The Placebo Effect In Song

Happy Birthday, SketpVet! 🙂

Today marks the first anniversary of this blog. Not a momentous event for the world at large, but yet another reminder of the fleeting nature of time for me. Apparently, in the last year I have put up 135 posts and the site has been visited 7468 times. I’ve certainly learned a great deal, about medicine and about writing, and I’ve met a number of interesting people. I hope it has been interesting and useful to at least a few of you.

As an anniversary post, I thought I’d put up something I started on near the beginning but never actually posted.

Last summer, I spent a week at Lark Camp, a folk music workshop/festival/party in the Mendocino Woodlands. I tend to refer to it, affectionately, as Hippie Drum Camp, mostly because I went with the idea of learning to play the bodhran (hence the “drum” part; the “hippie” part should be self-evident). Apart from a brief and agonizing (for me and everyone around me) flirtation with the clarinet in grade school, I have never played an instrument. But I’ve always gone to Celtic cultural events (and pubs) and I know all the songs, so I wanted to learn more about the music. It was a fantastic experience, and I’ve spent the last year trying to learn a couple of instruments so I can go back this summer and participate more fully.

One of the folks I met there was a fiddle player who shared a song he had written called The Placebo Effect. We had a very interesting conversation about his experiences with managing his own diabetes and trying to avoid medication, and about all of the things he had investigated or tried as part of this experience. I had just started this blog, and I thought the song offered some eloquent and funny insight into the issue of placebo effects and unproven or alternative therapies from the perspective of an intelligent, educated non-scientist. At the time, I wasn’t certain he would welcome my making the lyrics public, but I recently found he did so some time ago on his own blog so hopefully he won’t mind.

Apart from the internal merit of the wit and humor, the song illustrates how someone can come to look at the complex relationship between individual experience and scientific knowledge. It is always difficult to argue with someone who feels better after using a therapy, even if the facts are pretty clear that the therapy doesn’t work. Feeling better is real whether or not it means what the person thinks it does or has any relationship to actual physical health.

In trying to promote science-based medicine, my ultimate goal is always to steer people toward what will truly help them or their pets and to steer them away from false hope and the harm that comes from mistaken ideas about cause and effect. But I try always to remember that CAM is popular because it meets a need. It provides hope, even false hope, and it addresses the psychological dimensions of illness in ways that mainstream medicine doesn’t always (though I think this is less true in veterinary medicine for a variety of reasons). I think we can have the best of both worlds–effective science-based medicine and humane, affirming care. But to do this we have to try and understand what appeals to people about CAM and what about scientific medicine pushes them away even when it is the more likely to help them.

This song touches on the issues of uncertainty in medicine, on the fact that general data can’t always predict what will help or harm the individual, and that the slow process of scientific progress, though it is far more likely to reach the right answer in the end, is often too slow to help those who are suffering right now. None of this justifies unproven or outright bogus medicine, but it does explain a bit why even ineffective therapies can be popular, and it reminds us of some of the limitations to scientific medicine that we have to deal with in the effort to guide people towards the best, real therapies available. It also reminds us that CAM is not the sole province of the ignorant, gullible, or stupid. I don’t necessarily agree with the writer’s take on science and knowledge, but from our conversation and his blog I have no doubt he is smart and well-informed. We must be careful not to make the mistake of caricaturing or patronizing those who don’t see the issues around CAM the way we think they are best seen. This blog is as much about learning for me as it is about trying to teach others, and from this fellow and his song I think I have learned a few valuable things.

Oh, and did I mention it’s funny?

In the woods on a sunny day late in July,
all the air was abuzz with mosquito and fly.
In an effort to cope I was spraying some DEET
on my arms, elbows, shoulders,
legs, ankles, and feet,
when a fiddler came by and said
“Don’t waste your time —
there’s no evidence that that stuff
works worth a dime”.
I explained to him I wouldn’t
care if there was,
’cause it helps me so long as
I think that it does.

Chorus:
I would never reject any fake remedy;
the placebo effect is what works best on me.

If I take enough fish oil, I
need not grow old,
if I take echinacea I won’t
catch a cold.
And if I should come down with a
cold anyway,
a few doses of zinc will soon
make it okay.
Now as far as I know there’s no
clinical study
showing zinc really makes you feel
one bit less cruddy.
So it might not be true, yet
I’ve heard that it’s so.
In such matters as this there is
no way to know.

I would never reject any fake remedy;
the placebo effect is what works best on me.

If you can’t afford insulin,
I have heard tell
that ground cinnamon does the job
perfectly well.
There are herbs with strange nicknames
in English and Latin
which I’ve heard are as useful
as Pfizer’s new statin.
I suppose that some day we will
know for a fact
how a body exposed to such
cures will react.
By the time that these answers are
finally found,
I’m afraid I’ll already be
under the ground.

I would never reject any fake remedy;
the placebo effect is what works best on me.

All this week in a tent, yet my
back feels just fine
I assume all that yoga
protected my spine.
And it seems my blood pressure has
come down a bit;
I conclude making music can
help me stay fit.
These are only assumptions, they
may not be true,
and if I wanted proof, well,
my options are few.
For, to test your health habits, there’s
one thing to try:
life your life over different
and see if you die.

I would never reject any fake remedy;
the placebo effect is what works best on me.

And it really is not just good
health that’s at stake,
for the thoughts that we live by
are most of ’em fake,
and we get through each day by
accepting as right
every half-assed conception
we dreamed up last night.
If I master this dance, then it
means I’m no fool,
if I wear the right clothes it will
mean that I’m cool,
and if I could play well every
tune on this list,
it would prove to me I have a
right to exist.

I would never reject any fake remedy;
the placebo effect is what works best on me.

Though to say it out loud here takes
plenty of gall,
I think music’s the greatest
placebo of all.
For as long as we’re playing we
think life is fine
and the wide world around us is
not run by swine.
Through a skeptic might ask what
this fake joy is worth,
at least fake joy’s the kind you can
have here on earth.
So that moral that I would leave
with you is this:
do not seek tragic wisdom
where bullshit is bliss!

I would never reject any fake remedy;
the placebo effect is what works best on me.

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