STEVE SILBERMAN, A LONGTIME WRITER FOR WIRED MAGAZINE, is the recipient of the 2010 AAAS Kavli Science Journalism Award for Magazine Writing. In the interview below, Silberman provides insight into the process of writing a science article, and particular his award-winning piece for Wired -- from the development of an idea to his interaction with scientists.
Silberman's feature article, “The Placebo Problem” – reveals how dummy pills called placebos are impacting the development and marketing of new medications by pharmaceutical companies. He also discusses some of the complications. One particular complication: under the right social and environmental circumstances, a sugar pill may generate responses from the human body that match or exceed the benefits of a real medication.
“One of the misconceptions my article was able to undo was this notion that the placebo effect is just psychological,” Silberman explained. “It’s not. The placebo response is very real, very biological and very quantifiable.” In the piece, Silberman explores in-depth the science behind the “placebo effect.” Below, he provides insight into the process of writing a science story, from the development of an idea to his interaction with scientists.
THE KAVLI FOUNDATION (TKF): Steve, a story about placebos doesn’t sound like a typical Wired story, which is often thought of as a magazine focused on computers and new technology.
STEVE SILBERMAN: In one way that's what Wired is, and in another way it isn’t. I’m now working on a book, but I wrote for Wired fulltime for 14 years, and we didn’t see the magazine as simply being about technology. We used to say, "Wired is about the future." We saw our mission as presenting smarter ideas -- ideas that are creative, innovative, and disruptive -- and to provide insightful perspectives on whole systems. In this context, a story about placebos makes sense, because the human body and mind is the most profound and most dynamic whole system we know of.
Still, I had to approach this story carefully to reach the Wired readership. The editor-in-chief is allergic to the kind of magical thinking that science bloggers call "woo" -- careless use of phrases like “mind-body medicine,” or proposing mysterious, non-scientific causes for things that really should be explained scientifically. The placebo effect is in fact evocative and somewhat mysterious and definitely exists in the shady borderlands of mind and body. So I decided to start out the story on a very solid business note, talking about the challenges that pharmaceutical companies faced in trying to develop a new drug. Then I laid out how their investments and R&D scientific expertise were being undone by a factor they couldn’t control – the mind’s amazing ability to begin to heal itself when we think we’re taking medicine.
TKF: But it was the mind-body experience that drew you to the story.
SILBERMAN: Correct. By the time you're in the middle of the story it gets into some really interesting questions about what is the division between matter and mind, or the division between someone’s environment and their state of health. If you think about it, the placebo effect is not about the sugar pill that you’re taking; it’s about the therapeutic environment in which the pill is taken. I actually prefer to use a phrase used by one of the scientists in my piece, who calls it the “placebo response.” The placebo response is what the body does to mobilize its own healing network to improve health when we think we’re taking medicine.
The placebo effect is a really complex phenomenon that gets into some very nuanced social issues. For instance, placebos work differently in different cultures. One of my favorite factoids in the story is that in most cultures, a blue placebo will be perceived as having a tranquilizing effect, which typically makes blue a good color for placebo sleeping pills. However in Italy, where the color of the national soccer team is blue, blue is experienced as an exciting color, so blue placebos in Italy have a stimulating effect.
TKF: What did you learn in the course of writing the piece that surprised you?
SILBERMAN: One thing I didn't know before writing the story was how much main stream medicine depends on the placebo response to be effective. In America, direct-to-consumer advertising plays a huge role in eliciting placebo responses in patients. And the drug makers know this. They spend a tremendous amount of money not only developing and testing drugs, but also developing advertising that will not only market the drugs, but boost their effect through the placebo response.
I also learned how drug testing has dramatically changed in the last 20 years. In the past, pharmaceutical companies either conducted drug trials themselves within the company, or had housewives and college students serve as volunteers. Now there’s a whole industry of contract research organizations that, for the most part, does the drug testing. And because they want large pools of “therapeutic virgins” for clinical trials – people who are not already taking multiple medications – they look outside America and often turn to populations in places like India and China and Africa. This is extremely important to the story, because the social environment is crucial for eliciting the placebo effect, such as how one perceives the care that one is receiving.
TKF: Was there a defining moment for you when researching this piece where everything came together?
SILBERMAN: I did have one of those moments, but it’s not in the piece. I was talking to Anne Harrington, who is Professor for the History of Science at Harvard University, and we were talking about the placebo response. She wrote a book called “The Cure Within,” which touches on the placebo effect, and she told me, “People get so confused about the placebo effect. They lose track of what a simple idea it is. Remember when you would hurt yourself in the playground and your mommy would kiss your booboo? That’s the placebo effect.” Her simple image made the whole idea so simple and so comprehensible. So rather than getting lost in esoteric notions, her statement made the placebo effect seem both very real and very ordinary and familiar. I was able to go on and work on the piece after that with that very basic understanding in mind.
TKF: You also use academics and scientists in every possible way. For inspiration and guidance, as sources and instruction...
SILBERMAN: Yeah, that’s true. And one of the most valuable ones was William Potter, who came from Lilly. In my initial contact with the pharmaceutical companies, I would get these boilerplate responses about how they were in control of the placebo effect; but then I found Potter, who had been a drug developer at both Merck and Eli Lilly. With a representative of Lilly on the line, William Potter was generous and honest and frank, and we ended up talking for an hour. Part of what made him compassionate about this was he was the son of a country doctor, so he would go on house calls with his dad to take care of sick people. He came from the old school, personal model of health care, which is completely relevant to the placebo effect, because if you feel you are being taken care of in a personal way by a doctor, it elicits the placebo response in a huge way. He had also been a psychiatrist and came from a background of doing talk therapy with people who had mental illness, and talk therapy is another extremely powerful mechanism for eliciting the placebo affect.
TKF: In one of your blogs, you say that scientists and journalists have in common a particularly keen sense of humility. What do you mean by that?
SILBERMAN: Well, both good scientists and good journalists keep firmly in mind what they don’t know and how little they know, then try to acquire the data to fill in that empty space. Good science is about cleansing your mind of preconceptions and letting the data tell you what’s true. So I feel like both scientists and journalists – the best scientists and journalists – have a firm sense of how little they know in the face of an awesome and complex universe. Scientists and journalists are committed to finding out what the truth really is, and not allowing their own limited ideas about how things are to determine the scope of their work.