The Placebo Files
Right around the time
X-Files returned to television last year, while I
was waiting for column #4 to come out, I found myself poking around
on certain websites
that call themselves non-fiction, but which—to me at least—have
a lot in common with SF. This was partly to provide Facebook
advertising fodder for the column, but partly because they had such
What we narrowly define
as SF these days is purely for entertainment or possibly education,
but in the olden days pulp
SF sold products,
just like comic
books used to do, and just like television still does.
That shift away from commerce probably led to shifts in the kinds of
stories that made it into the magazines. These days we rarely read
about miracle cures, or how to develop our minds, or how we can use
our minds to produce miracle cures. Those themes have split off into
what we now call New Age literature, which I am saying is a branch of
SF, in the same way that paranormal/UFO conspiracy literature
branched off from SF, due initially to the work of editor Ray
Palmer. One of the key features of both sub-genres is
that they don't identify themselves as fiction. I can't identify when
or where the New Age/SF speciation happened at this point, but it
might be a good project for a masters student.
Today I want to
present a real “miracle cure,” documented in the
medical literature by reputable scientists, and discuss some proposed
mechanisms for that recovery. In other words, I want to give you some
really cool ideas to play around with in your fiction, which don't
rely on crystal energies, or quantum resonances, or any other verbal
The first concerns a
young girl with lupus,
an autoimmune disorder, meaning that her immune system became
confused. For some unknown reason, it stopped recognizing some of the
proteins on the surfaces of her own cells as “self.” In
other words, the girl’s immune system began to perceive her own
cells as “foreign,” and to attack her own organs and
tissues. We shouldn't be surprised at this; the immune system is also
responsible for killing cancer cells, which are only slightly
altered from normal ones, so the distinctions it has to make are
subtle and dynamic. They change over time as we age. Proteins come
and go from the surfaces of cells. A baby's cells will look different
from those of a child and from those of a teenager in puberty. Hit
#3 for more on the importance of 3d shape as the
driver of biological identity.
In any case, with the
immune system out of control, one way to suppress it is to kill off
the attack cells. There are dozens of these, each associated with
specific targets; medical doctors take whole courses on immunology.
One of the toxic drugs used for this purpose is called
which acts by cross-linking the cells’ DNA, triggering the cell
suicide program called apoptosis.
It kills immune cells, but not entirely selectively—they are
your cells, after all, and they share vulnerabilities with the
rest of your body, so there are always unpleasant side effects. The
game is to get the dose of cyclophosphamide high enough to put the
lupus in remission but low enough to minimize damage to the patient's
other tissues and organs.
Dr. Bob Ader at the
University of Rochester (where I did my Ph.D. work) had previously
managed to suppress the immune system of rats using Pavlov's methods
of classical conditioning, after an accidental
discovery. He gave the rats chocolate milk containing
cyclophosphamide, which had the expected effect. The rats were more
easily killed off by various viruses. What was unexpected was that
after that “training,” he could do the same thing with
chocolate milk alone. This is similar (but not identical) to
nausea in A Clockwork Orange, where the
narrator-droog Alex is sickened first by injections of lithium
chloride paired with violent visual images, and later by those images
alone. The medical dogma of the time was that the immune system was
autonomous, that there were no connections from the brain to the
immune system. We now know differently. The spleen and other organs
where immune cells are generated have embedded nerve endings, and
immune cells have neurotransmitter receptors
on their surfaces.
application of Ader's technique, with the young lupus
patient, took the form of a series of monthly treatments. First, the
drug was paired with a strong and unique flavor (cod liver oil), plus
the scent of roses. It was important to use something unfamiliar to
the patient (and her immune system) to avoid diluting the effect
across her other experiences. The next month, after she had somewhat
recovered from the toxic side-effects of the cyclophosphamide, she
got only the flavor and the odor, with no drug. On the third month,
she got the full cocktail again, like a Pavlovian booster shot. This
alternation continued for several months, leading to a full remission
with half the overall dose of the toxic immune-suppressing
drug. When the case
study was published, the patient was preparing to
enter college, after several years of extra life. I read somewhere
that she died in her twenties, probably due to the damage the lupus
had already done to her heart. If she were still alive, she'd be
almost my age now.
Bob Ader also died in
2011, but his work on the Pavlovian conditioning
of drug responses continues in research laboratories.
More and more people have begun to suspect that the placebo
effect—arguably the most general and powerful tool that modern
medicine has, but rarely uses
effectively—is an example of classical conditioning. In other
words, to use psychology language, the placebo effect is a
conditioned response. This opens up a whole new variable for
medicine to exploit, what B.F. Skinner called the reinforcement
schedule. Dosage becomes not just a function of how
much drug is taken, and how often, but of what other stimuli the drug
is paired with, and how strong the coupling is between the drug and
the other stimuli. Unfortunately, this idea has not yet made it into
the medical curriculum, which opens up a pretty cool opportunity for
SF authors to get ahead of the curve and influence a new generation
of doctors with their stories.
pharmaceutical companies have not jumped in to fund this work. They
regard the placebo effect as a nuisance,
a distraction from their focus on drug therapies, something that
complicates their studies, makes it harder to prove that a given drug
works. Who knows what fictional lengths they might go to in
suppressing information that would damage their business model?
Just to wrap it back around to the conspiracy stories we started
with, only a thousand short words ago.
Randall Hayes is the
main conspirator behind Greensboro Science Cafe and Agnosia Media,
LLC. His stated goal is to rule the universe from beyond the grave.
No, wait, that was David Lo Pan. Randall's stated goal is to improve
science fiction (and medical education) while making beer money.
Including possibly my favorite episode of all, “Mulder and Scully Meet the Were-Monster.”
First in a two-part series.
Virginia Tech apparently has a large SF collection. Who knew?
An extremely interesting book, and yes, he was the Atom’s namesake.
How is a spider like a cotton plant?
An obituary is a weird place to read science, I suppose, but the original papers were written before databases, so you’d have to
go to an academic library to find most of them. Specifically the U of R’s library, where I once spent a lot of time.
Serious SPOILER ALERT on this post, if you care about that sort of thing. Also, I won’t link directly to the book/movie, because they are not at all PG-13.
Though we got lucky with this one.
Behaviorally Conditioned Immunosuppression and Murine Systemic Lupus Erythematosus
And with the mouse version.
Neurotransmitter Receptors on Microglia
One random example of an immune cell.
This documentary talks to a bunch of my graduate faculty, not just Dr. Ader. Episode 1 recounts the heroic case study that I use every
summer with my students. I never knew the patient’s name before.
This is that case study, which I have to photocopy every summer because it’s not stored online anywhere I can find.
Although this ethics article argues that lots of doctors are using placebos under the table. Conspiracy? I think not. Mostly we just need to
clarify between deceit and unconscious conditioning processes, which don’t much care about awareness.
Not open access, unfortunately.
Read more by Randall Hayes