Wednesday, June 18, 2008

Placebo Effect in Halacha

The last post got me thinking about the how the Placebo Effect works with halacha. In the last post we discussed what type of medicinal treatments are permitted according to halacha, and which are prohibited due to darchei haemori. We concluded that post as follows:

The Rashba seems to be saying that in order for a medicine to be considered rational we don't have to know why it works. We only need to have a rational basis for using the medicine. A rational basis can exist due to logic (it makes logical sense that this medicine should work even though it hasn't yet been tested) or due to observation (we have no idea why it works we just have observed that it does). What is forbidden is to use a medicine that we have no rational reason to believe works. If it makes no sense why it should work, nor has it been observed to work then it is forbidden.

It's the observation line that I want to focus on. As I wrote in the post, there are two reasons why a particular medicine or medical treatment could be considered rational. One is that it is logical that the treatment should work. Even if it is a totally new treatment that hasn't been tested it can still be considered a rational treatment if their is some logical reason why doctors think it will work.

The second reason that a treatment could be considered rational is because we have observed that it works - even though we don't know why or how it works. What's interesting to consider is that ever since the early 20th century medical science has been working under the premise that there exists a placebo effect. Meaning that a completely ineffective therapy can still work, simply because the patient believes that it will work. The question therefore is - what do we do with the rishonim who permitted certain medical treatments because those treatments were observed to be effective. Was that observation a "real" observation or was it just the placebo effect working? And in general, must we take the placebo effect into account as far as halacha? Do we define observation l'halacha the same way scientists define it? If we do, then that would mean that one could never take any medicine or medical treatment that hadn't been tested in a placebo-controlled study in a double-blind fashion (unless there was a logical reason why the medicine should work).

The placebo effect does make it into halacha in another scenario. Imagine a patient who believes that some non-kosher medicine will heal him. Now, the doctors actually don't believe it. It's totally untested and illogical. The question becomes is it considered a valid medical treatement or not? If it is, then we might be able to use it even though it isn't kosher (assuming other necessary conditions are met). If not, we surely cannot give someone non-kosher for no reason.

How can it possibly be considered a real medical need? The answer is that since the patient believes it will work it might just help him. Basically, it's the placebo effect at work. In fact there are poskim who have permitted just this case in certain specific situations for exactly this reason. The psychological benefit of taking the medicine is enough to declare it "medical" and permit it. Because the patient truly believes that this might work it becomes a possibly effective treatment and may become muttar even if it isn't kosher.

This then brings us back to our question regarding the times of the rishonim. Even if there were no placebo-controlled studies, the fact is that the people fully believed that these treatments worked. They had even "observed" them working. Therefore, the treatments, in a sense, did work precisely because people believed it! Accordingly, this may be enough halachically to be considered a real medicine and it becomes muttar. Just some food for thought.

* No post on Talking in Learning is intended halacha l'maaseh. Always consult your halachic authority for final rulings.