it is something that felt good we make up a reason why it is good and if it felt bad we make up a reason why it is bad. That is our default way of thinking.
Here is an example of how this works: You say to me, "I have a 4000 year old treatment that is a secret formula and Joe says it works great and it is all natural and not like those processed medicines that the big pharmaceutical companies want to sell you." Guess what? I am likely to believe what you say. You are telling me what I am prepared to hear due to the way my brain is programmed.
Suppose that I tell you about the origin of species. How about the nature of matter? What if I described human genetics? These things would be very hard for a human to grasp. They are not written in Homo sapiens 4.1.
Here is a random statement from science that people often have difficulty grasping: "Natural selection is the gradual process by which biological traits become either more or less common in a population as a function of the effect of inherited traits on the differential reproductive success of organisms interacting with their environment." Humans have a hard time understanding this statement because it is written in Logic 2.0 not Homo sapiens 4.1
Our brains are programmed to easily understand certain kinds of information and to have difficulty understanding certain other kinds of information. This kind of brain function is common throughout the animal kingdom.
For example, dogs have brains that are programmed to eat meat, sleep, have sex, chase small moving objects, sniff other dogs butts and so on. Bats have brains that are programmed to hang upside down in a cave and fly around at night eating tiny flying bugs out of the air. Beavers have brains that are programmed to build dams and squirrel brains are programmed to eat nuts and so on, and so on. Can you imagine these animals doing behavior that they are not programmed to do?
Imagine trying to get a dog to eat vegetables or to stop chasing rabbits? Why is it that you can't even have a rational conversation with your dog? It is because his brain does not have the system program called complex language.
After having said all of that, I am now going to say something that will sound like I am contradicting myself. "Humans actually do all kinds of things that our brains are not programmed to do."
For example, I am sitting at my computer using logic to write this essay ... I hope. Throughout most of our evolutionary history my brain was not really programmed to do that. So, how can I do it?
Wait a minute ... "If understanding that everything needs to be in the correct programming language is not in the correct programming language, then how am I even having this conversation?"
Lets back track a bit and do some evolutionary biology as a background to understanding this stuff. You may find this stuff boring but bear with me. I'll be brief.
Those species in the taxonomic family of great apes that left the jungle six million years ago have been on an evolutionary dead end road. They have had to cope with repeated ice ages and changing food sources out on the savannah. We think that one of the reasons homo sapiens survived was because we evolved the ability to change faster than evolution was capable of changing us. We evolved a limited ability to intentionally alter our own behavior. We evolved the ability to do things that we are not programmed to do.
Let me provide an example from my personal experience:
I have multiple sclerosis and I belong to a support group of individuals who also have this condition. I am the only physician in the group. It is often the case that someone is talking about how bee stings or juju beads or ear candling or acupuncture or Reiki or something is a great treatment for MS. I don't argue unless it is something that is expensive or dangerous. I understand that if I make a logical argument and present good evidence, then I am not likely to alter their opinions.
One day when I was attending a meeting a friend of mine named Mary came up to me with large eyes and some excited body movements. She proclaimed, "I have found the cure for MS!"
I said, "Great, what is it?"
That is what I said but I was thinking, "Not again."
She said, "Bee-venom therapy."
I said, "OK ... ahm, do you know that Bee-venom is a poison?"
She said, "Yes, but it has been used for thousands of years and was originally discovered by the ancient Egyptians."
I tried not to grimace and asked, "Do you have to actually be stung by a bee?"
She said, "Yes, of course, you start off with a series of live bee stings gently administered by an Apitherapy Society registered clinician and it only costs $1,500.00." The American Apitherapy Society
I said, "Wow! Mary, we need to talk."
This is a treatment that I felt compelled to dissuade her from because repeated bee stings can result in creating an allergic reaction that could be life threatening. However, I could see in her eyes that she was already convinced to an extent that I was unlikely to change. I overcame my desire to talk about evidence. I wanted to say something that spoke to her gut. I wanted to persuade her to stop using bee venom. I could not think of something fast enough and the moment passed. This happens to me all the time. It is as if I can't speak the language of my own species!
If you want to know more about Bee Venom Therapy go to: Bee Venom Therapy by Steven Novella.
In this example Mary is doing what she is programmed to do. She is making up a rationalization for something that feels good in her gut. I am not. I am going outside my programming and trying to use Logic 2.0. I was having compatibility issues but managed to muddle my way through.
OK, back to evolutionary biology.
Humans did not evolve to do logic. It would not be a type of thinking that would result in survival. In order to do logic you must have accurate intelligence. Without accurate intelligence your logical conclusions will be incorrect and it is not possible to have accurate intelligence about most things in nature.
Post hoc rationalization does not require accurate intelligence. Although it is a classic logical fallacy, it is actually a pretty smart way to think for a species that wants to survive.
In order to survive a species will rely on its innate impulses, its experience, and a rationalization of events that provides the best odds of survival.
For example, if you are a horse and the herd starts running full speed in the wrong direction, what should you do? You have an innate program that directs you to run with the herd. It feels good when you do that. This is a strong impulse. Your experience has been that when you run with the rest of the herd you are able to get food and avoid predators. Your observation that the herd is taking off and running fast in the wrong direction will lead to a post hoc rationalization. You might think that there must be a huge danger in the correct direction making the wrong direction an acceptable alternative. It turns out that there are a group of cowboys coming to try and save your herd from an oncoming fire but the entire herd was spooked and ran off a cliff by mistake.
Can you imagine a single horse in this situation stopping and thinking to itself, "Hmmmm ... I think the logical thing to think is that they are coming to save us from a fire and I am going to go where the cowboys direct me to go while the rest of the herd runs off the cliff."
That would never happen. Horses are not programmed to think like that. They are herd animals. (We are too.)
I want to emphasize that the way human brains think is smart ... but not logical.
For example, another program that is not compatible with Logic 2.0 but is compatible with post hoc rationalization is called Intuition. This is a program that uses information stored in large data banks from back up hard drives that are connected to your HB. It uploads information that you are not consciously aware of and this upload happens instantaneously. The information that is uploaded is disordered and incomplete. It is synthesized by Intuition which directs a system wide impulse to action. You act in a certain way but you don't really know why. You rationalize an explanation that may or may not be the real reason. You are able to act quickly and decisively and you feel satisfied even though you don't have a logical explanation. You might say, "I had a gut instinct" or "I had an intuition."
Intuition does not perform a logical assessment. It has access to all of your stored data but that is only a tiny fraction of the intelligence it would need to perform a logical analysis. Intuition performs a rationalization by integrating emotional and cognitive information to produce a guess that has a high probability of directing a correct course of action. That is the brilliant way our brains evolved to negotiate this environment in which we live.
With all that evolutionary biology in mind why don't we get back to the explanation of why people believe in fake medicine. You may be thinking, "How does Dr. Levy really know what treatments are real and which ones are fake?"
In modern medicine new treatments are discovered using the scientific method. First, you ask a question such as, "Does acupuncture treat medical illness?" Second, you make a testable hypothesis such as, "I think that acupuncture treats colon cancer." Third, you make a prediction such as, "A needle placed in the center of the right buttocks will cure adenocarcinoma (colon cancer)." Fourth, you do an experiment such as, "I will treat 10 people who have colon cancer with a needle in the center of their right buttocks and they will survive significantly better than 10 people who I treat with a fake needle." Finally, you analyze the results of the experiment and draw a conclusion.
In this case, there was no statistically significant difference between the treatment group and the control group. Your conclusion is that acupuncture performed in the right buttocks does not alter the outcome of colon cancer. It will take a large number of studies like this one in order to conclude that acupuncture does, or does not, treat any medical illness.
It turns out that a large number of studies have been done and we can conclude that acupuncture treats pain, nausea, and psycho-somatic illness. We can also conclude that the curative agent is suggestion and things like needle placement do not matter.
This is not the traditional way that humans have determined what treatments work. Over the centuries people would see illness come on and go away and they would make up some rationalization about what made it go away. They would communicate this knowledge to other humans using the correct programming language so that they could convince others that they were correct. That is how the ancient Chinese came up with acupuncture.
Interestingly, the first guy to suggest an organic cause of illness, Hippocrates, was a charlatan in his day for suggesting such an outrageous notion. His ideas treated no one any better than all the placebo therapies of the times. His stuff would have been, by definition, Placebo Medicine.
It is only by chance that his ideas turned out to be right. He did not arrive at his ideas through logical thinking. He was simply rationalizing an explanation just like everyone else. Of the millions of rationalizations his turned out to be spot on correct!Hippocrates of Cos 460 BC- 377 BCD
Default programs in HB run automatically in response to stimuli. These programs are innate impulses. They are very hard not to do.
Here is a great example of how hard it is not to do an innate impulse. I am currently coaching baseball with a group of 14 year old boys. I am trying to get them to keep their eyes on the ball all the way to the point of contact with the bat. They have a natural inclination to avert their eyes at the instant the ball hits, or misses, the bat. They must overcome this overwhelming desire to cringe or look away. They must keep their eyes on the ball. Their brains are programmed to look away. It is very hard to do.
Here is a similar example from placebo medicine. Consider that I am asking a person to ignore their gut feeling that ear candling is a reasonable medical treatment. (Ear candling is a purported medical therapy where you place a lit candle in the patients ear and drip hot wax into the ear canal resulting in an alteration to their brain that cures an illness.) I am asking them to think logically about the fact that there is a tympanic membrane, a middle ear, and a round and oval window that separates the external ear canal from the brain. There is zero possibility that ear candling can have any effect on the brain. Unless, of course, the hot wax were to burn a hole in the tympanic membrane but that would be a really bad thing.
I am not saying that people who believe in placebo medicine are stupid. IQ is not the issue. They understand what I am saying but their sense that ear candling might work is very strong. Even the sound of the words "ear candling" makes them feel good in their gut. The idea that there is an anatomical barrier between the wax and the brain is not something they can see. It does not feel good in their gut. It is really hard to get them to give up this idea.
Another reason that placebo medicine is believed by so many people is a bit counter intuitive after you have read what I have written so far. It is that placebo medicine actually works. Not in the way it is claimed to work but it works nevertheless. Hold your confusion for a moment and keep reading.
There are a variety of reasons why it works. For example,
1. The natural course of most illnesses is to improve.
2. Patients often have a desire to please an authority figure so they often report exaggerated improvement when asked.
3. Expectation of an improvement can cause a patient to think an improvement happened when none did.
4. Unseen or unknown events can cause a patient to misperceive that something therapeutic has occurred.
5. Unseen or unknown agents that are not under study can be responsible for the patient's improvement.
1-5 are examples of placebo medicine working by deception. There is one additional reason why it might work that is actually related to real physiologic effect. The power of suggestion can cause real changes in neurotransmitters that can have a compensatory effect on your physiology. For example, you can treat pain and nausea pretty well with most placebo treatments because suggestion can cause the release of endorphins. Sleep and anxiety and a few other compensatory physiologic phenomena may also be improved in this way. Thus, suggestion can trigger one of our innate mechanisms for ameliorating injury but it cannot kill bacteria or get rid of cancer cells.
Because placebo medicines can do this, it is easy to convince people that they can do more. This is what I mean when I say, "Placebo medicine works but not in the way it is advertised."
Here is another reason that people believe. Placebo medicine is a trillion dollar per year industry. If you can make money because you believe something, then you will have a high likelihood of continuing to believe that something.
Another reason that people believe in placebo medicine is that the human brain is programmed to continue believing what it is already believing. Humans tend to be hard headed. It is very difficult to get us to change our opinion or think outside the box. Empirical evidence often fails to change the opinion of a human. If you follow politics you must have realized that people will hang on to ideas that are out-dated or proven wrong for really long periods of time. An article I saw yesterday said, "One in four Americans believe that the sun is in orbit around the Earth." Really?
My guess as to why we evolved hard headedness is that things that have worked well in the past are likely to work in the future. Sticking with our routines probably gives us a survival advantage. Being hard headed may increase our odds of survival.
It is hard for scientists and doctors to get people to understand that treatments they have believed in the past to be real are not real.
Here is another good reason to believe in placebo medicine. The alternative belief sucks. We are a frail little species that has little control over anything and we live in a dangerous environment. No matter what we do we will suffer and suffer and suffer and die. We desperately want there to be some hope that we can be cured and maybe even that everything will be OK and we won't die. I would rather believe a bald faced lie about a cure than face a cold hard reality. Maybe those of our ancestors that were less able to believe like this were tormented to the point of making survival more difficult. For whatever reason, evolution favored those who blindly believe.
OK, finally, here is the real reason why everyone should believe in fake medicine. Levystien does not believe in fake medicine. Levystien is an idiot. Idiots don't believe in things that are real. Therefore, fake medicine is real! Do you see that logic does not always work?
I hope that anyone who reads this can now understand the neuroscience of why humans believe in fake medicines. I especially hope that skeptics and intellectuals understand this stuff so they can have some compassion towards people who believe in alternative medicine.
Skeptics usually think that people who believe in fake medicine are stupid. They often think it is an IQ problem. That is inaccurate based on this essay. Why don't we turn the tables on skeptics and ask, "Why is it that skeptics believe inaccurate things about people who believe in placebo medicine?"
Morgan Levy, MD
ReferencesOn-line Book:Morgan Levy, MD- Placebo MedicineOn-line videos:Morgan Levy, MD- The Neuroscience of The Placebo Effect
12 TED talks- Our Brains: predictably irrationalOn-line essay:Morgan Levy, MD- Why do Smart People Believe Dumb Things?Research study:Brendan Nyhan, PhD, Jason Reifler, PhD, Sean Richey, PhD, Gary L. Freed, MD, PhD (2014) Effective Messages in Vaccine Promotion: A Randomized Trial, Pediatrics. Published online March 3, 2014
BooksR. Barker Bausell (2007) Snake Oil Science The Truth About Complimentary and Alternative Medicine, Oxford University PressDavid Brooks (2011) The Social Animal, Random HouseMichael S. Gazzaniga (2011) Who's in Charge?: Free Will and the Science of the Brain, (1st ed.). Harper collins
Jonathan Haidt (2012) The Righteous Mind, PantheonEric S. Juhnke (2002 ) Quacks and Crusaders The Fabulous Careers of John Brinkley, Norman Baker, and Harry Hoxsey, Univ. Press of KansasFranklin G. Miller, Luana Colloca, Robert A. Crouch, Ted J. Kaptchuk (2013) The Placebo: A Reader, The Johns Hopkins University Press Chris Mooney (2012) The Republican Brain The Science of Why They Deny Science-and Reality, WileyChris Mooney (2011) The Science of Why We Don't Believe Science How our brains fool us on climate, creationism, and the vaccine-autism link.—Mother Jones. Brendan Nylan (2014) When Beliefs and Facts Collide, The UpshotSimon Singh and Edzard Ernst (2008) Trick or Treatment?: Alternative Medicine on Trial, NortonW. Grant Thompson, MD (2005) The Placebo Effect and Health, Prometheus Books