No Side Effects is an Important Effect

No Side Effects is an Important Effect

I remain curious as to why people use, and continue to use, useless pseudo-medicines. I read the literature, but I find the papers unsatisfactory. They seem incomplete, and I suspect there are as many reasons that people use pseudo-medicines as those who use them.

Still, it doesn't stop from broad generalizations.

These pseudo-medicine do nothing, so why do people continue to use them? Some are hands-on, touching,  which is important in soothing people. I suspect much of the effect of hands-on pseudo-medicines  can be attributed to social grooming, the medical equivalent of picking off fleas.  Makes apes feel better, and we are apes.

I expect therapies to do something, not only the primary effect, but to have side effects. 

It turns out the doing nothing and having no side effects may be an important factor in people thinking that a useless therapy is effective.

PLOS One had a recent article The Lack of Side Effects of an Ineffective Treatment Facilitates the Development of a Belief in Its Effectiveness

They suggest

While most would agree that people frequently resort to those treatments they believe are more effective, we propose that the reverse also holds: frequent use of a treatment, because of the lack of side effects or other considerations, fuels the belief that it is effective, even when it is not.

They use the ultimate in nothing, homeopathy, as an example, noting that  the use of the nostrum results in the causal illusion, especially when the process being treated has a high spontaneous resolution rate.  People take homeopathy and get better, but they erroneously think they get better because of the homeopathy.  The old true-true and unrelated.

They note

Basic research suggests that the more often a patient takes a completely useless medicine, the more likely she will develop a belief in its effectiveness. This is particularly true when the desired outcome (the healing) takes place frequently.

Pseudo-medical interventions are used primarily for processes that are going to get better no matter what is done, so the opportunity to credit the pseudo-medicine for the improvement is high.

No one had evaluated the effect medication side effects could have in determining the belief that a useless therapy has efficacy. Their

prediction is that, because a lack of side effects encourages the use of the treatment with high probability, it facilitates the illusory belief that the treatment is working.

They used a computer model. Students were asked to treat a dangerous disease called "Lindsay syndrome" with a drug called Batatrim. There were divided into two groups

The high-cost group was informed that Batatrim would produce a severe and permanent skin rash as a side effect in every patient who takes it. The no-cost group was not told about any side effect.

They were then shown the records of 50 consecutive patients with the disease and asked if they would treat with Batatrim.  Sounds like Bactrim, an antibiotic,  so I would expect it to cause side effects.  But that is the ID in me talking.

Whether or not the patient improved was determined randomly, but 70% of the time the fictitious patient got better.

After the treatment was decided and the computer randomly assigned the results, the subjects had feedback:

In the no-cost group, the outcome was displayed as a picture of a healthy face and the message, "The patient has recovered from the crisis", whereas the outcome absence was displayed as a picture of an ill face (greenish, covered in sweat) identical to the one presented in the top panel of the computer screen, and the statement, "The patient has not recovered from the crisis." ... By contrast, the high-cost group was shown pictures and messages conveying not only the disease outcome, but also the side effects of Batatrim when it was used. Thus, whenever the medicine was given, the picture of the patient showed a skin rash, and the statement also included the words "...and has severe side effects." Likewise, whenever the medicine was not given, the words "...and has no side effects" were added to the message.

At the end the subjects were asked to rate the perceived effectiveness of Batatrim. When there were no side effects reported the subjects were much more likely to give the medication AND were much more likely to rate the drug as effective.

In this study, we have shown that knowing a medicine produces side effects prevented the overestimation of its effectiveness that is typically observed when the percentage of spontaneous remissions is high [7], [10]. We demonstrated that the mechanism by which this effect works rests on the lower frequency of the treatment usage exhibited by those participants who were aware of the medicine’s side effects.

To my mind, having no side effects is equal to saying that the drug has no effects.  The two go hand in hand.  To advertise a treatment as having no side effects is to say it is useless.

But in the world of pseudo-medicines having no effect and no side effects work to fool the patient, by way the causal illusion, to think there is in fact causality and that the drug is effective.

Having no side effects promotes use of the medication and for a process that has a high spontaneous resolution rate, promotes reinforcement of the causal illusion. Since it is harmless, you use it more often and see it 'work' more often.

Fascinating.  And it helps explain why people continue to use products like homeopathy.

Points of Interest 7/18/2014
Points of Interest 7/17/2014