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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