The talisman effect
Chris Ellis, general practitioner, Pietermaritzburg, KwaZulu-Natal, South Africa
Early most mornings I shuffle into the kitchen to make coffee for the family. You may visualise the cupboard in our kitchen above the counter to my right. This is where the family’s store of vitamins is kept. There are numerous bottles of vitamins and minerals labelled from A all the way to Z. There is vitamin C and lots of vitamin Bs and then a whole lot of minerals such as zinc and magnesium and even selenium. Our kitchen cupboard may hold the whole of the periodic table for all I know.
A cursory inspection of members of the family arriving at breakfast reveals no obvious evidence of scurvy, pellagra, or beriberi in the consumers of their vitamin enriched cereals, so I have conducted a family focus group to find out the reason for this profligate consumption of food supplements. The answers have ranged from “Because they are good for you” and “They prevent me from getting colds” to “They will stop me getting Alzheimer’s like you, father.”
I have rejected their conclusions with the contempt that medicine reserves for non-believers of the scientific method. There is no hard evidence, I have cried, futilely, to the ranks of the opposition. This is why I have come to the conclusion that the multibillion dollar vitamin business is based on what I call the talisman effect. A talisman is a protection against evil or disease. It usually takes the form of a piece of jewellery or a pendant hung round the neck to provide magical protection (from the Greek telesma, to consecrate). Almost all cultures and religions have signs, figures, or artefacts that are thought to protect the wearer against misfortune and disease. The crucifix, St Christopher medals, the sign on the door, the black ribbons on the trucks, the amulets and the ankle and wrist bands on babies in the traditional worlds.
The talisman effect of vitamins and many other modern interventions in providing protection against illness seems to be cryptically embedded in the human psyche. How does the ritual of the medication, the belief in efficacy, and the feeling of protection affect the outcome of illnesses? The interventions may indeed have some benefits, but, like the placebo effect in treatment, the talisman effect in prevention may be more difficult to identify and measure in our deeply atavistic belief systems.
BMJ 2010; 341:c5916 doi: 10.1136/bmj.c5916 (Published 19 November 2010)
Cite this as: BMJ 2010; 341:c5916