More on a good issue . . .

Of the BMJ, that is. This article, by Scott Simpson and his basketball team, is available to the Great Unwashed.

It turns out that in placebo-controlled clinical trials for treatment of various life threatening conditions, people on placebo who were adherent had lower mortality than people on placebo who were not adherent. In some trials, of course, people who were adherent to the active intervention (the drug) did even better than the people who were adherent to the placebo, i.e., don't let the criticism of drug marketing and over-prescribing that you read here obscure the reality that yes, some drugs do actually work. (In two of the trials, the people who were more adherent to the drug had higher mortality than those were non-adherent, i.e. the drugs were harmful. That's why you do trials, I guess.)

But the point is that there are very powerful influences on our health which can't be measured out and put in a bottle. Some ineffable mixture of belief, self-efficacy, and generally trying to take care of yourself by listening to your Grandma and eating right, sleeping right, and declining to drink, smoke or chew or go with the girls who do -- or whatever it is, we don't entirely know -- is worth more than the $7,256 per person we spend on health care every year.

This also gives us a bit of insight into the placebo effect -- a powerful tool that you can't ethically use, because it depends fundamentally on lying to people. That's a knot I'd love to find a way to untie.