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by tsimionescu 745 days ago
It varies a lot. For many conditions, like cancers, the placebo effect is basically random noise (cancers sometimes just reduce or go away on their own, regardless of treatment or even of the appearance of treatment ; we don't know the natural rate of this, because it's unethical to not treat people who you know have cancer). In addition, in non-blind trials, there is a "placebo effect" that amounts to mistakes or lies by those involved in the research in favor of a positive outcome. This is not a real effect in patients at all, just an artifact in the reported data.

Then, for conditions linked to our psyche, including pure psychological conditions but also things like pain, blood pressure, heart rate, nausea, and some others - the placebo effect is more real, but usually temporary. Some people who have been living in some amount of despair at their condition experience a positive surge of hope once treatment starts, and they can ignore the pain, or feel some push to get out of their depression, or calm their anxiety which was exacerbating, say, the high blood pressure etc. This effect almost always tapers off if the treatment is not doing anything more fundamental.

Coupled with the fact that we don't understand how psychological disorders work at the chemical level at all, especially in relation to the conscious mind and interventions on that (e.g. therapy, but also various religious practices), this means it's very hard to account for this without a double-blind RCT.

3 comments

> they can ignore the pain,

Just to note that on pain specifically, belief that one has been administered a drug can cause the body to synthesise painkillers. This has been most rigorously demonstrated by the fact that these painkilling effects are suppressed by naloxone (an opioid antagonist).

I'm fairly convinced this is not much different than the way that your body will prime itself if it knows you have an alarm going off at a given time. I don't have the paper anymore, but it was shown that your hormone profile will change with just the knowledge of an alarm. Similar results have been found for other drugs and using cues to the body so that it will prime them itself.

I'd love to read more on how this links to the powers of ritual and general routines. Specifically, if I'm not misremembering, it isn't just "belief that one has been administered a drug", but it has to be a drug that you have had before. Or that you have seen work on someone else. Just taking sugar pills does nothing. Taking sugar pills that you thought were the aspirin pills you took last time you were sick can cause the body to react.

> I'd love to read more on how this links to the powers of ritual and general routines. Specifically, if I'm not misremembering, it isn't just "belief that one has been administered a drug", but it has to be a drug that you have had before. Or that you have seen work on someone else. Just taking sugar pills does nothing. Taking sugar pills that you thought were the aspirin pills you took last time you were sick can cause the body to react.

Not always, you can see effects from open placebos, where you tell the participant that they're getting a placebo but placebos have been clinically proven to reduce pain.

It even seems to work when you warn participants in the consent docs that you may lie to them (authorised deception).

I agree that it's probably a broader effect than just sugar pills, it should probably be called expectancy effects.

Benedetti et al have done a load of work on recovering surgical patients that suggest that many, many drugs (including valium) mostly work based on these kinds of effects. Its a fascinating field (and what I did my PhD on).

Fascinating
The placebo effect is not a single thing. That is, there are ways of amplifying the effect and minimizing the effect. For maximum effect, treatments ought to be designed to take advantage of the placebo effect to the extent possible. That’s because placebos have low side effects and are often very effective. However, this creates some challenges — how do you test which placebo effect works best? What do you use as a placebo? It’s not that hard, really — just use a placebo with less of a placebo effect.

Niacin was used as the placebo for Timothy Leary’s Good Friday experiment [1], where he randomly dosed catholic monks on psilocybin. Unlike a sugar pill, Niacin creates some facial flushing — so you do feel something. But it would be very clear eventually that you didn’t get the psilocybin. But that doesn’t negate the findings of the experiment.

[1] https://en.wikipedia.org/wiki/Marsh_Chapel_Experiment

Sure, for those conditions that have subjective components (e.g. pain, mood) or where there is more or less direct conscious control of the condition (e.g. heart rate, BP), you can vary the strength of such effects.

But in many other conditions, you can't, because that kind of placebo effect is just noise. For example, you can't vary the effectiveness of placebo effects in antibiotics studies (though you may be able to reduce certain side effects like headache or nausea).

Well, you can if there is a mental connection to the immune system. E.g. attitudes toward life and toward disease seems to affect outcomes in cancer patients. And placebos can affect that.
That's true, but I'm not sure such a link has ever been established. Is there any study that has found measurable variance in cancer or infection outcomes based on differences in mental outlook?
Here’s an article that speaks to this: https://www.onclive.com/view/markman-column-optimism-plays-a...

In short, yes! Mental outlook has a big effect on outcomes. It won’t cure you, but it will improve your physical outcomes.

This is the meta analysis they refer to: Rozanski A, Bavishi C, Kubzansky LD, Cohen R. Association of optimism with cardiovascular events and all-cause mortality: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(9):e1912200. doi:10.1001/jamanetworkopen.2019.12200

Fascinating, thank you for sharing this, I'll take a deeper look.
The problem as I see it is that all medicine is fundamentally trying to find effective scaffolding on the human body, triggering it's own ability to heal. A surgeon can't repair a corpse. What causes the body to heal itself more effectively? I would think this is brutally difficult to study, since it's all subjective.
I think part of medicine is that, but part of medicine is trying to keep you alive despite your body. Or maybe what I'm arguing here is the "body healing itself". But for example, if you have autoimmune disease, or allergies, you want the body to slow down and take it easy because it's harming itself.
sure. How effective is faith/placebo at curing those conditions I wonder?