31 ms·

Even when we know they’re “fake,” placebos can tame our emotional distress

213 points by akeck 3y ago

permo-w 3y ago
reminds me of public apologies
bell-cot 3y ago
I'd bet the same applies to both old social and religious rituals - but sugar pills are well-suited to and culturally accepted by modern scientific study. So nobody's likely to study mailing a paper-based note of apology (to the friend you're distressed over hurting), nor praying to $Deity (who you might not really believe in), etc.
- lazyasciiart 3y ago
  What makes you think that? https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377.2007.tb01041.x https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377...
blurbleblurble 3y ago
Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? Something unsettling about this for me. So much of illness wrapped up in distress. We need reassurances, however irrational the ritual that brings them. Why is there no space for this in conventional medicine?
- kube-system 3y ago
  Because it isn't quite that simple. Overprescription of antibiotics isn't usually done only for the placebo effects, but other social reasons as well. A significant subset of patients react poorly to "it's probably viral and so we probably can't do anything". As bad as antibiotic overuse is, lying to patients and fraudulently prescribing a treatment is still much worse than giving someone antibiotics in the 5% chance that something is bacterial. I don't think that lying to patients to falsely reinforce their untrue beliefs is a solution to the problem -- it'll probably create an additional problem by reinforcing beliefs of the legitimacy of pseudoscience.
  - jcutrell 3y ago
    I think there’s a chance here to actually tell them the truth. “This stuff is not studied to work. It is a placebo.” OP study says this can still be effective.
    - kube-system 3y ago
      Although not as effective as deceptive placebos. I personally suspect that the subset of people for which honest placebos work well overlaps significantly with the same subset of people who already believe "pill = good" above the expert advise of their doctors.
  - treeman79 3y ago
    On a 4 page list of my notes on issues and treatments I mentioned that my symptoms always got better on doxycycline for a couple of months. My ancient neuro-ophtomogist oh, you have Sjogrens. I’m like what’s that? Apparently he had seen that many times before. Turned out he was right.
- somenameforme 3y ago
  Antidepressant/SSRIs are a much bigger one. The actual experimental evidence for these drugs, contrasted against placebo, is shockingly weak. Moreso, SSRIs come with tremendous side effects. At the very least we should be making an effort to gradually phase these out of society. In reality, we've gone the other direction and floored it - with SSRI prescriptions growing exponentially.
  - mannykannot 3y ago
    I have seen the argument that the weak evidence for their effectiveness is entirely due to them being better placebos. What makes them a better placebo? Ironically, it is (according to this theory) that their side-effects are obvious to the patient, so those who are actually on them are more sure than the controls are that they are taking the drug under test, as opposed to the placebo being used in the trial.
    - LoganDark 3y ago
      SSRIs do have a studied and recorded physical effect of inhibiting serotonin reuptake, but what that actually does to someone is still not entirely understood, past "it can help with depression and/or maybe ADHD". It's unfortunate that SSRIs have harmful long-term effects—I know some people who have been dependent on SSRIs for around a decade, and probably will be forever because of the neurotoxicity.
      - somenameforme 3y ago
        The main point is it's not even clear it can help with depression, at least not anymore than a sugar pill. I'm going to avoid referencing any single study since you can find a study to support practically any reasonable view. Instead I'd just encourage you to look up: 'ssri vs placebo' anywhere. The overwhelming body of evidence concludes that if there's any effect, it's absolutely negligible. And, as a previous poster mentioned, it may well simply be due to the fact that doing a double blind with SSRIs is not really possible. They have such a tremendous physical effect than any subject will absolutely know if they're getting the "real" thing. And to be clear a placebo doesn't mean the effect of such isn't real. Mental state provably affects the body in all sorts of ways. Interestingly enough the placebo effect is often substantially stronger in Americans than in other groups as well [1]. The two main hypothesis there are that more poorly performing drugs are making it past regulators, the other is that the overwhelming amount of direct-to-consumer medical advertising creates a greater faith in the power of pills than in other countries - US/New Zealand are the only developed countries that allow direct to consumer medical ads. Or perhaps a mixture of both, like in many things. [1] - https://qz.com/525995/why-the-placebo-effect-is-getting-stronger https://qz.com/525995/why-the-placebo-effect-is-getting-stro...
- Herval_freire 3y ago
  There is space for placebos in conventional medicine. Doctors CAN and are allowed to prescribe placebos. However medicine strives to maintain a separation between an actual body of scientific knowledge and placebo treatments. So, yes, while a placebo can be effective nobody is going to transcribe that placebo onto actual scientific knowledge as if it wasn't a placebo. Right, so antibiotics work as a placebo, but am I going to put that knowledge down into textbooks that antibiotics can cure the common cold just because such knowledge effectively works as a placebo? No.
  - flavius29663 3y ago
    > antibiotics can cure the common cold Antibiotics are not pure placebo. They are also given to make sure there isn't a bacteria ready to take advantage of the weakened immune system. The regular treatment for COVID also included antibiotics, for the reason I mentioned.
- mannykannot 3y ago
  Prescribing antibiotics where they will be nothing more than a placebo is undesirable, but prescribing homeopathy where it will be nothing more than a placebo (i.e. in every case except dehydration) would have a number of undesirable consequences, including a predictable increase in the number of people who will turn to homeopathy when antibiotics are needed for themselves and, more importantly, for their children. This reminds me of a cartoon (in the New Yorker?) where a patient is demanding a better placebo as the current one is not working.
- otikik 3y ago
  > Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? You are comparing something that has cured many of humanity's illnesses (in fact, there's a good chance that you are alive thanks to antibiotics) with something that has the curative properties of rubbing quartz crystals or drinking blessed water. Of course there is something unsettling about that comparison.
  - jcutrell 3y ago
    I’m not sure what the bias is here - maybe halo effect? - but the issue at hand is that the antibiotics are being used in a scenario where they cannot be effective. They are, in that way, a placebo to the same degree that homeopathy is, despite any other properties outside of the acute situation. Say I have some really great tasting distilled water. Perfectly pure, exactly what I need if I wanted to quench my thirst. Now, I also have an empty gas tank. Should I put water or flat Coca Cola in the gas tank? They are both bad, despite the separately superior qualities of the water. Or, maybe a better comparison is putting diesel in vs coke. They are equivalently bad for the engine despite one of them being used for a similar but separate situation.
    - otikik 3y ago
      Your metaphor is does not work well because water and coke are both pernicious to a car. A better one would be quelching thirst with water versus coke. Both will calm thirst, and are reasonably “neutral”. The second has pernicious effects, especially in some people (diabetes for example) Distilled water has other uses besides drinking. It can be used in chemistry for example. You would not get good results in chemistry if you replaced distilled water with coke. “I can drink water, surely I can use coke instead of water on this chemistry experiment, because I can also drink coke” is clearly faulty logic. And yet, that’s exactly what people do with homeopathy. While it should always be presented as a “complement” to medicine(because it can have some mental/placebo effect in some people, in some cases), very often people take it as a substitute (the marketing word is “alternative”) to medicine. This is something that the homeopathic industry can’t help but “allow happening”. In fact they are motivated to promote that way of thinking. First it increases direct sales. Secondly, the more mixed up their product is with medicine, the stronger the placebo effect will be, and that will increase sales further. Unfortunately the placebo effect is very limited. You can’t mend a broken arm with placebo alone. You can’t cure cancer with placebo alone. And yet people replace chemotherapy with homeopathic “remedies”. And then they die. In short: doctors should never give homeopathic remedies, because that puts them on the same level as medicine. That will ultimately make some homeopathic makers richer, but it will also get some people killed.
luckylion 3y ago
For some definition of “we” and “know”.
- LoganDark 3y ago
  This argument always bothers me a bit, because words are almost always used with "some" definition.
  - luckylion 3y ago
    I was trying to highlight that these words and the definitions you choose do a lot of lifting there. What's "we", or rather you or I, are you only your conscious mind which 'knows' something, or are you also the subconscious that doesn't know that at all? I'm certainly more we than I but I say I because it's easier and doesn't require tons of explanations. Recently I discovered that I've gotten a slight needlephobia. I'm perfectly fine with needles. I'm willing to give you my blood or get my shot, I don't have a problem with needles. But if you come close to me with a needle and I'm aware of it and believe that you'll stick it into me, I'll just shut down my conscious mind. But I obviously don't. But I absolutely do. Which one of those am I? Which one 'knows' something about placebos? Which one is affected by illnesses and medication the most? And what do you actually 'know' there? Do you know it doesn't contain any medication? Do you know that it usually still has a good chance of helping you? How is it fake if it has an effect? Do you 'know' that you don't 'know' how or why it works exactly? But does that make it fake, or does that make it surprising that it works? I know how basically nothing about how anything works, but it still works, and that's not surprising to me. But I'm lazy (all of me) and I didn't want to write all of that, so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything.
    - LoganDark 3y ago
      > so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything. I can't tell if this is sarcasm or not, but in any case, thank you for the clarification.
treeman79 3y ago
My dad used to joke about how placebos helped my mom and older sisters many body ache complaints. I just thought severe pain was normal until I was diagnosed with autoimmune, MS and a few other things. Doctors told me for years it was just in my head and that I just needed medication for anxiety. Proper medication and diet changes resolved pain and anxiety. My mom and sisters all have same issues. Dad and doctors gaslight them and me for decades. The highlight when I was in the ER coughing up blood. ER doctors explaining how I was faking it since my blood work was normal. Until chest X rays came back. Then doctor also went pale.
- Herval_freire 3y ago
  This is an illustration about not just placebos but how delusional people are. These are doctors who were taught to be investigative and logical yet they were so delusional they have to say that you were faking the blood that you were coughing up. A lot of "logical" people like to rag on cults or religious groups but what they don't understand is that delusion is pervasive. Most humans lie to themselves extensively and you dear reader, are likely not an exception. Take for example the armies of people who told me AI won't ever take over their jobs and chatGPT is just a stochastic parrot. There is merit to both sides of the debate, but I guarantee you a lot of the hostility against AI comes from delusional lies people tell themselves to cover up a possible future trivializes their job skills. Not trying to start an argument on AI here, but I bring this topic up because it's the most current example of mass delusion I can think of. You have to bring up the current delusion to show people how strong the capacity to lie to oneself is.
- Night_Thastus 3y ago
  The more I talk to people in my life (friends, family, mentors, teachers, etc) the more this story seems to repeat itself. People who have a somewhat uncommon issue, and are forced to go from doctor to doctor until one finally recognizes the problem and knows what to do. I think that we have a couple problems. One is that we just don't have enough doctors to give thorough care to each person. They're under too much time crunch to really investigate. The second is that the human body is hopelessly complex and I'm not sure humans will ever be able to be good at diagnosing problems with it effectively. Until we develop real gAI and much better imaging techniques, I'm not sure we will ever solve this problem in a satisfactory way.
johndhi 3y ago
Open placebo studies are super interesting to me. One of the difficulties of pharma is proving efficacy over placebo... because placebo is a very strong factor! I feel like we could, as a medical community, leverage placebo to improve health outcomes much better than we do today. Why not? It seems the only reason not to is some weird Victorian notion about the capital-T Truth.
- sublinear 3y ago
  > some weird Victorian notion about the capital-T Truth. Only if neither the patient nor insurance are paying for it. Otherwise that's just straight up grift.
- boomboomsubban 3y ago
  If a doctor gives you a placebo, you only get the placebo effect. If a doctor gives you medicine, you get the placebo effect plus whatever extra benefit the medicine provides. We already are leveraging the placebo effect, unfortunately we are also doing it in a negative way by highlighting side effects.
  - LoganDark 3y ago
    > the placebo effect plus whatever extra benefit the medicine provides. Plus, the act of noticing those extra effects can give you another placebo effect on top, e.g. if the medicine has some noticeable effect, the placebo can get stronger, or cause other effects to accompany it. Of course there is also consciously learning to leverage the effects of the medicine, which is a non-placebo~
  - munk-a 3y ago
    For some medications those side effects can be severe though - I think there's some rationale in actually purposefully leveraging the placebo effect without giving the patient a medication that could harm them.
    - boomboomsubban 3y ago
      The side effects are also influenced by the placebo effect. Maybe they'd be less problematic, but they'd still exist.
pbourke 3y ago
> In one placebo group, people were told by a friendly, trustworthy, and empathetic researcher that the videos had a physiological impact that activated “early conditioned emotional schemata through the color green.” > “It was a fake idea, a fake rationale behind it,” Gaab said. “And it worked, people loved it.” It worked as well as a group psychotherapy treatment Gaab and his colleagues used with study subjects a few years earlier. Were people explicitly told that it was a fake idea at the outset, and went along with the ruse? Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? Or do I need to receive “Problem X pills” from some authority in order to see a placebo effect? I had always assumed that a key component of the placebo effect is not knowing whether you’re receiving the treatment or the control.
- groby_b 3y ago
  Nope. you'll still get a benefit when you know. (https://www.apa.org/monitor/2011/03/placebos https://www.apa.org/monitor/2011/03/placebos - sorry, don't have a real link handy)
- kayodelycaon 3y ago
  Being completely serious here. Go to any store selling homeopathic medicine and pick something off the shelf. Maybe it's placebo or maybe it works. Just make sure to do your own research first, some things are actually toxic or interact with medications. :)
- __MatrixMan__ 3y ago
  > Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? I've been told that this is the basis for magic, and that the answer is yes. Better still is to come up with a ritual that transforms them into problem-X pills, something symbolic of problem X. With practice, your magic might even become stronger (because you have prior experiences that make you believe).
segasaturn 3y ago
Yeah I've known this for a while, I suffer from anxiety and obsessive compulsive disorder and am well aware that my compulsions are total placebo and have no connection to my obsessions but still find they calm the anxiety almost completely. I think people are just drawn to ritual, be it religion or placebo/quack medicine or OCD.
assbuttbuttass 3y ago
> research published this year from Gaab and his colleagues showed even taking imaginary pills could reduce test anxiety I'd be curious how effective it is versus deep breathing, or any other anxiety-calming practice. The mind is extremely susceptible to the power of suggestion, but I'm not convinced there's anything special about a "placebo" versus ordinary mindfulness.
thecrash 3y ago
It is said that a visitor once came to the home of Nobel Prize–winning physicist Niels Bohr and, having noticed a horseshoe hung above the entrance, asked incredulously if the professor believed horseshoes brought good luck. “No,” Bohr replied, “but I am told that they bring luck even to those who do not believe in them.”
- peteradio 3y ago
  Anytime I find a horseshoe I throw it in the trunk of my jeep, never had an accident since ... knocks on wood.
- jffhn 3y ago
  Reminds me of this quote: "Do not be ashamed to speak nonsense! You only have to be attentive to your own nonsense." (Wittgenstein, Miscellaneous Remarks (Vermischte Bemerkungen))
- hinkley 3y ago
  One of my favorite Civ VI quotes: > "I don't believe in astrology; I'm a Sagittarius and we're skeptical." - Arthur C Clarke
- WallyFunk 3y ago
  On the subject of luck: https://quoteinvestigator.com/2012/07/21/luck-hard-work/ https://quoteinvestigator.com/2012/07/21/luck-hard-work/
- arkj 3y ago
  I’ve heard Zizek repeat this a lot in his talks but has never been able to find a reliable source for this claim
  - boomboomsubban 3y ago
    Somebody else searched, and Bohr did seem to say it, but he was quoting a neighbor at the vacation home. https://backreaction.blogspot.com/2011/12/advent-calendar-21-bohr-and-horseshoe.html https://backreaction.blogspot.com/2011/12/advent-calendar-21...
vonnik 3y ago
The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and through specific actions, the placebo effect can be maximized. In fact, it used to be part of a medical doctor's training to take on the mantle of an authority capable of producing placebo effects, back when they had little else to give. The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. It's hard for people to do this to themselves, deliberately -- like turning the knob on a pressure cooker while you're inside the cooker... But obviously being credulous helps a lot!! There is actually a literature on this, but it's adjacent to the medical journals: Daniel Moerman describes himself as a medical anthropologist. He wrote a book called “Meaning, medicine and the ‘placebo effect' “. https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-Anthropology/dp/0521000874 https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-An...
- hdjjhhvvhga 3y ago
  > The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Isn't it risky? Saying "everything will be fine" or "this will definitely help" with authority when you know the probability can have consequences, and in the end patients will stop believing you.
  - retrac 3y ago
    It's perhaps less "everything will be fine" and more "whatever happens, you're in good hands". A certain confident assertiveness, even when there's nothing to be confident about. I've not had the experience some have, with physicians pretending to be mini-gods. So far, the ones I've met have been quite willing to admit they have no idea what's going on when that's the case. That can be done in a way that leaves you feeling like you have support and practical things to do in the meantime, or it can leave you feeling lost. A friend who is a nurse who works in hospice has some critical things to say about the bedside manner of some of her peers. When there is nothing to be done, but how nothing is done can still matter a lot. Sometimes it's simple as despair leading to self-neglect that leads to more rapid worsening of illness. That effect seems to be related to the placebo effect.
halfjoking 3y ago
Placebos can also work in reverse - if you strongly believe a medication or procedure is harmful then you will be harmed by it. That's why it's entirely unethical to force a medical product on a population. Take for example the mRNA covid vaccine. Let's say it did what they claimed at the start and stopped transmission 100% without ever causing a side effect. Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit. People who believe a vaccine is dangerous but take it to save their job will get harmed whether it caused a side effect or not. The emotional distress alone can be debilitating. If the mind is so powerful it can strongly affect health outcomes, how could anyone think it's ethical to punish someone for making their own medical decision?
- lazyasciiart 3y ago
  Because their emotional distress and placebo effects don’t outweigh the benefit to everyone else of having them vaccinated. And requiring vaccination to keep your job is not a punishment, any more than we punish people with epilepsy by saying they can’t drive. It’s an attempt to reduce the risk to society posed by their medical state.
  - em-bee 3y ago
    what's more, the distress is not caused by facts but by misinformation and people deliberately causing a scare. car traffic is more dangerous than the vaccine yet rarely is anyone experiencing distress over that.
- piotrkaminski 3y ago
  > Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit. That's ridiculous -- of course benefits can outweigh psychological side-effects. Usually you'd want those benefits to accrue to the person suffering the side-effects, but living in a civilized society means accepting that sometimes the good of the many outweighs the pain of the few. If a vaccine for a deadly, highly communicable disease can completely stop transmission then I think it's perfectly ethical to require everyone to accept it or isolate from those willing to do so.
kilbuz 3y ago
The book "Bad Science" has wonderful discussions and examples of the placebo effect as it relates to medical research. Highly recommended.
coding123 3y ago
I'd like to see a placebo study where they have 2 placebos: 1. This medicine will cure your muscle pain, but it has very bad side effects: Insomnia, depression, back pain, knee pain - but don't worry only a small percentage of people see these issues (like 1%) 2. This medicine will cure your muscle pain, and has no side effects, in fact it will make you happy and help you sleep better.
agumonkey 3y ago
I think a lot of this psychological layer has been ignored because it wasn't phenomenologically interesting to study as a science, but the important of the semantic/emotional layer is hard to ignore. A simple thought (say someone tells you something regarding your child that is not true but you believe it) can fuck up your biology down to physiological death. Sadly, and obviously, the reverse isn't true, you can rarely cure infections through neurons triggering pathway cascades. But still.
misssocrates 3y ago
It could be argued this is why wearing masks can be helpful, for some, even though there is no evidence they protect against respiratory viruses. > Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
- TurkishPoptart 3y ago
  I prefer wearing my tinfoil hat :D
- PaulDavisThe1st 3y ago
  From the cited paper: > The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. Statement from the publishers: https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review https://www.cochrane.org/news/statement-physical-interventio... > The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.'
  - deleted 3y ago
    [deleted]
  - misssocrates 3y ago
    That's why I said there is no evidence.
furyofantares 3y ago
I've tried to internalize an understanding that placebo effects are real and can be large, with the expectation that this understanding should increase placebo efficacy without sacrificing my commitment to truth (that is, I don't seek out woo, but I do expect some woo is actually a real, strong placebo effect and I'd like to be able to replicate it myself sans-woo.)
- hinkley 3y ago
  Part of the "mind over matter" aspect of the human body is that a deliberate act is sometimes enough to get things moving. That act in increasing the number of times of day you think about your predicament and the depth of attention you apply to it. While there's a lot of promise in harnessing that, it's also the source of a lot of superstition.
PaulDavisThe1st 3y ago
For years (decades, actually), I've been a believer in the idea that deliberately and systematically harnessing the placebo effect will be the biggest medical development of the first half of the 21st century. However, I've become aware of studies and claims that actually the placebo effect itself is an illusion caused by poor statistical understanding and poor study design (sometimes necessitated by the study matter). At this point I am deeply unsure what to make of things.
- hinkley 3y ago
  Warts are an immune system that hasn't identified an intruder yet. There are plenty of folk remedies that are basically about tricking the brain into telling the body to get on with it. One involves tracing it and burning the paper. The last wart I had (when I was younger) I got mad (and angrier) at it one day and started trying to cut it out. I'm certain there were bits of it I missed, but it was gone in a week. I decided I had finally had enough and my body got the message.
gnatman 3y ago
There's a great episode of NPR's Hidden Brain about the placebo effect called "All The World's A Stage—Including The Doctor's Office". https://www.npr.org/transcripts/718227789 https://www.npr.org/transcripts/718227789
thomastjeffery 3y ago
Emotions are an association between "fake" and "real". We can take advantage of this with objectivity: if you have an objective perspective on emotion itself - as a process that transfers data between imaginary thought and physical feeling - then you can alter the surrounding circumstances of emotions, and actively pursue specific thoughts that are connected to desirable feelings. But the utility doesn't end there: you can also directly hijack the process itself. Emotion is only truly understood from an implicit inference perspective: the explicit definition I just gave is not provable the way a mathematical theorem is. The only available evidence is from experiencing the result. It's a soft science, but it's still useful enough to construct reliable tools. Here's my testing method: breathing. I know that the physical act of breathing is not functionally different, whether it's intentional or automatic. I know that physically, my lungs are filtering oxygen from my environment into my blood (with a breath in), and CO2 from my blood into my environment (with a breath out). Simply breathing does not have a noticeable effect on my emotional state, save for providing a baseline of functional cardiovascular support. I can feel happiness, anger, depression, pain, euphoria, or any other physical sensation: all the time breathing in and out with the same fundamental process. These elements of the breathing process have been explicitly proven, much like a mathematical model. So how can breathing hijack emotion? Story. The associations that an emotion is made of are volatile. They can be changed. We all experience emotional change that is unintentional: based on the experience of our surrounding circumstances. We can also make emotional changes that are intentional: based on the experience of our own imagination: by playing out a story. Here's an example: Imagine the feeling of ice on your skin. It feels cold to the touch, even the air nearby it. The rest of your body is comfortably warm: blissfully unaware of the chilling sensation from ice in that one place. Your lungs are not for filtering oxygen and CO2 anymore: now they draw in that sensation of cold touch, and filter out the sensation of warm comfort. Each breath in draws another lungful of chill into the bloodstream. Your heart pumps, and your blood meticulously draws out (like the CO2 before) the warm comfort from the body, to be replaced by the chilling touch of ice. Each breath out releases that warmth out into the air around you, to be scattered away in the wind. Do you feel it? Now replace the cold touch with heat. Excitement. Peace. The Rolling Stones told us that love is, "just a kiss away"; but it's even closer than that: you can find it in a breath.
thenerdhead 3y ago
I've read up a bit about this topic, but is there any books or recommendations that really cover the idea of what is popularized as the "mind-body connection + placebo effect"? There's obviously the best sellers / self-help crap in the world and even books on back pain being healed from this general "placebo" effect or at least the new awareness of it. I've noticed this personal effect to be a constant theme in my life. I'm a chronic overthinker (OCD perhaps) and when I become aware enough of said "placebo effect", my problems go away and new ones take their place. Maybe that's just life, but there's such a strong power to placebo I'd love to learn more about.
- nabnob 3y ago
  Irving Kirsch, psych professor at Harvard, wrote a book called "The Emperor's New Drugs" which argues that antidepressants are basically just placebos. I haven't read the book but I have seen a lot of interviews and articles on his research and it's pretty damning.
  - thenerdhead 3y ago
    Thank you. Very interesting!
  - NickM 3y ago
    I have read this book, and can confirm, it is extremely interesting and pretty damning. I'm frankly surprised it hasn't had more of an impact; it really does seem like SSRIs are causing a lot of harm to a lot of people in the form of side effects, and the scientific evidence seems to point strongly toward them being no better than any other active placebo. Yet, they continue to be prescribed in ever-increasing numbers.
    - nabnob 3y ago
      Well, to be blunt, it's because there are billion dollar pharmaceutical companies that want to keep making money off of these drugs, with around 20% of adults taking anti-depressants at any given time.
- 3y ago
smeej 3y ago
This reminds me of the "homesickness prevention pills" my mom sent with me to sleep away camp. They were just unlabeled M&Ms, and I knew that, but I'll be darned if those things didn't cure the homesickness right up!
- em-bee 3y ago
  they reminded you that your mom cares about you. they are special because you didn't just buy them yourself, but your mom sent them to you as a gift. just like when my grandma made me cookies.
- nerdface 3y ago
  This is so wholesome
  - eurasiantiger 3y ago
    [flagged]
Zigurd 3y ago
Humans evolved in a world of arbitrary danger. That we evolved an affinity for coping mechanisms to the extent they have undeniable physical manifestations seems likely.
intalentive 3y ago
If the placebo effect comes down to the power of suggestion, then hypnotism is potentially a valid form of treatment.
- deleted 3y ago
  [deleted]
- w_for_wumbo 3y ago
  It works better if you believe in it. Feels like hardcore skeptics are doing themselves any favours by completely discounting the power of their mind to affect the environment (their body) which it is connected to.
cycomanic 3y ago
An interesting aspect of placebo is that supposedly the strength of the effect has been increasing in the last decades. So much so that quite a few approved medications would likely not get approved anymore, because their effect would not be strong enough compared to the placebo effect.
- boomboomsubban 3y ago
  That doesn't make sense. If the approval process were happening now, the new trials would have the drug benefit from the higher placebo effect.
- bitcurious 3y ago
  The placebo effect getting stronger as the population of earth increases is probably the most compelling evidence for us living in a simulation.
- notfed 3y ago
  I find this hard to believe, only because it would be stupidly hard to measure this in an unbiased manner across generations, and the replication crisis is just so rampant.
taeric 3y ago
Placebos are a ripe topic. Specifically of interest to me, is that it is clear that placebos can work even when you know they are placebos for "solving" things; this implies that they can also work for making things worse. And letting that sink in is terrifying. Just telling people that they are going to do worse on something can, in fact, cause them to do worse at said thing. Even if the reasons are completely wrong. That is, placebos aren't limited to cures.
- sd9 3y ago
  The nocebo effect. "This video will hurt" - CGP Grey https://youtu.be/O2hO4_UEe-4 https://youtu.be/O2hO4_UEe-4
  - taeric 3y ago
    Thinking of how this fits in to conspiracy theories and general thoughts on public policy are... less than pleasant, all told. I personally take it as a good reason to have even more patience and empathy for folks; but I don't get that impression from everyone else. :(
j45 3y ago
I wonder if the placebo effect can extend to learning, where you imagine taking a placebo that helps relieve your stress about having to learn something new after a long time. If anyone is familiar with research and reading at the intersection of placebos/psychology/learning, it would be great to read!
- RheingoldRiver 3y ago
  Well, not quite what you are asking but, it has been shown that asking some demographic questions prior to testing can alter some outcomes (specifically Black students' math scores) [0] although other papers find no difference when looking at other factors such as asking about gender prior to physics tests [1], this is known collectively as "Stereotype Threat." So given that "Stereotype Threat" is a thing, I would absolutely believe that you can apply the placebo effect to learning as well. [0] https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046 https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046 [1] https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf
  - j45 3y ago
    That’s super interesting, thanks. I would kind of start to think about formative vs summarize questions but unrelated questions you get right could Until I can find the link to the study, anecdotally I have found that sharing a message about adult learning prior to learning can also have have a positive effect - which sounds similar to the above.
Maursault 3y ago
Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment. Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?” He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.”[1] [1] Matthew 17:18-20
DoreenMichele 3y ago
The twist: The pill was a form of deception. It contained only lactose, sucrose, and glucose; it was a placebo. Sugar is not chemically inert. It actually takes the edge off pain and general misery. I wish they would stop publishing results indicating that "We believe sugar does absolutely nothing whatsoever in the body, so if you consume sugar pills, clearly any reaction to it is complete bullshit made up by your mind because you believed in it."
- crazygringo 3y ago
  OK, but the amount of sugar in a pill is tiny. It's presumably not a piece of hard candy, but rather mixed with standard pill fillers. I don't think that's enough to take the edge off of anything.
  - DoreenMichele 3y ago
    It's presumably an amount you could look up if you genuinely want to argue this for some reason.
    - boomboomsubban 3y ago
      "Sugar pill" is a generic term for an inactive substance. It doesn't contain a meaningful amount of sugar, and similar effects are present using other substances. How would we test diabetes medicine if the only options were either medicine or sugar? Trying to claim the placebo effect is from taking a tiny amount of sugar is silly. If sugar alone was curing things, the US would basically never get sick.
      - DoreenMichele 3y ago
        No, placebo is a generic term for a presumably inactive substance. I quoted the article. They gave people sugar in this case.
        boomboomsubban 3y ago
__MatrixMan__ 3y ago
This is why I keep my mouth shut when I run into somebody who is into crystals or homeopathy or some other pseudoscientific thing. As long as their "solution" isn't likely to cause additional harm, and they're not being overly greedy re: how much money they're making, then the hope they're selling is real even though it might be of dubious justification.
- notfed 3y ago
  I guess it depends on the illness. If it's an actually-treatable disease, maybe not totally rude to suggest (non-?)alternatives, haha.
partiallypro 3y ago
This is going to sound stupid, but I've always wondered if one day we just find out that sugar pills do have medicinal value.
- airstrike 3y ago
  I take an "anti-stress" "natural" "medication" most nights when I want to go to sleep. I know it's basically just flavored sugar but it knocks me out and I'm asleep in 5 mins. Who needs melatonin when I've got this placebo ritual that works just as well with no side effects?
- notfed 3y ago
  I always thought this too, "sugar" pill never sounded neutral. Maybe it should be a "water" pill. But then we reserve the term "water pill" for pills that make you pee, gahh. Naming pills is hard. (Let's not even talk about the risks of off-by-one errors here.)
- deleted 3y ago
  [deleted]
hollerith 3y ago
Question for those that welcome the placebo effect: does it worry you that if placebos can affect you strongly, that fact is a sign that you are broken in some fundamental way? I mean, you have emotional distress, and straightforward ways of dealing it do not work, so you have to pay some authority figure to prescribe a placebo. Does that not make you want to investigate how deep your brokenness goes? (Actually, I think that the placebo effect is not strong enough and does not apply to enough real-world situations to be worth paying much attention to and that there are just a lot of bad studies in some fields.)
pknerd 3y ago
There is a very interesting book "you are a placebo" discusses the placebo effect. The author cured himself by practicing it.
- mito88 3y ago
  regular strength placebo / extra strength placebo
ggm 3y ago
There's a famous incident on Australian TV where a TV presenter is told about how well a placebo works, and he assumes its a brandname or drug name and asks if they could be made available on the Pharmaceuticals Benefit Scheme (the national subsidy for expensive pharmacy cost sharing) and what's holding back GP's from prescribing them. Certainly made me laugh but if you catch your wind its a bit of a Yogi Berra wisdom moment: if we did routinely prescribe placebos then they might actually help reduce the cost burden of real drugs with comparable efficacy, which are subsidised.
ookblah 3y ago
Makes me think about the "ASMR" effect and how some videos center around intentional stuff or just alternative medicine. It's like you know these crystals aren't doing jack but it's still relaxing on some level.
- pyinstallwoes 3y ago
  Well crystals are used for the pizeoelectric effect and involved in a lot of modern technology in relation to the EMF spectrum. So, there's at least "ammo for justification" even if that's all it takes for placebo's to be activated (Shepherd: I don't care what you believe in, just believe in something!)
- Aromasin 3y ago
  Same with aromatherapy. I know it's crap, my partner knows it's crap, but hell if I don't sleep like a baby if she sprays our pillows with a Lavender scent before going to bed; I sometimes take a bottle with me when I travel, and it knocks me out better than any amount of melatonin or sleep medication could achieve. I'm sure it's just association by now, but it works.

213 points by akeck 3y ago

reminds me of public apologies

I'd bet the same applies to both old social and religious rituals - but sugar pills are well-suited to and culturally accepted by modern scientific study. So nobody's likely to study mailing a paper-based note of apology (to the friend you're distressed over hurting), nor praying to $Deity (who you might not really believe in), etc.

lazyasciiart 3y ago
What makes you think that? https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377.2007.tb01041.x https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377...

blurbleblurble 3y ago

Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? Something unsettling about this for me. So much of illness wrapped up in distress. We need reassurances, however irrational the ritual that brings them. Why is there no space for this in conventional medicine?

kube-system 3y ago
Because it isn't quite that simple. Overprescription of antibiotics isn't usually done only for the placebo effects, but other social reasons as well. A significant subset of patients react poorly to "it's probably viral and so we probably can't do anything". As bad as antibiotic overuse is, lying to patients and fraudulently prescribing a treatment is still much worse than giving someone antibiotics in the 5% chance that something is bacterial. I don't think that lying to patients to falsely reinforce their untrue beliefs is a solution to the problem -- it'll probably create an additional problem by reinforcing beliefs of the legitimacy of pseudoscience.
- jcutrell 3y ago
  I think there’s a chance here to actually tell them the truth. “This stuff is not studied to work. It is a placebo.” OP study says this can still be effective.
  - kube-system 3y ago
    Although not as effective as deceptive placebos. I personally suspect that the subset of people for which honest placebos work well overlaps significantly with the same subset of people who already believe "pill = good" above the expert advise of their doctors.
- treeman79 3y ago
  On a 4 page list of my notes on issues and treatments I mentioned that my symptoms always got better on doxycycline for a couple of months. My ancient neuro-ophtomogist oh, you have Sjogrens. I’m like what’s that? Apparently he had seen that many times before. Turned out he was right.
somenameforme 3y ago
Antidepressant/SSRIs are a much bigger one. The actual experimental evidence for these drugs, contrasted against placebo, is shockingly weak. Moreso, SSRIs come with tremendous side effects. At the very least we should be making an effort to gradually phase these out of society. In reality, we've gone the other direction and floored it - with SSRI prescriptions growing exponentially.
- mannykannot 3y ago
  I have seen the argument that the weak evidence for their effectiveness is entirely due to them being better placebos. What makes them a better placebo? Ironically, it is (according to this theory) that their side-effects are obvious to the patient, so those who are actually on them are more sure than the controls are that they are taking the drug under test, as opposed to the placebo being used in the trial.
  - LoganDark 3y ago
    SSRIs do have a studied and recorded physical effect of inhibiting serotonin reuptake, but what that actually does to someone is still not entirely understood, past "it can help with depression and/or maybe ADHD". It's unfortunate that SSRIs have harmful long-term effects—I know some people who have been dependent on SSRIs for around a decade, and probably will be forever because of the neurotoxicity.
    - somenameforme 3y ago
      The main point is it's not even clear it can help with depression, at least not anymore than a sugar pill. I'm going to avoid referencing any single study since you can find a study to support practically any reasonable view. Instead I'd just encourage you to look up: 'ssri vs placebo' anywhere. The overwhelming body of evidence concludes that if there's any effect, it's absolutely negligible. And, as a previous poster mentioned, it may well simply be due to the fact that doing a double blind with SSRIs is not really possible. They have such a tremendous physical effect than any subject will absolutely know if they're getting the "real" thing. And to be clear a placebo doesn't mean the effect of such isn't real. Mental state provably affects the body in all sorts of ways. Interestingly enough the placebo effect is often substantially stronger in Americans than in other groups as well [1]. The two main hypothesis there are that more poorly performing drugs are making it past regulators, the other is that the overwhelming amount of direct-to-consumer medical advertising creates a greater faith in the power of pills than in other countries - US/New Zealand are the only developed countries that allow direct to consumer medical ads. Or perhaps a mixture of both, like in many things. [1] - https://qz.com/525995/why-the-placebo-effect-is-getting-stronger https://qz.com/525995/why-the-placebo-effect-is-getting-stro...
Herval_freire 3y ago
There is space for placebos in conventional medicine. Doctors CAN and are allowed to prescribe placebos. However medicine strives to maintain a separation between an actual body of scientific knowledge and placebo treatments. So, yes, while a placebo can be effective nobody is going to transcribe that placebo onto actual scientific knowledge as if it wasn't a placebo. Right, so antibiotics work as a placebo, but am I going to put that knowledge down into textbooks that antibiotics can cure the common cold just because such knowledge effectively works as a placebo? No.
- flavius29663 3y ago
  > antibiotics can cure the common cold Antibiotics are not pure placebo. They are also given to make sure there isn't a bacteria ready to take advantage of the weakened immune system. The regular treatment for COVID also included antibiotics, for the reason I mentioned.
mannykannot 3y ago
Prescribing antibiotics where they will be nothing more than a placebo is undesirable, but prescribing homeopathy where it will be nothing more than a placebo (i.e. in every case except dehydration) would have a number of undesirable consequences, including a predictable increase in the number of people who will turn to homeopathy when antibiotics are needed for themselves and, more importantly, for their children. This reminds me of a cartoon (in the New Yorker?) where a patient is demanding a better placebo as the current one is not working.
otikik 3y ago
> Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? You are comparing something that has cured many of humanity's illnesses (in fact, there's a good chance that you are alive thanks to antibiotics) with something that has the curative properties of rubbing quartz crystals or drinking blessed water. Of course there is something unsettling about that comparison.
- jcutrell 3y ago
  I’m not sure what the bias is here - maybe halo effect? - but the issue at hand is that the antibiotics are being used in a scenario where they cannot be effective. They are, in that way, a placebo to the same degree that homeopathy is, despite any other properties outside of the acute situation. Say I have some really great tasting distilled water. Perfectly pure, exactly what I need if I wanted to quench my thirst. Now, I also have an empty gas tank. Should I put water or flat Coca Cola in the gas tank? They are both bad, despite the separately superior qualities of the water. Or, maybe a better comparison is putting diesel in vs coke. They are equivalently bad for the engine despite one of them being used for a similar but separate situation.
  - otikik 3y ago
    Your metaphor is does not work well because water and coke are both pernicious to a car. A better one would be quelching thirst with water versus coke. Both will calm thirst, and are reasonably “neutral”. The second has pernicious effects, especially in some people (diabetes for example) Distilled water has other uses besides drinking. It can be used in chemistry for example. You would not get good results in chemistry if you replaced distilled water with coke. “I can drink water, surely I can use coke instead of water on this chemistry experiment, because I can also drink coke” is clearly faulty logic. And yet, that’s exactly what people do with homeopathy. While it should always be presented as a “complement” to medicine(because it can have some mental/placebo effect in some people, in some cases), very often people take it as a substitute (the marketing word is “alternative”) to medicine. This is something that the homeopathic industry can’t help but “allow happening”. In fact they are motivated to promote that way of thinking. First it increases direct sales. Secondly, the more mixed up their product is with medicine, the stronger the placebo effect will be, and that will increase sales further. Unfortunately the placebo effect is very limited. You can’t mend a broken arm with placebo alone. You can’t cure cancer with placebo alone. And yet people replace chemotherapy with homeopathic “remedies”. And then they die. In short: doctors should never give homeopathic remedies, because that puts them on the same level as medicine. That will ultimately make some homeopathic makers richer, but it will also get some people killed.

luckylion 3y ago

For some definition of “we” and “know”.

LoganDark 3y ago
This argument always bothers me a bit, because words are almost always used with "some" definition.
- luckylion 3y ago
  I was trying to highlight that these words and the definitions you choose do a lot of lifting there. What's "we", or rather you or I, are you only your conscious mind which 'knows' something, or are you also the subconscious that doesn't know that at all? I'm certainly more we than I but I say I because it's easier and doesn't require tons of explanations. Recently I discovered that I've gotten a slight needlephobia. I'm perfectly fine with needles. I'm willing to give you my blood or get my shot, I don't have a problem with needles. But if you come close to me with a needle and I'm aware of it and believe that you'll stick it into me, I'll just shut down my conscious mind. But I obviously don't. But I absolutely do. Which one of those am I? Which one 'knows' something about placebos? Which one is affected by illnesses and medication the most? And what do you actually 'know' there? Do you know it doesn't contain any medication? Do you know that it usually still has a good chance of helping you? How is it fake if it has an effect? Do you 'know' that you don't 'know' how or why it works exactly? But does that make it fake, or does that make it surprising that it works? I know how basically nothing about how anything works, but it still works, and that's not surprising to me. But I'm lazy (all of me) and I didn't want to write all of that, so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything.
  - LoganDark 3y ago
    > so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything. I can't tell if this is sarcasm or not, but in any case, thank you for the clarification.

treeman79 3y ago

My dad used to joke about how placebos helped my mom and older sisters many body ache complaints. I just thought severe pain was normal until I was diagnosed with autoimmune, MS and a few other things. Doctors told me for years it was just in my head and that I just needed medication for anxiety. Proper medication and diet changes resolved pain and anxiety. My mom and sisters all have same issues. Dad and doctors gaslight them and me for decades. The highlight when I was in the ER coughing up blood. ER doctors explaining how I was faking it since my blood work was normal. Until chest X rays came back. Then doctor also went pale.

Herval_freire 3y ago
This is an illustration about not just placebos but how delusional people are. These are doctors who were taught to be investigative and logical yet they were so delusional they have to say that you were faking the blood that you were coughing up. A lot of "logical" people like to rag on cults or religious groups but what they don't understand is that delusion is pervasive. Most humans lie to themselves extensively and you dear reader, are likely not an exception. Take for example the armies of people who told me AI won't ever take over their jobs and chatGPT is just a stochastic parrot. There is merit to both sides of the debate, but I guarantee you a lot of the hostility against AI comes from delusional lies people tell themselves to cover up a possible future trivializes their job skills. Not trying to start an argument on AI here, but I bring this topic up because it's the most current example of mass delusion I can think of. You have to bring up the current delusion to show people how strong the capacity to lie to oneself is.
Night_Thastus 3y ago
The more I talk to people in my life (friends, family, mentors, teachers, etc) the more this story seems to repeat itself. People who have a somewhat uncommon issue, and are forced to go from doctor to doctor until one finally recognizes the problem and knows what to do. I think that we have a couple problems. One is that we just don't have enough doctors to give thorough care to each person. They're under too much time crunch to really investigate. The second is that the human body is hopelessly complex and I'm not sure humans will ever be able to be good at diagnosing problems with it effectively. Until we develop real gAI and much better imaging techniques, I'm not sure we will ever solve this problem in a satisfactory way.

johndhi 3y ago

Open placebo studies are super interesting to me. One of the difficulties of pharma is proving efficacy over placebo... because placebo is a very strong factor! I feel like we could, as a medical community, leverage placebo to improve health outcomes much better than we do today. Why not? It seems the only reason not to is some weird Victorian notion about the capital-T Truth.

sublinear 3y ago
> some weird Victorian notion about the capital-T Truth. Only if neither the patient nor insurance are paying for it. Otherwise that's just straight up grift.
boomboomsubban 3y ago
If a doctor gives you a placebo, you only get the placebo effect. If a doctor gives you medicine, you get the placebo effect plus whatever extra benefit the medicine provides. We already are leveraging the placebo effect, unfortunately we are also doing it in a negative way by highlighting side effects.
- LoganDark 3y ago
  > the placebo effect plus whatever extra benefit the medicine provides. Plus, the act of noticing those extra effects can give you another placebo effect on top, e.g. if the medicine has some noticeable effect, the placebo can get stronger, or cause other effects to accompany it. Of course there is also consciously learning to leverage the effects of the medicine, which is a non-placebo~
- munk-a 3y ago
  For some medications those side effects can be severe though - I think there's some rationale in actually purposefully leveraging the placebo effect without giving the patient a medication that could harm them.
  - boomboomsubban 3y ago
    The side effects are also influenced by the placebo effect. Maybe they'd be less problematic, but they'd still exist.

pbourke 3y ago

> In one placebo group, people were told by a friendly, trustworthy, and empathetic researcher that the videos had a physiological impact that activated “early conditioned emotional schemata through the color green.” > “It was a fake idea, a fake rationale behind it,” Gaab said. “And it worked, people loved it.” It worked as well as a group psychotherapy treatment Gaab and his colleagues used with study subjects a few years earlier. Were people explicitly told that it was a fake idea at the outset, and went along with the ruse? Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? Or do I need to receive “Problem X pills” from some authority in order to see a placebo effect? I had always assumed that a key component of the placebo effect is not knowing whether you’re receiving the treatment or the control.

groby_b 3y ago
Nope. you'll still get a benefit when you know. (https://www.apa.org/monitor/2011/03/placebos https://www.apa.org/monitor/2011/03/placebos - sorry, don't have a real link handy)
kayodelycaon 3y ago
Being completely serious here. Go to any store selling homeopathic medicine and pick something off the shelf. Maybe it's placebo or maybe it works. Just make sure to do your own research first, some things are actually toxic or interact with medications. :)
__MatrixMan__ 3y ago
> Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? I've been told that this is the basis for magic, and that the answer is yes. Better still is to come up with a ritual that transforms them into problem-X pills, something symbolic of problem X. With practice, your magic might even become stronger (because you have prior experiences that make you believe).

segasaturn 3y ago

Yeah I've known this for a while, I suffer from anxiety and obsessive compulsive disorder and am well aware that my compulsions are total placebo and have no connection to my obsessions but still find they calm the anxiety almost completely. I think people are just drawn to ritual, be it religion or placebo/quack medicine or OCD.

assbuttbuttass 3y ago

> research published this year from Gaab and his colleagues showed even taking imaginary pills could reduce test anxiety I'd be curious how effective it is versus deep breathing, or any other anxiety-calming practice. The mind is extremely susceptible to the power of suggestion, but I'm not convinced there's anything special about a "placebo" versus ordinary mindfulness.

thecrash 3y ago

It is said that a visitor once came to the home of Nobel Prize–winning physicist Niels Bohr and, having noticed a horseshoe hung above the entrance, asked incredulously if the professor believed horseshoes brought good luck. “No,” Bohr replied, “but I am told that they bring luck even to those who do not believe in them.”

peteradio 3y ago
Anytime I find a horseshoe I throw it in the trunk of my jeep, never had an accident since ... knocks on wood.
jffhn 3y ago
Reminds me of this quote: "Do not be ashamed to speak nonsense! You only have to be attentive to your own nonsense." (Wittgenstein, Miscellaneous Remarks (Vermischte Bemerkungen))
hinkley 3y ago
One of my favorite Civ VI quotes: > "I don't believe in astrology; I'm a Sagittarius and we're skeptical." - Arthur C Clarke
WallyFunk 3y ago
On the subject of luck: https://quoteinvestigator.com/2012/07/21/luck-hard-work/ https://quoteinvestigator.com/2012/07/21/luck-hard-work/
arkj 3y ago
I’ve heard Zizek repeat this a lot in his talks but has never been able to find a reliable source for this claim
- boomboomsubban 3y ago
  Somebody else searched, and Bohr did seem to say it, but he was quoting a neighbor at the vacation home. https://backreaction.blogspot.com/2011/12/advent-calendar-21-bohr-and-horseshoe.html https://backreaction.blogspot.com/2011/12/advent-calendar-21...

vonnik 3y ago

The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and through specific actions, the placebo effect can be maximized. In fact, it used to be part of a medical doctor's training to take on the mantle of an authority capable of producing placebo effects, back when they had little else to give. The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. It's hard for people to do this to themselves, deliberately -- like turning the knob on a pressure cooker while you're inside the cooker... But obviously being credulous helps a lot!! There is actually a literature on this, but it's adjacent to the medical journals: Daniel Moerman describes himself as a medical anthropologist. He wrote a book called “Meaning, medicine and the ‘placebo effect' “. https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-Anthropology/dp/0521000874 https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-An...

hdjjhhvvhga 3y ago
> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect. Isn't it risky? Saying "everything will be fine" or "this will definitely help" with authority when you know the probability can have consequences, and in the end patients will stop believing you.
- retrac 3y ago
  It's perhaps less "everything will be fine" and more "whatever happens, you're in good hands". A certain confident assertiveness, even when there's nothing to be confident about. I've not had the experience some have, with physicians pretending to be mini-gods. So far, the ones I've met have been quite willing to admit they have no idea what's going on when that's the case. That can be done in a way that leaves you feeling like you have support and practical things to do in the meantime, or it can leave you feeling lost. A friend who is a nurse who works in hospice has some critical things to say about the bedside manner of some of her peers. When there is nothing to be done, but how nothing is done can still matter a lot. Sometimes it's simple as despair leading to self-neglect that leads to more rapid worsening of illness. That effect seems to be related to the placebo effect.

halfjoking 3y ago

Placebos can also work in reverse - if you strongly believe a medication or procedure is harmful then you will be harmed by it. That's why it's entirely unethical to force a medical product on a population. Take for example the mRNA covid vaccine. Let's say it did what they claimed at the start and stopped transmission 100% without ever causing a side effect. Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit. People who believe a vaccine is dangerous but take it to save their job will get harmed whether it caused a side effect or not. The emotional distress alone can be debilitating. If the mind is so powerful it can strongly affect health outcomes, how could anyone think it's ethical to punish someone for making their own medical decision?

lazyasciiart 3y ago
Because their emotional distress and placebo effects don’t outweigh the benefit to everyone else of having them vaccinated. And requiring vaccination to keep your job is not a punishment, any more than we punish people with epilepsy by saying they can’t drive. It’s an attempt to reduce the risk to society posed by their medical state.
- em-bee 3y ago
  what's more, the distress is not caused by facts but by misinformation and people deliberately causing a scare. car traffic is more dangerous than the vaccine yet rarely is anyone experiencing distress over that.
piotrkaminski 3y ago
> Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit. That's ridiculous -- of course benefits can outweigh psychological side-effects. Usually you'd want those benefits to accrue to the person suffering the side-effects, but living in a civilized society means accepting that sometimes the good of the many outweighs the pain of the few. If a vaccine for a deadly, highly communicable disease can completely stop transmission then I think it's perfectly ethical to require everyone to accept it or isolate from those willing to do so.

kilbuz 3y ago

The book "Bad Science" has wonderful discussions and examples of the placebo effect as it relates to medical research. Highly recommended.

coding123 3y ago

I'd like to see a placebo study where they have 2 placebos: 1. This medicine will cure your muscle pain, but it has very bad side effects: Insomnia, depression, back pain, knee pain - but don't worry only a small percentage of people see these issues (like 1%) 2. This medicine will cure your muscle pain, and has no side effects, in fact it will make you happy and help you sleep better.

agumonkey 3y ago

I think a lot of this psychological layer has been ignored because it wasn't phenomenologically interesting to study as a science, but the important of the semantic/emotional layer is hard to ignore. A simple thought (say someone tells you something regarding your child that is not true but you believe it) can fuck up your biology down to physiological death. Sadly, and obviously, the reverse isn't true, you can rarely cure infections through neurons triggering pathway cascades. But still.

misssocrates 3y ago

It could be argued this is why wearing masks can be helpful, for some, even though there is no evidence they protect against respiratory viruses. > Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

TurkishPoptart 3y ago
I prefer wearing my tinfoil hat :D
PaulDavisThe1st 3y ago
From the cited paper: > The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. Statement from the publishers: https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review https://www.cochrane.org/news/statement-physical-interventio... > The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.'
- deleted 3y ago
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- misssocrates 3y ago
  That's why I said there is no evidence.

furyofantares 3y ago

I've tried to internalize an understanding that placebo effects are real and can be large, with the expectation that this understanding should increase placebo efficacy without sacrificing my commitment to truth (that is, I don't seek out woo, but I do expect some woo is actually a real, strong placebo effect and I'd like to be able to replicate it myself sans-woo.)

hinkley 3y ago
Part of the "mind over matter" aspect of the human body is that a deliberate act is sometimes enough to get things moving. That act in increasing the number of times of day you think about your predicament and the depth of attention you apply to it. While there's a lot of promise in harnessing that, it's also the source of a lot of superstition.

PaulDavisThe1st 3y ago

For years (decades, actually), I've been a believer in the idea that deliberately and systematically harnessing the placebo effect will be the biggest medical development of the first half of the 21st century. However, I've become aware of studies and claims that actually the placebo effect itself is an illusion caused by poor statistical understanding and poor study design (sometimes necessitated by the study matter). At this point I am deeply unsure what to make of things.

hinkley 3y ago
Warts are an immune system that hasn't identified an intruder yet. There are plenty of folk remedies that are basically about tricking the brain into telling the body to get on with it. One involves tracing it and burning the paper. The last wart I had (when I was younger) I got mad (and angrier) at it one day and started trying to cut it out. I'm certain there were bits of it I missed, but it was gone in a week. I decided I had finally had enough and my body got the message.

gnatman 3y ago

There's a great episode of NPR's Hidden Brain about the placebo effect called "All The World's A Stage—Including The Doctor's Office". https://www.npr.org/transcripts/718227789 https://www.npr.org/transcripts/718227789

thomastjeffery 3y ago

Emotions are an association between "fake" and "real". We can take advantage of this with objectivity: if you have an objective perspective on emotion itself - as a process that transfers data between imaginary thought and physical feeling - then you can alter the surrounding circumstances of emotions, and actively pursue specific thoughts that are connected to desirable feelings. But the utility doesn't end there: you can also directly hijack the process itself. Emotion is only truly understood from an implicit inference perspective: the explicit definition I just gave is not provable the way a mathematical theorem is. The only available evidence is from experiencing the result. It's a soft science, but it's still useful enough to construct reliable tools. Here's my testing method: breathing. I know that the physical act of breathing is not functionally different, whether it's intentional or automatic. I know that physically, my lungs are filtering oxygen from my environment into my blood (with a breath in), and CO2 from my blood into my environment (with a breath out). Simply breathing does not have a noticeable effect on my emotional state, save for providing a baseline of functional cardiovascular support. I can feel happiness, anger, depression, pain, euphoria, or any other physical sensation: all the time breathing in and out with the same fundamental process. These elements of the breathing process have been explicitly proven, much like a mathematical model. So how can breathing hijack emotion? Story. The associations that an emotion is made of are volatile. They can be changed. We all experience emotional change that is unintentional: based on the experience of our surrounding circumstances. We can also make emotional changes that are intentional: based on the experience of our own imagination: by playing out a story. Here's an example: Imagine the feeling of ice on your skin. It feels cold to the touch, even the air nearby it. The rest of your body is comfortably warm: blissfully unaware of the chilling sensation from ice in that one place. Your lungs are not for filtering oxygen and CO2 anymore: now they draw in that sensation of cold touch, and filter out the sensation of warm comfort. Each breath in draws another lungful of chill into the bloodstream. Your heart pumps, and your blood meticulously draws out (like the CO2 before) the warm comfort from the body, to be replaced by the chilling touch of ice. Each breath out releases that warmth out into the air around you, to be scattered away in the wind. Do you feel it? Now replace the cold touch with heat. Excitement. Peace. The Rolling Stones told us that love is, "just a kiss away"; but it's even closer than that: you can find it in a breath.

thenerdhead 3y ago

I've read up a bit about this topic, but is there any books or recommendations that really cover the idea of what is popularized as the "mind-body connection + placebo effect"? There's obviously the best sellers / self-help crap in the world and even books on back pain being healed from this general "placebo" effect or at least the new awareness of it. I've noticed this personal effect to be a constant theme in my life. I'm a chronic overthinker (OCD perhaps) and when I become aware enough of said "placebo effect", my problems go away and new ones take their place. Maybe that's just life, but there's such a strong power to placebo I'd love to learn more about.

nabnob 3y ago
Irving Kirsch, psych professor at Harvard, wrote a book called "The Emperor's New Drugs" which argues that antidepressants are basically just placebos. I haven't read the book but I have seen a lot of interviews and articles on his research and it's pretty damning.
- thenerdhead 3y ago
  Thank you. Very interesting!
- NickM 3y ago
  I have read this book, and can confirm, it is extremely interesting and pretty damning. I'm frankly surprised it hasn't had more of an impact; it really does seem like SSRIs are causing a lot of harm to a lot of people in the form of side effects, and the scientific evidence seems to point strongly toward them being no better than any other active placebo. Yet, they continue to be prescribed in ever-increasing numbers.
  - nabnob 3y ago
    Well, to be blunt, it's because there are billion dollar pharmaceutical companies that want to keep making money off of these drugs, with around 20% of adults taking anti-depressants at any given time.
3y ago

smeej 3y ago

This reminds me of the "homesickness prevention pills" my mom sent with me to sleep away camp. They were just unlabeled M&Ms, and I knew that, but I'll be darned if those things didn't cure the homesickness right up!

em-bee 3y ago
they reminded you that your mom cares about you. they are special because you didn't just buy them yourself, but your mom sent them to you as a gift. just like when my grandma made me cookies.
nerdface 3y ago
This is so wholesome
- eurasiantiger 3y ago
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Zigurd 3y ago

Humans evolved in a world of arbitrary danger. That we evolved an affinity for coping mechanisms to the extent they have undeniable physical manifestations seems likely.

intalentive 3y ago

If the placebo effect comes down to the power of suggestion, then hypnotism is potentially a valid form of treatment.

deleted 3y ago
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w_for_wumbo 3y ago
It works better if you believe in it. Feels like hardcore skeptics are doing themselves any favours by completely discounting the power of their mind to affect the environment (their body) which it is connected to.

cycomanic 3y ago

An interesting aspect of placebo is that supposedly the strength of the effect has been increasing in the last decades. So much so that quite a few approved medications would likely not get approved anymore, because their effect would not be strong enough compared to the placebo effect.

boomboomsubban 3y ago
That doesn't make sense. If the approval process were happening now, the new trials would have the drug benefit from the higher placebo effect.
bitcurious 3y ago
The placebo effect getting stronger as the population of earth increases is probably the most compelling evidence for us living in a simulation.
notfed 3y ago
I find this hard to believe, only because it would be stupidly hard to measure this in an unbiased manner across generations, and the replication crisis is just so rampant.

taeric 3y ago

Placebos are a ripe topic. Specifically of interest to me, is that it is clear that placebos can work even when you know they are placebos for "solving" things; this implies that they can also work for making things worse. And letting that sink in is terrifying. Just telling people that they are going to do worse on something can, in fact, cause them to do worse at said thing. Even if the reasons are completely wrong. That is, placebos aren't limited to cures.

sd9 3y ago
The nocebo effect. "This video will hurt" - CGP Grey https://youtu.be/O2hO4_UEe-4 https://youtu.be/O2hO4_UEe-4
- taeric 3y ago
  Thinking of how this fits in to conspiracy theories and general thoughts on public policy are... less than pleasant, all told. I personally take it as a good reason to have even more patience and empathy for folks; but I don't get that impression from everyone else. :(

j45 3y ago

I wonder if the placebo effect can extend to learning, where you imagine taking a placebo that helps relieve your stress about having to learn something new after a long time. If anyone is familiar with research and reading at the intersection of placebos/psychology/learning, it would be great to read!

RheingoldRiver 3y ago
Well, not quite what you are asking but, it has been shown that asking some demographic questions prior to testing can alter some outcomes (specifically Black students' math scores) [0] although other papers find no difference when looking at other factors such as asking about gender prior to physics tests [1], this is known collectively as "Stereotype Threat." So given that "Stereotype Threat" is a thing, I would absolutely believe that you can apply the placebo effect to learning as well. [0] https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046 https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046 [1] https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf
- j45 3y ago
  That’s super interesting, thanks. I would kind of start to think about formative vs summarize questions but unrelated questions you get right could Until I can find the link to the study, anecdotally I have found that sharing a message about adult learning prior to learning can also have have a positive effect - which sounds similar to the above.

Maursault 3y ago

Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment. Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?” He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.”[1] [1] Matthew 17:18-20

DoreenMichele 3y ago

The twist: The pill was a form of deception. It contained only lactose, sucrose, and glucose; it was a placebo. Sugar is not chemically inert. It actually takes the edge off pain and general misery. I wish they would stop publishing results indicating that "We believe sugar does absolutely nothing whatsoever in the body, so if you consume sugar pills, clearly any reaction to it is complete bullshit made up by your mind because you believed in it."

crazygringo 3y ago
OK, but the amount of sugar in a pill is tiny. It's presumably not a piece of hard candy, but rather mixed with standard pill fillers. I don't think that's enough to take the edge off of anything.
- DoreenMichele 3y ago
  It's presumably an amount you could look up if you genuinely want to argue this for some reason.
  - boomboomsubban 3y ago
    "Sugar pill" is a generic term for an inactive substance. It doesn't contain a meaningful amount of sugar, and similar effects are present using other substances. How would we test diabetes medicine if the only options were either medicine or sugar? Trying to claim the placebo effect is from taking a tiny amount of sugar is silly. If sugar alone was curing things, the US would basically never get sick.
    - DoreenMichele 3y ago
      No, placebo is a generic term for a presumably inactive substance. I quoted the article. They gave people sugar in this case.
      - boomboomsubban 3y ago

__MatrixMan__ 3y ago

This is why I keep my mouth shut when I run into somebody who is into crystals or homeopathy or some other pseudoscientific thing. As long as their "solution" isn't likely to cause additional harm, and they're not being overly greedy re: how much money they're making, then the hope they're selling is real even though it might be of dubious justification.

notfed 3y ago
I guess it depends on the illness. If it's an actually-treatable disease, maybe not totally rude to suggest (non-?)alternatives, haha.

partiallypro 3y ago

This is going to sound stupid, but I've always wondered if one day we just find out that sugar pills do have medicinal value.

airstrike 3y ago
I take an "anti-stress" "natural" "medication" most nights when I want to go to sleep. I know it's basically just flavored sugar but it knocks me out and I'm asleep in 5 mins. Who needs melatonin when I've got this placebo ritual that works just as well with no side effects?
notfed 3y ago
I always thought this too, "sugar" pill never sounded neutral. Maybe it should be a "water" pill. But then we reserve the term "water pill" for pills that make you pee, gahh. Naming pills is hard. (Let's not even talk about the risks of off-by-one errors here.)
deleted 3y ago
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hollerith 3y ago

Question for those that welcome the placebo effect: does it worry you that if placebos can affect you strongly, that fact is a sign that you are broken in some fundamental way? I mean, you have emotional distress, and straightforward ways of dealing it do not work, so you have to pay some authority figure to prescribe a placebo. Does that not make you want to investigate how deep your brokenness goes? (Actually, I think that the placebo effect is not strong enough and does not apply to enough real-world situations to be worth paying much attention to and that there are just a lot of bad studies in some fields.)

pknerd 3y ago

There is a very interesting book "you are a placebo" discusses the placebo effect. The author cured himself by practicing it.

mito88 3y ago
regular strength placebo / extra strength placebo

ggm 3y ago

There's a famous incident on Australian TV where a TV presenter is told about how well a placebo works, and he assumes its a brandname or drug name and asks if they could be made available on the Pharmaceuticals Benefit Scheme (the national subsidy for expensive pharmacy cost sharing) and what's holding back GP's from prescribing them. Certainly made me laugh but if you catch your wind its a bit of a Yogi Berra wisdom moment: if we did routinely prescribe placebos then they might actually help reduce the cost burden of real drugs with comparable efficacy, which are subsidised.

ookblah 3y ago

Makes me think about the "ASMR" effect and how some videos center around intentional stuff or just alternative medicine. It's like you know these crystals aren't doing jack but it's still relaxing on some level.

pyinstallwoes 3y ago
Well crystals are used for the pizeoelectric effect and involved in a lot of modern technology in relation to the EMF spectrum. So, there's at least "ammo for justification" even if that's all it takes for placebo's to be activated (Shepherd: I don't care what you believe in, just believe in something!)
Aromasin 3y ago
Same with aromatherapy. I know it's crap, my partner knows it's crap, but hell if I don't sleep like a baby if she sprays our pillows with a Lavender scent before going to bed; I sometimes take a bottle with me when I travel, and it knocks me out better than any amount of melatonin or sleep medication could achieve. I'm sure it's just association by now, but it works.