A bomb is about to go off, blowing up hundreds of innocent people. One terrorist knows the location. You’ve got them in custody. Do you torture them to find out where it is?

Thus runs the common moral dilemma beloved of Hollywood movies and TV shows, frequently these days it seems staring Kiefer Sutherland. Are you a mealy mouthed liberal or are you willing to take the tough action necessary to fight terrorism?

Real life isn’t that straightforward – it doesn’t present such clear-cut scenarios, and anyway evidence from torture isn’t reliable: could you really be sure the terrorist told you the truth rather than a fib to waste your time? And the tough-guy macho act in real life all too often results in the innocent being harassed, tortured or killed as you charge off in the wrong direction based on incomplete or misleading information (remember Iraq and its weapons of mass destruction that were supposedly just waiting to be found by US and UK troops?).

However, a case a constituent raised with me recently got me thinking about the placebo effect – and the genuine dilemma it presents, particular for those – like myself – of a liberal mindset who believe in giving people as much information and power over their own lives as possible.

The placebo effect is seen when people are given treatment, such as pills, where the psychological impact of thinking that the treatment will make you better actually does – even if the pills are inert, containing no health-giving recipe at all. Give people a “medicine” that is really nothing such, but tell them it will make them better – and, lo, it can do.

It’s a weird display of the power of the mind when given a suggestion; a happy flip side perhaps of the power of the mind over the body you so often see when one of a couple who have been happily married for decades passes away – and then the other slips away shortly afterwards as if their mind simply no longer has any desire to keep their body going.

Of course it doesn’t work for all people in all circumstances (that would make the NHS’s job easy if it did!), but it’s a real, solid, verifiable effect – and one that medical scientists have to take into account when testing new medicine because, without allowing for it, their tests may otherwise fool them into thinking that some possible new medicine really does have health-giving properties when in fact it is only the placebo effect at work.

This to me seems as close as we get to modern magic in the sciences. It sounds a mad idea really in many ways isn’t it – the idea that if you think something will make you better, it really does? And yet – that’s just what modern science has found time and time again.

There are all sorts of wonderful details around the placebo effect – such as the colour of the pills impacts on how strong the effect is, because some colours are implicitly more strongly associated with making you better than others – and of course the colours that work best vary from culture to culture!

Which brings me to the dilemma. If a GP telling me that a treatment is extremely likely to work makes it actually more likely to work (because of the placebo effect) then shouldn’t they perhaps lie to me and tell me that even if it isn’t really that likely to work?

Ben Goldacre (I think) made the point well in The Guardian a little while back that this perhaps helps explain some of the popularity of alternative medicines compared with traditional medicine. For traditional medicine, GPs have shifted hugely in their outlook – being told to tell patients the full range of information about possible treatments, their chances of success and possible side-effects – and thereby sowing doubt into patients’ minds. But alternative medicine is often presented by its practitioners with absolute confidence – and so (regardless of any other benefits) scoring an immediate win on the placebo front.

Now – there are all sorts of benefits about keeping patients properly informed, including keeping a checking on conventional wisdom or vested interests getting out of control.

Yet here is the riddle: if doing that means they are actually less likely to get well in that immediate here and now case, who wouldn’t be tempted to shade the information? Would you be tempted to tell you child or partner a small fib about how sure you are the treatment is to work even if you know otherwise? And would that really be wrong?

For that personal circumstance – I am happy to let others make their own judgement in their own circumstances. But overall – there doesn’t seem to be a way to square the circle. Interesting dilemma…!

This article first appeared on Liberal Democrat Voice.

(c) Lynne Featherstone, 2008