Can Placebos Work On Skeptics?

The placebo effect is, at first glance, a little difficult to account for. It posits that drugs that don't work, work. "Placebo" means "that which pleases", as opposed to that which works. Placebos simply please the patient by making him think he's getting medicine.

We owe the modern understanding of the placebo to a doctor from the 1950s called Henry Beecher. In 1955 Dr Beecher published "The Powerful Placebo" in the Journal of the American Medical Association. He examined studies that compared an active treatment to a placebo and found that on average across all the studies, 35 percent of patients recovered or improved with the placebo. The obvious conclusions from that are, 1: any study that doesn't have a placebo control group is likely to give a false positive result, and 2: placebos are, as Dr Beecher pointed out, '"powerful". That's the beginning of the age of double-blind controlled studies, the gold standard in evidence based medicine (though a problematic one for several reasons).

The trouble is that the idea of the "power of the mind" is so seductive that many of us like to read Dr Beecher's results as meaning that placebos are 35 percent effective. That's better than most drugs, and suggests that "placebo" should be every doctor's first prescription (actually, it sometimes is; 60 percent of Israeli doctors have knowingly given a patient a placebo).

Think about it: The placebo groups had no controls. So there's no saying how much of the "placebo effect" in each case is actually the natural course of the disease, or "politeness reporting", where people tell authority figures like doctors what they think they want to hear, or even just people who got better on their own. 

If you think that begs a question, you're not alone. In 2001 Danish researchers Asbjorn Hrobjartsson and Peter Gotszche published "Is the Placebo Powerless?" in the New England Journal of Medicine. Comparing the effects of placebos with no-treatment groups, they found "little evidence that placebos had powerful clinical effects".

One important division they found, perhaps the most significant for our purposes, was this: in objective outcomes, placebos had negligible effects. If you're taking a placebo for high blood pressure, the placebo doesn't make your blood pressure fall — not reliably, anyway. If you're taking one for pain, though, it can be highly effective.

But that's contradicted by research in other quarters. When doctors painted warts with an inert dye and told patients the wart would now disappear, guess what? It did. Patients who had newly implanted pacemakers improved — by objective measures! — before the pacemakers were switched on.

See Also: The Healing Power Of Placebo

Patients with colitis who were treated with placebos reported less pain — a common effect which we'll go into below — but also actually had less inflammation when scanned. And the more placebo they took the better they got: in a study where two groups of patients with ulcers were given placebos, one was given one pill. The other group got two pills. The two-pill group got better faster; they were taking more placebo.

The Conditional Placebo

The placebo effect appears to be linked to consciousness. It doesn't work on people who are asleep or unconscious. It doesn't prevent or improve ailments like broken bones or prevent pregnancies. It does have powerful effects on more nebulous but very real complaints. In between the two groups are illnesses and conditions that have a mental element as well as a physical one. The placebo's effect on these conditions is still under research. However, right now lit looks like placebos can only have objective effects through subjective means — placebos lower your blood pressure, improve depression or get rid of warts if you think they will.

So: is the placebo a confidence trick, or is it more like the effects of, say, hypnosis? Hypnosis works best on people who know they're being hypnotised and want it to work. It's a voluntary, guided process. It works on skeptics who have agreed to shelve their doubts until after they try being hypnotised, but if you really don't want it to work, it won't. Yet it has recorded objective effects, including people undergoing surgery with only hypnosis for anaesthetic. 

Question: If I don't believe a treatment works, and you know it's a placebo in the first place, are we in the same position?

Maybe. But what about those patients in studies who were told the drugs they were taking were placebos — and yet chose to continue taking them? One man was in a study to determine whether there was a placebo effect in operation in surgeries for arthritic knees. He had the "placebo" surgery — skin incisions only, without any work done on the joint at all. He still refers to it as the surgery that cured him. In another study patients were told that the pill they were taking was a placebo, and that it could be used as a "dose extender", allowing them to drop their dose of the real drug.

Apart from its effects, of course. In other studies, patients who have been given placebos have asked for repeat prescriptions.

It's sometimes tempting to roll your eyes or to imagine that these people somehow haven't understood their situation — but perhaps they understand very well. Perhaps, they are simply taking advantage of something that we dpi know for certain exists: a deeply rooted set of psychological effects. 

There's no such thing as a placebo

Is it time to reconsider the placebo effect? In fact, we've always know there's no such thing; a placebo is ineffective by definition. If you take a powerful drug like vancomycin you'll be subject to some direct physical effects. If you take a chalk and sugar pill you won't. The effect is "in your mind" — and so is the cause. 

Rather than wondering whether the placebo effect works on skeptics, which might ultimately be a meaningless question, maybe we should instead be focussing on how skeptics can harness the psychology of expectancy, motivation, conditioning and the effects of our own endogenous chemical supplies. 

Many of these effects are based on authority and confidence. Higher priced things taste better, and bigger pills deliver more pain relief than smaller ones. If the pills are more expensive, they're even more effective. If you can see through "tricks" like that, what effects would work without requiring a suspension of disbelief? Good advice from a  doctor you trust and a positive mental outlook are really the source of the placebo effect in the first place. If you know you doctor doesn't deal in soft soap, when she says, "these will help", guess what? They probably will — because they're the right drug, and because someone you trust told you so.

See Also: Be Careful With Calcium Pills - They May Harm Your Heart

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