Like any writer and educator, I like metaphors. A good metaphor can help clarify a topic and a great metaphor will be memorable.

I have the arrogance to think that the information I have to share, both as an infectious disease doctor and as a blogger/podcaster, is actually important. I want my medical residents to remember what I have to say, as they may not always have ID back up. Towards that end I try and tie the concepts I want them to remember to vivid and/or funny phrases, metaphors, and similes. Whether or not I am successful I will leave to the judgement of others.

I have used a variety of metaphors over the years to describe the placebo effect. Essentially placebo alters the perception of a process, but not the actual process. The patient thinks they are better when, in fact, they are not.

The best example of the placebo effect, which I return to again and again, is the NEJM article: Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. Only albuterol, a real medication, resulted in objective improvement of asthma while any intervention, real or not, resulted in subjective improvement.

So I have used a variety of metaphors over the years to describe this placebo effect.

One is ape grooming. Having a caring intervention with a health care provider is the equivalent of ape grooming. It relieves stress and when stress is reduced people feel better. However,  in deference to a million years of evolution, health care workers will not attempt to pick fleas off.

Another is beer googles. I am much better looking and far more amusing if you have consumed pint or three of IPA. Or 4. Placebo is like beer, making the world appear better than it is.

Another is kissing a boo-boo. When children have minor injuries they like to have their parent kiss the injury, making it all better. The kiss does nothing for the trauma, but the child is comforted by the interaction and feels better. It turns out that is not an appropriate metaphor.

Ooops.  I was fooled.  The following was satire and I fell for it.  Never mind. Sorry.

Kissing a child's injury is better than placebo.

"We looked at 248 children who had minor bumps and scrapes on their arms and legs," explained Dr. Francis Campbell. "We found that that children who received a kiss from a parent on the area of the injury experienced faster and more significant pain relief than children who received no kiss and instead were given homeopathy."

Homeopathy, of course, is the ultimate placebo and is a poor placebo indeed.

If you are drinking milk (or beer) as you read this, stop now as it may be about to come out of your nose. Dana Ullman, described in the article as "famous for misinterpreting studies on medicine and homoepathy" said

Often times the benefits of homeopathy are not evident until around the same time that the injury or illness would have naturally resolved on its own.

Dana, Dana, Dana, that is what we have been saying all along. What you see as the benefits of homeopathy are simply the natural history of disease. He got it right for once and probably did not even understand what he was saying.