I attended a talk recently at the local Osteoporosis support group and heard the excellent Dr Eric Somerville give a riveting account of Quacks and their Quackery. His brief survey of the history of medical deception included an account of James Graham who opened his Temple of Hymen in Pall Mall in 1781 in which was his electrified celestial bed, aimed to help couples conceive. It was canopied by a dome covered in musical automata, fresh flowers, and a pair of live turtle doves. It released stimulating oriental fragrances, played organ music triggered by the occupants’ movements and had a moving clockwork tableau celebrating Hymen, the goddess of marriage. The current exhibition at the National Maritime Museum suggests that there is strong evidence that Emma Hamilton, later to be the mistress of Lord Nelson, was employed to help put couples in the mood to procreate. Clearly, no one would be fooled by such a contraption in the modern age, but quack remedies still abound. To be successful the quack needs a theory, a treatment, prestige from a grand building or title, advertising and preferably cash in advance and it is amazing how many of these treatments still flourish. From non-interventionist Christian Science to blue lamp therapy, home ozone generators, the anthroposophical theories of Rudolph Steiner, and Matthias Raths cellular medicine which persuaded large numbers of South Africans to treat AIDS with vitamin pills.
However, as Dr Somerville explained, if the remedies themselves are not harmful and they do not prevent the patient undergoing proper medical treatment when necessary, they may harm nothing more than the bank account. Indeed there are some who suggest that the act of believing that a treatment is effective is in itself beneficial. This is the placebo effect, and medical research has indicated that there are both real and perceived benefits from taking a substance or undergoing a procedure which is objectively not useful for the condition being treated. There has been much scientific research on the placebo effect and it seems to have some value in conventional medicine.
However there is a less well known opposite. The nocebo effect is where a patient taking an inert substance suffers negative effects. It seems that if the brain is persuaded that if something is good for you it has a positive effect, so why not thinking that something is bad for you results in a negative effect? It is much harder to study this if you consider the ethics of persuading a patient that the medication he is being given is bad for him.
So think about alcohol in the media. We are fed a relentless diet of bad news stories about the effect of alcohol consumption on our health, the recommended number of units per week has been reduced and minimum prices are to be introduced in Scotland, all in the name of protecting the health of the nation. What if the effect of these negative stories is to create a nocebo effect in the population and therefore create a self-fulfilling prophecy? Persuade enough people that drinking a pint is bad for them and it will become bad for them. As far as I know, little research has been done in this area, and it is not easy to see how a study can be designed.
Still it is refreshing to read an interview with Dr Helen Stokes-Lampard, the new chair of Britain’s GPs, where she takes a less judgemental and more persuasive approach to a range of issues, including alcohol consumption. Better to encourage people to succeed than condemn those that don’t.