What Would Robin Hanson Say?

I always wonder what kind of weight should I put on you linking to someone like Nortin Hadler in the positive way do that you do here. Is it a mild recommendation? Does it mean that you have some level of confidence that he is not a quack?

I’ve wondered if doctors would do it, and, honestly, I’ve hoped they would do it more. My grandmother is something of a hypochondriac, but the most dangerous health scares she had (with the exception of one) and the ones with the most lasting problems were caused by drug interactions for conditions she only thought she had. E.g., she was convinced she had a heart problem, so two different doctors put her on three or four different kinds of heart and cholesterol medication because they said it would keep her quiet, and it caused a series of ministrokes. Finally, my uncle started giving her multivitamins and telling her they were her heart medication (with the doctor’s approval, of course). Her heart and cholesterol were and are still fine.

For what a single anecdote is worth.

Actually, I think this has more to do with the patient than the doctor.

The patient comes in sick and knows, rather simply, that medicine makes people unsick. He does not know what medicine, how much, or even if any particular medicine will do much of anything for the particular sick he is.

The doctor, on the other hand, has a rough idea of what kind of sick the patient is and, assuming he is correct, knows whether or not medicine makes much sense. Some things, I believe, just need to take their course. But patients do not want to hear that. They came to a doctor. They want to be unsick. And, at least to them, that means medicine.

If the doctor does not prescribe SOMETHING, the patient may get a second opinion. And if that doctor prescribes something, he is likely to capture a new patient. To prevent this from occurring, doctors prescribe placebos.

…if only there were a way to credibly signal to your doctor that you will not be going elsewhere regardless of the treatment strategy he chooses.

Physicians learn about placebo use. Placebo use is effective and ethical in the right circumstances.

Examples: A patient has a problem that will get better on its own. However, this patient does not believe the doctor, and he feels that medication is needed. The doctor is unlikely to convince the patient, so it is ethical and effective to prescribe a placebo.

A patient is a known hypochondriac who refuses psychiatric help. The patient has an invented illness with psychosomatic pain. Prescribing a placebo may resolve this problem and alleviate pain (until the next time).

These examples are not rare, so I’m not surprised that most physicians have prescribed placebos.