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Intelligent Design, Spontaneous Remission and the Placebo

This is not going to be an article on Intelligent Design. But Intelligent Design is a member of a class of concepts that appear in scientific dialogue without ever having earned their way in the usual fashion of combining theory with evidence. Now Intelligent Design just happens to be a concept that scientists would like to banish from the discourse. But other concepts that similarly lack the particulars of a scientific theory have overcome the immune reaction and reside happily among us. Examples are the placebo effect, the idea of spontaneous remission, and the Anthropic Principle. These concepts were never intended to become true science. They serve a useful function as placeholders, even as overt “untheories.”

Just as the idea of Intelligent Design makes a place–at least in principle–for a “God of the gaps,” the placebo model and spontaneous remission serve in the role of filling gaps in our scientific models. Matters are least ambiguous with regard to the concept of spontaneous remission. No scientist who is uncomfortable with the idea of Intelligent Design is any more comfortable with the idea of spontaneous remission. The term is not meant literally. One assumes that the spontaneous remission of cancer will ultimately yield to mechanistic understanding. But we have not been prepared to deal with that issue up to now. So everyone understands that spontaneous remission is just a placeholder that allows the conversation to proceed on issues that we can handle.

Matters are somewhat the same regarding the placebo. All the non-specific factors attending to recovery are casually swept into that bin simply because they are not of interest to the discussants in the prevailing context. This holds even if the grand placebo is cumulatively quite competitive with the intended remedy. Still we largely leave it alone. (Perhaps there is a distant poetic analogy here to the original sequestering of the inconvenient singularities in Quantum Electrodynamics. Even infinities could be tucked away.)

And then we come to the Anthropic Principle. Our present universe may be the outcome of a concatenation of extremely low probabilities, but ultimately that cannot be used as an argument for anything. If these low probabilities had not worked out this way, we wouldn’t be here to discuss it. So the only models of the universe worth studying are those that allow for the possibility of our own existence. The Anthropic Principle will remain with us for a while as commentary, but it will never have meat on its bones as a scientific theory.

Now as knowledge accumulates, the domain in which these placeholders operate necessarily shrinks. We increasingly understand spontaneous remission in terms of sudden alteration in immune system functioning. As mechanisms of recovery are coming to be understood, the placebo model shrinks in its applicability. The placebo is not so much coming to be understood as it is being displaced by specific scientific models. Its former dominion is being carved up in a variety of ways. As more domains of human function are becoming visible to us, the placebo is gradually being edged out of the conversation. It is on its way to becoming an embarrassment in its opaqueness.

This brings us now to the matter of neurofeedback. The denial of agency for neurofeedback is just as fervent and passionate among the neurofeedback deniers as the objection to Intelligent Design is among scientists more generally. But here the shoe is on the other foot. Neurofeedback has a verifiable model, repeatable procedures, testable hypotheses, and by now a raft of formal studies behind it. Yet the neurofeedback deniers would instead strenuously prefer the non-model, the non-theory, the mere placeholder of the placebo. According to these critics, all that we are accomplishing amounts to nothing more than spontaneous recovery or the placebo effect, kindled somehow in our office with our fancy machinery and beguiling entreaties to the client. It boggles the mind. In the name of science, we are seeing a flight from where the science is actually occurring, back into the embrace of mere opaqueness.

Any attempt to shed light on the particulars of neurofeedback is subjected to hazing on their part, all in favor of a model that yields no understanding at all and makes no predictions. The placebo god answers no prayers. It is really quite bizarre, particularly if one considers that the stridency and vituperativeness of the critics increases as the evidence mounts up against them.

The scientific method was devised to guard against bias–acknowledged or unacknowledged–and the hazing on the pathway to publication is intended as a bulwark against scientific fraud and charlatanism. One might look at biases and prejudices as the “non-specific factors” attendant to any research. They are always present, but we have no convenient term for them like the placebo. What has been sorely missing in the nearly two-decade war against neurofeedback is the observation that these non-specific factors are operative not only on the researchers, filled with zeal as they may be about their findings. They are also operative among the critics. Up to now, the critics have had an essentially free ride while the proponents have had to bear the brunt of all intimations of bias.

There appears to be a built-in asymmetry that has had unfortunate consequences for our field in particular. It is that the proponent of a theory is assumed to be subject to the usual human frailties and hence of bias. The critic, however, is often assumed to be a dispassionate observer only interested in the integrity of the scientific process itself. We accord the critic the same respect we give to the referee at a ballgame. This asymmetry has badly unleveled the playing field.

In science we are exhorted not to complexify matters needlessly. The simpler explanations are usually to be preferred. With that in mind, the simplest explanation of the persisting critical posture vis-à-vis neurofeedback may be that we are really dealing with scientific charlatanism—to put it plainly for lack of a more politic or ambiguous labeling. Scientists who are on the sidelines on this issue should allow for the possibility of bias (or worse, charlatanism) on both sides of this issue, not just one.

In support of this proposition, I offer up the observation that our principal critics are not acting like scientists. They are not exhibiting curiosity, first of all. They don’t manifest zeal for the emerging findings. Everything that is offered up is met immediately with resistance and hostility. This is not how scientists are supposed to act. The campaign against neurofeedback is the only consistent observable throughout. One critic in particular is as hostile to neurofeedback as Grover Norquist is to government. If he could drown neurofeedback in a bathtub, he would do so adroitly, and with no regrets.

So let’s sum up:

The conjecture of Intelligent Design sits outside of science, but can never be quite banished. It is not a part of science by hypothesis, so it can never be ruled out from within the scientific model itself. The system of science can only assume its own completeness; it can never prove it.

The Anthropic Principle remains incontrovertible, quite irrespective of whether it holds any practical implications for our science. It also sits just outside of science itself, yielding no testable hypotheses.

The Placebo Effect will always be with us in our therapies, even as we enlarge our understanding of the mechanisms of human behavior. But it will diminish over time in its power to stifle investigation and sabotage discussion. It will subside over time as the default position with regard to alternative therapies, not just neurofeedback. It will always remain, however, as a placeholder, a convenient shorthand in conversation, and thus it will remain outside of the proper domain of science. Those few who actually purport to study the placebo always end up studying something else….

Finally, there is the issue of scientific fraud and charlatanism. One expects that a robust scientific enterprise will also shrink its compass. More scientists will be acting as a corrective on the excesses of others. But historically the role of fraud in medical research has been increasing. More ominously, nearly all scientific fraud is occurring in medical fields. Research fraud also sits just outside of science, and it can never be formally accounted for within science itself. In scientific research, random errors are treated systematically, but systematic errors are discovered randomly. Research fraud is like a systematic error. We always remain vulnerable to it.

Scientific charlatanism is possibly at its most insidious when it infects the critical role that the larger scientific community is expected to play in arbitrating what passes for legitimate science. The above-mentioned asymmetry needs to be acknowledged and taken into account. The scope of scientific fraud may shrink, but we cannot ever entirely ignore this threat to the integrity of our scientific enterprise. Bias and scientific fraud also stand just outside of science itself, but the shadow that they cast cannot ever be definitively banished. This one isn’t going away.

In human affairs, it is often the most noble of enterprises that cloak the worst offenses. The recent Church scandal comes to mind, or Jewish insurance agents defrauding Holocaust survivors. Similarly, the privileged status that has been accorded the outside critic in science is particularly subject to abuse. It is time for truly dispassionate scientists to regard the thorough-going opposition to neurofeedback by certain respected authorities with suspicion. Since the piling up of evidence upon evidence is not having any effect, one can only assume that other, non-specific factors are in play.

Siegfried Othmer, Ph.D.

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