placebo

A placebo (by 1785) is medicine that has no actual medicine in it! It looks just like a pill or an injection but all that is in it in most cases is just sugar or salt water. If the patient believes it is medicine, though, it can still sometimes work! Sickness and health seem to be a matter of mind and body.

Findings:

• Two placebo pills work better than one.
• A large placebo pill works better than a medium one.
• Injecting a placebo with a needle works better than taking it by mouth as a pill.
• A more painful injection of a placebo works better than one that hurts less.
• Placebos given by kind doctors work better than those given by curt ones.
• Placebos can take effect even before they are taken!
• Placebos work best for headaches, back pain and depression.
• Naloxone, an opiate blocker, counteracts the effect of a placebo.
• Placebos work less well on people with Alzheimer’s, a brain disease.
• Placebos work better now than in the past, at least in the US (where drug advertising has increased).

The power of food colouring:

• Red and black placebos work better than white ones.
• Green placebos make patients less worried.
• Yellow placebos make patients less sad.
• Blue placebos make patients sleepier.
• Pink placebos make patients more awake.

Placebos have actual physical effects. They are not imagined. Brain imaging shows that placebos help the body to release endorphins, its own natural painkiller.

In 1807, according to Thomas Jefferson, most medicine was based on the placebo effect – what he called “a pious fraud”, stuff that would never hold up under clinical trials: “bread pills, drops of colored water, powders of hickory ashes,” as he tells it. Because some of what doctors did caused more harm than good, epidemiologists estimate that it was not till 1905 that you were better off going to a doctor than not.

Psychotherapy, by this measure, is still in the quack medicine phase. It works almost completely by the placebo effect. Studies show that what matters is not what kind of psychotherapy your psychologist practises – they all work equally well. What matters is that you think he or she is a psychologist.

Sham surgeries work too thanks to the placebo effect. For at least some surgeries, most of the benefit seems to come from the anaesthesia and the opening incision, not the actual surgery.

Prozac, Zoloft, Effexor and certain other drugs seem to work mainly through a placebo effect. To get US government approval they have to run clinical trials showing they are statistically better than a placebo by a clear margin – but they do not have to be twice as good.

A nocebo is the opposite of a placebo. It is fake medicine that you think will hurt you. Placebo is Latin for “I shall please”. Nocebo is Latin for “I will cause harm.” In one study people were given a sugar pill and told that it would make them throw up. Later 80% of them were throwing up!

– Abagond, 2020.

See also:

• endorphin
• shaman
• The Stanford Prison Experiment
• BiDil
• The Tuskegee Experiment
• J. Marion Sims

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