Daniel Moerman places the words "Placebo effect" in quotations because he believes that the placebo effect should be redefined. A placebo, he explains is inert. It has no causal effect. A more appropriate definition of the placebo effect he asserts is the "meaning response."
It is because of our beliefs and the meaning we assocate with a placebo that determines its effectiveness. Despite this simple formula for determining who will respond to a placebo, it is not a very good predictor for a given individual at a given time. Studies show that there is no method to determine which individuals will respond to a placebo. Attempts have been made to remove placebo responders from studies. Occasionally, researchers will conduct a precursor trial run with a completely unrelated substance to indentify those who might respond to a placebo in an effort to cull these responders from the "real study". These attempts have been futile.
No reliable indicators have ever been found that identify individual placebo responders. In fact, a person who responds to a placebo in one study has no increased likely hood of responding to a placebo in subsequent studies. More remarkably, if one eliminates the approximately one third of the populace who initially respond to a given placebo, the remaining group will contain about the same proportion of responders in subsequent studies.
Moerman never makes the connection between these facts and the parallels to natual physical laws at the quantum level. And though they might be only coincidental, I think it worth the comparisons.
Note that a placebo has no causal effect, but instead it is meaning that determines the "effect" of a placebo. The late physicist David Bohm asserted that the entire universe is organized at all levels according to meaning. If this is true, then it substantiates Moerman's claim that meaning is operating at the macro level. But the similarites to physical law don't end here.
Moerman observed that when placebo responders are eliminated from a group, the same statistical relationships hold for the remainder of the group--approximately one third of the remaining group will still be responders in the next study.
Simlarities can be drawn with quantum processes such as the jump of the electron in orbit around the nucleus of an atom or the well-known process of nuclear decay. If one knows the half-life of a mass, it is possible to calculate exacly what proportion of the substance will remain after a given amount of time, yet nothng can be said about the transmutaion of any given atom. Divide the mass into two portions, and the half-life of each portion remains the same. As Moerman has shown this is exacly what we witness in placebo studies. It is possible to calculate statistically how many in a group will respond, but nothing can be said about which specific individuals will respond. In both cases, whether dealing with the placebo responders or nuclear decay, the process is determinate for the whole, but indeterminate for the individual person or particle. I have previously described this as a law--"nature conserves meaning".
Moerman documents many studies involving placebos from around the world. He notes that cultural differences, knowledge, and the practitioner all statistically contribute to the meaning response. In particular, it has been demonstrated that the character and personality of the physician has more to do with the outcome of placebo studies than the make up of the patient. Moerman contends that a positive and upbeat clinician or doctor transmits subltle cues to the patient making for a more positive outcome. He states that it is what the doctor "knows" that is important. If the doctor believes his patient has a possibility of getting a powerful drug, patients will do better than if he knows they will only be getting a placebo. The conclusion is sound, but the mechanism, I believe is dubious. I'm doubtful that some sort of "subtle" cues are passed onto the patient in such a consistent mannner. I wonder if it is reasonable once again to find the answer in physical law.
In the famous "double-slit" or "two-hole" experiments, it has been demonstrated that an "observer" is not necessary to change the behavior of particles. In fact, it is the mere possibility that the path or route of the particle can be determined at some point in the future that determines the outcome of the experiment. In experiments done by Marlan Scully at the Universtity of California at Berkeley it was found that it is our knowledge that determines the behavior of particles
"...It is our "potential" knowledge of the quantum system , not our actual knowledge that helps decide the outcome" (Davis, 1996).
Of course these associations with quantum processes are merely conjecture.
Daniel Moerman's book is well documented and it is obvious that much research went into this publication. If one wants a sound understanding of the placebo effect, or the "meaning response", this book is the one to read. Well done.
This book review by David Kreiter, author of "Quantum Reality: a New Philosophical Perspective".