What is it about the placebo effect that makes it so hard to study scientifically?

The idea of ritual is what science detests. The scientific revolution is about getting rid of culturally embedded behaviors, uncovering natural universals. A drug is a natural universal. Penicillin works in Africa or Asia. A ritual depends on belief, religion and imagination. Ritual is specific to culture. Placebo effect is presumably about the appearance of things, the belief in things, the ritual of things. There is something inherently unscientific about it.

It may be that ordinary people have demanded the investigation of alternative medicine. It may be that alternative medicines have demanded the placebo investigation. But I think that the NIH has really accelerated the placebo stuff. The big NIH conference on the placebo effect in 2000 was very important in initiating this conversation. NIH is a governmental bureaucratic institution, but it also really tries to be innovative and look into important questions.

You were an activist in your student days. Do you think of your work today as radical?

I think my work is radical in terms of science. But I try to abide by scientific rules. I try to be imaginative and innovative, potentially critical. I operate at the margins and I don't march with thousands of other scientists. But I work at the NIH and I fundraise for HMS. That's pretty straight. I still haven't cut my hair though.

Some people caution that the surge in alternative medicines signals the beginning of a non-scientific age. Do you think we are entering one?

I'm a scientist, but I can live with superstition. Scientific perspective is so rational that it forgets that the passion and foibles of human beings are part of the dialogue and discourse of all ages. I don't mean to say science is bad, but there's a hubris there that science has all the answers and you've just got to get rid of all the superstitious stuff and then we'd have a great world. I think we have to get rid of the arrogance and racism and intolerance and xenophobia, and that would be more important than getting the public to be purely rational.

Science's demand for privilege has to be negotiated, not automatic. There are a lot of reasons to be disappointed with science. In the same way, there are a lot of reasons to be really pleased with it. Getting rid of the arrogance will make people more appreciative of science, more than suppressing other tendencies with strict rationalism.

I think the NIH has every right and absolute responsibility to be absolutely scientific in everything it does because that's its job. But I can tolerate Haitian hoodoo medicine. Hmong refugees have a right to Hmong medicine. And I believe that Christians, Jews and Muslims have the right to pray to the creator of the universe and I don't object if my wife believes in astrology. I think patients have a right to that; I don't care whether it's scientific or not.

What career advice would you give to young scientists?

You really have to do what you love and what interests you. Also, I believe it is never too late. I never did anything with science until 1999-2000, and I'm on PBS now!

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