The promise of pills that do nothing | Hacker News Reader

The promise of pills that do nothing

neo.life

I feel like the placebo effect is greatly underappreciated. It shouldn't just be viewed as an annoying confound for drug efficacy studies, but rather as a fascinating observation about human nature. How is it exactly that mere expectation can bring about physiological changes? Isn't that a subject worthy of research in and of itself?

It's important to remember that the placebo effect only exists in a few specific symptoms that are known to have an important psychological component - pain, blood pressure, anxiety, nausea etc. In these cases, placebo interventions have a measurable positive effect (or negative, for nocebo) compared to no intervention.

But in the vast majority of other illnesses, placebo is exclusively a confounding factor. People's bones don't fuse from sham surgery. Sugar pills don't cure malaria or TB. Placebo chemotherapy doesn't kill cancer cells. The placebo effect does exist in these cases as well if not using double-blind trials, or if conducting patient subjective assessments, but it disappears if lab techs and objectively measurable data are investigated (things like viral load, not patient perception of their symptoms).

This is the key. The placebo effect only works for subjective measurements that the patient has to report qualitatively. A placebo asthma treatment will cause patients to report that their breathing has improved, but it won’t change how much air is actually going into and out of their lungs. This makes it useless for most things. Maybe it’s ok for pain, since pain is purely perceptual anyway, but for anything else it’s just going to cost people money without actually helping them.

There's a little more than pain - anxiety is another example where just having something to take can help immensely. But yes, in general placebo is greatly over-hyped and oversold with much influence from people who believe in 'healing energy' and mind-over-body practices and such.

That’s a good point. For pain and anxiety and other mental states it’s probably ok to give someone a placebo if it convinces them to change the state of their own mind, provided they have asked for the change.

They haven't even necessarily changed the state of their mind. It's hard to accurately report your own subjective experiences in a measurable way. Maybe you're not sure where your pain falls on a 1-10 scale. There's a range of numbers you think might fit how you feel.

Before a placebo treatment, you pick something at the higher end. After the treatment, you think maybe it helped, so you pick something on the lower end despite feeling the same.

Maybe you even feel worse than you did at the start of the study but you've gotten used to a higher baseline amount of pain and you're having a relatively good morning compared to that so you report a low number.

This is about how your self-reports change, not necessarily about how your state of mind changes.

But the number you report for the level of pain is a thought in your mind; it is the state of your mind, or a summary of it. If you report a different number, your state of mind must have changed.

Sure, every time anything happens to you, your state of mind is different. My point is that the relevant part of your state of mind doesn't necessarily change.

If you report a different number, that means some things in your mind changed. Those things may or may not include the level of pain you're experiencing.

Let's take an example with a bit more objectivity. If you ask me to rate how long a tv show is on a scale of 1-10 and I know the show is 30 minutes, how do I turn that into a 1-10 scale? Suppose I mostly watch shows with 12-minute episodes. This is relatively long, so I give it an 8.

Later I start watching hour-long shows. You ask me again how long this show is on a 1-10 scale. Now I put it at a 5. I don't think the show got shorter, and I don't experience it as being shorter. I just changed how I contextualize the length of shows for a 1-10 scale.

It would be silly to say that watching hour-long shows is a good way to shorten the mental experience of watching a 30-minute show.

Years ago, while I was in a pretty bad place, after a period of insomnia and one particularly bad night, I woke up with what I thought was chest pain. At the time, I had been worried about heart problems for a while, totally unjustified (young and no risk factors), simply based on stories I read of young people sometimes having heart attacks. I didn't seek help at first but as I was concentrating obsessively on my heart region and the sensations, the perceived pain grew stronger and stronger, until I persuaded myself I was having a heart attack and called an ambulance. I thought I would die before reaching the hospital, regretting that I didn't call earlier. They did a whole battery of tests, found nothing. Gave me 0.25mg Xanax, doctor asked if I was having stress at work (I was), and then I learned people can absolutely get realistic pains just from their mind alone.

It's not a stretch to understand that if you consistently imagine such issues the stress hormones and other biochemical changes caused by such sensations will create actual damage in the organs.

Subjective symptoms can be affected by placebo. Chemical data from the body isn't really.

Subjective symptoms can modulate biochemistry and that affects the body. See voodoo curses.

The way subjective symptoms modulate biochemistry is generally quite benign and rapidly reversible unless you have a severe underlying condition.

It's no secret that there's a connection between emotional states and body chemistry (neurochemistry included.) I suggest it's a two way street of communication, maybe in the manner of a feedback loop.

Why shouldn't thoughts influence the body? If the body can cause thoughts, then surely it could go both ways such that thoughts effect changes in the body. Because of course thoughts are a bodily process.

It seems to me that dualism is in error and consequently has done marked damaged to our understanding of ourselves. Thoughts are not non-physical and neither are the mind & body distinct or separable.

Wim Hof and his breath training seem to correlate with many of the same effects as placebo, meaning he's able to consciously trigger normally autonomic systems in his body that are thought responsible for many of the positive results attributed to placebo.

https://www.smithsonianmag.com/science-nature/science-explai...

It makes sense that triggering different systems in the body could result in medical benefit. The science of placebo effect is very active, but runs into fundamental issues of neuroscience pretty quickly. Science needs to figure out how brains work before we unlock the secrets of the placebo effect.

What makes you think nobody has researched it?

AFAICT there's quite a lot of study on the phenomenon, and it's a lot more complex than just expectation bringing about physiological change. Some portion of it is likely action of the immune system, general "regression to the mean" effects, and some of it is that patients who are receiving treatment are likely to report milder symtoms and less pain (so there may not always be a physiological change, just a psychological one).

Either way, I don't think you can count the placebo effect as a medical miracle waiting to be exploited, or as something that medical science just ignores.

A lot of people study it. I’m blanking on exactly the book, but Robert Sapolsky writes quite a bit about it. Might be in Why Zebras Don’t Get Ulcers.

IIRC there are different kinds of placebo effects. One of the most robust is pain relief. I think Sapolsky makes the case that endorphins (“endogenous morphines”) do some of the leg work here, but that’s probably not the whole story.

A really important element of this I think is neuroplasticity (the brain's ability to rewire itself) and I feel that the placebo effect along with other psychosomatic effects is an important part of that. If you read "The Brain that Changes itself" for example, there's a lot of info into studies of visualisation as a treatment for chronic pain. The short summary is that there is a lot of research into people for whom normal pain treatments have been exhausted getting some relief from using visualisations to essentially reinforce other neural pathways so the pain circuits in the brain are not triggered as much. Some of this research is referenced in the book.

There is a dark side to placebo research and especially the work of Ted Kaptchuk and it is this: patients often report feeling better after a placebo treatment, and they subjectively do, but their condition has not actually improved and they still need proper treatment.

  The recent albuterol vs. placebo trial reported in the New England Journal of Medicine (NEJM) found that experimental subjects with asthma experienced substantial, measured improvements in lung function after inhaling albuterol, but not after inhaling placebo, undergoing sham acupuncture, or “no treatment.” It also found that the same subjects reported having felt substantially improved after either albuterol or each of the two sham treatments, but not after “no treatment.” Anthropologist Daniel Moerman, in an accompanying editorial, wrote, “the authors conclude that the patient reports were ‘unreliable,’ since they reported improvement when there was none”—precisely as any rational clinician or biomedical scientist would have concluded.

That's another study he was involved with. Full details here: https://sciencebasedmedicine.org/dummy-medicine-dummy-doctor...

Are there any other studies outside of asthma ? emotional stress is highly coupled with lung/cardiovascular function.

When I had bad asthma, the difference between me staying at home and me going to ER was anxiety.

So even if placebo is just that, an emotional ease, it triggers somatic effects that eases the asthmatic response.

You're trying to make an argument as to why the placebo indirectly could have had an actual effect, but this is exactly what the study showed that id did not have. There was no effect, only a reported improvement which did not correspond to an actual improvement.

eg. "Study reported the subject did not see any red apples, only green" and your asking "Maybe the subject was wearing tinted glasses that could made a green apple seem red?"

The answer is obviously no, that cannot be the case, because that would have led to an observed red apple, and there was no such observation. Just like there was no observed improvement in the asthmatic response from the placebo, then it's also obvious that there was no indirect improvement from emotional ease, because if that was the case, then there had to have been an observed improvement.

Taking medication appears to have become a ritual that we have to go through to become healthy even when the problem is psychological in nature.

Isn’t that true for many drugs?

Homeopathic "medicine" is widely available in retail pharmacies across the US, such as Walgreens. You have to look carefully to make sure sometimes as they are right on the shelf adjacent to real medicine.

Tim Minchin said it well: “Do you know what they call Alternative medicine that's been proved to work? Medicine.”

https://youtu.be/jIWj3tI-DXg

I'm a little disappointed in myself that I didn't come up with this. Selling placebo pills to treat people using placebo effect. I guess I need to work on my evil genius skills.

Is there perhaps a relationship between the placebo affects and people that meditate or do extended prayer sessions?

Is the effectiveness of the placebo correlated to the advertising and marketing of the product?

This appears to be the case. It's quite intriguing in some sense as the implication is that good marketing does not solely have the effect of making you buy stuff that you don't need, but additionally implants in you the expectation that something will perform well, which in turn may makes it more likely to become true.

I remember reading about this in Dan Ariely's book "Predictably Irrational".

Here's summary of the relevant chapter on Wikipedia [1]: "While the effect of placebo has been knowingly and unknowingly practiced for millennia, the interesting observation Ariely and his collaborators made was that prices of the prescribed medicine can be used as a placebo as well"

The underlying paper [2] spells this out as well: "We demonstrate that marketing actions such as pricing can alter the actual efficacy of products to which they are applied. [...]"

[1] https://en.wikipedia.org/wiki/Predictably_Irrational#The_Pow...

[2] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=707541

Dan Ariely has been almost completely discredited and that entire field of research in general has had almost no studies replicate.

https://www.buzzfeednews.com/article/stephaniemlee/dan-ariel...

I'm not sure if the link you provided supports the conclusion that Dan Ariely is "almost completely discredited". That seems overly harsh. Quoting from the tag line, "Renowned psychologist Dan Ariely literally wrote the book on dishonesty. Now some are questioning whether the scientist himself is being dishonest."

For what it's worth, the placebo study relevant to this discussion does not seem to be on the list of disputed studies from what I can tell [1]. That said, I'd be curious to know if that one also failed to replicate, please share if you have knowledge of this.

[1] https://en.wikipedia.org/wiki/Dan_Ariely#Accusations_of_data...

The 'faith' center of our brain is extremely powerful, the more a situation appears to be potentially improving, positive, normal, the better your brain will operate (based on my own weird experience).

And the price! Homeopathic medicines are ridiculously expensive. So they must work, right? ;(

The most expensive sugar pills money can buy. Exploring the failings of homeopathic medicine:

https://www.mcgilldaily.com/2011/02/the-most-expensive-sugar...

>At the recent McGill conference, “Confronting Pseudo-science, A Call to Action,” James Randi of the James Randi Educational Foundation began his presentation by downing an entire bottle of homeopathic sleeping pills. He then continued his presentation without so much as a yawn, despite the supposed effects of dozens of pills floating through his body. This anticlimactic demonstration raises the question: what exactly was in those sleeping pills?

A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes:

https://journals.plos.org/plosone/article?id=10.1371/journal...

>Conclusion: The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.

Or, in other words, “how can we sell these idiots sugar pills”

If you know it's a placebo, it won't work. Folks, please don't buy sugar pills.

You might find this interesting.

> Half of the study volunteers were told they were getting an “open-label” placebo and the others got nothing at all. He found that there was a dramatic and significant improvement in the placebo group’s IBS symptoms, even though they were explicitly told they were getting a “sugar pill” without any active medication.

https://www.health.harvard.edu/blog/placebo-can-work-even-kn...

The story of placebos is actually pretty complex.

Some of them may have thought the researchers were lying about it being a sugar pill and was actually active

Yeah, I'm not sure that would work outside the environment of a study.

Thought: They should give some cash and instruct the participants to buy a specific OTC brand that is known to be placebo themselves so they have confidence that it is a placebo.

James Randi tried to overdose with a fatal dose of Homeopathic Sleeping Pills, but couldn't.

Homeopathy, quackery and fraud | James Randi:

https://www.youtube.com/watch?v=c0Z7KeNCi7g

>http://www.ted.com Legendary skeptic James Randi takes a fatal dose of homeopathic sleeping pills onstage, kicking off a searing 18-minute indictment of irrational beliefs. He throws out a challenge to the world's psychics: Prove what you do is real, and I'll give you a million dollars. (No takers yet.)

Minor correction:

There were actually more than a thousand people who took James Randi’s “One Million Dollar Paranormal Challenge” between 1964 and 2015, many of them live on stage or broadcast on live television. No one ever successfully completed the scientific testing and won the prize, though.

The Million Dollar Paranormal Challenge was terminated in early 2015 when James Randi retired, so it is no longer available for new applicants today.

While that may be true, I find it repulsing that somebody somewhere is charging real money for placebo effect results.

You really have to look into the details here. Dr. Ted J. Kaptchuk is a an infamous alt medicine advocate[0] and his manipulations are well documented.

In this case the subjects were told "this is a placebo, it has no active ingredients but it can still help you" and that makes all the difference.

In a similar study, when patients are told "this is a placebo, it has no active ingredients and will do nothing at all when you take it" they have little to no relief.

0. https://sciencebasedmedicine.org/dummy-medicine-dummy-doctor...

I’m interested to learn more but I didn’t find any references to the IBS study in the webpage you linked. But to be fair I skimmed it.

Actually, studies have shown that placebos work sometimes even when people know. This is a great podcast about this topic and the page also has links to some studies: https://www.npr.org/2019/04/29/718227789/all-the-worlds-a-st...

From one of the studies [1]: >Patients were randomized to either open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” or no-treatment controls with the same quality of interaction with providers.

I wonder what the results would have been with a less suggestive presentation.

[1] https://journals.plos.org/plosone/article?id=10.1371/journal...

> “Sure it does. The bucket method works whether or not you believe in it.”

> “That’s absurd!” sputters Mark. “I don’t believe in magic that works whether or not you believe in it!”

> “I said that too,” chimes in Autrey. “Apparently I was wrong.”

https://www.lesswrong.com/posts/X3HpE8tMXz4m4w6Rz/the-simple...

And if you know that your anxiety condition is irrational, it will just go away (/s). Our minds are much more complex than statements on a whiteboard.

People interested in the placebo effect should look up Joe Dispenza, the testimonials on YouTube are a good start. Ignore the self-proclaimed "skeptics" with knee-jerk reactions to the decorum, and to Joe Dispenza's credentials. He strikes me as sincere and the testimonials are definitely legit. It's very eye-opening how much the mind has an influence on the body. This should not be surprising, and made me think of stories of how voodoo curses work.

"Ignore the self-proclaimed "skeptics" with knee-jerk reactions to the decorum, and to Joe Dispenza's credentials. He strikes me as sincere and the testimonials are definitely legit"

Why should we ignore the "skeptics" but not the unattributed "testimonials". Joe Dispenza is a quack, voodoo conspiracy theorist, who seems to border line lie about his credentials.

"The placebo has had profound healing effects on many people. But, do we really need the pill if the healing power is within us? Dr. Joe Dispenza delves into the depths of the mind to reveal the connection between belief, perception, energy fields and the mystery of the placebo."

Ok.. energy fields.. got it.. I will file that right next to perpetual motion machines.

Yeah, you're illustrating the example perfectly. You're triggered by the terms used, whereas I was drawing attention to the actual lived experience of thousands of people.

Here's a playlist of 580 video testimonials: https://youtube.com/playlist?list=PLD4EAA8F8C9148A1B

Are they all actors?

Yes, this is an understudied / ignored field. You can't expect the people in it to present themselves exactly how your cliché "scientist" does.

I didn't suggest that anyone involved was an actor, I'm quite sure they are not in fact. I do believe that these people are easily manipulated however and that people like Joe Dispenza take advantage of this to earn fame and fortune. For every 100 people that we see who appear to benefit from the lifestyle changes they implement because of this guys "science" (and those changes may well be benefitial!), there may be another 1000 who don't get real treatment and suffer unnecessarily due to believing this quackery.

It is an understudied / ignored field for the same reason prayer isn't studied for it's ability to cure disease.

A quote from one of the testimonial videos you linked me to:

"It's really hard to talk about because not a lot of people can relate to quantum healing ... " This makes sense.

If you believe in this, and it helps you, good for you. You should not try to present it as something deserving of scientific backing however.

But BELIEF is EXACTLY the point. Joe Dispenza just uses (or, in your view, abuses) scientific terms to explain the HOW to his audience. You can't teach belief to people if you prefix everything with hesitancy or overly qualify everything, that would go counter to the effect you're trying to have.

Again, in summary the "teaching" of Joe Dispenza is that belief creates emotion, emotion modulates biochemistry, biochemistry can be harmonized (placebo) or disharmonized (nocebo).

The scientific wording is just a wrapper, if that's distasteful to you, fine, but it's nothing more than a superficial reaction, one that's very common in the "skeptic" community.

The problem is that this "teaching" is demonstrably false for all but a handful of conditions. Whether he coats it in misapplied sciencey-sounding gobbledygook ('quantum healing' lol), it doesn't change the fact that it won't "cure" anything other than pain, anxiety, nausea, stress and a handful of other symptoms. And we have actual medicine that helps much more for all of these.

That is not true at all and you don't really understand the full spectrum of the placebo effect. It's not about having the subjective illusion of healing, it's about modulating biochemistry to affect healing. There are cases where, for instance, placebo branch participants in a study for antidepressants had measurable brainwave pattern changes after "treatment". What you're describing is an outdated / misunderstanding of placebo.

No, you are just not familiar with the data. There is no such thing as 'modulating biochemistry', the placebo effect is not different from no treatment at all except for the few cases I talked about. This has been throughly tested, and the conclusions are overwhelming: there is no such thing as spiritual healing or quantum healing or other such bullshit. Its all fraud and picking the few people who have happened to recover.

Even in the playlist you gave, it's mostly people who have had improvements in things like pain, irritation, scratching, stuttering. The rest is happenstance: cancers sometimes go into remission, treatments with low chance of success sometimes work and so on.

Again every time this has been studied well it has proven to be ineffective. Sometimes subjective effects are even explicitly contradicted: placebo inhalers make people with asthma feel better, but they do not in fact improve their blood oxygen levels one iota.

You have a playlist of 580 testimonials of these frauds 'helping' people. Look for such things, and see how many millions of testimonials you'll find of people who have not survived after trying to rely on 'faith healing' and 'bioenergetics' and 'eastern medicine' and so on.

Edit to add: your example of brain pattern changes in people suffering from depression on placebo treatments is again perfectly in line with known medical practices. Depression and many other psychological illnesses are well known and reported to be improved by non-pharmacological treatments such as psyhco-therapy. The gold standard in treatment of depression is a combination of psychotherapy and anti-depressants, which has been proven to be more efficient than either on its own. However, this doesn't in any way prove that psychotherapy can help with tuberculosis, as you seem to believe.

> Even in the playlist you gave, it's mostly people who have had improvements in things like pain, irritation, scratching, stuttering. The rest is happenstance: cancers sometimes go into remission, treatments with low chance of success sometimes work and so on.

I've watched hundreds of them, that's not an accurate description at all.

I don't think you even know what Joe Dispenza's method even consists of. Again, you seem triggered by words such as "quantum", "bioenergetics", etc. I've seen many testimonials that can definitely NOT be dismissed as easily as you imply.

Conversely, see "voodoo death": https://en.wikipedia.org/wiki/Voodoo_death

> Voodoo death, a term coined by Walter Cannon in 1942 also known as psychogenic death or psychosomatic death, is the phenomenon of sudden death as brought about by a strong emotional shock, such as fear. The anomaly is recognized as "psychosomatic" in that death is caused by an emotional response—often fear—to some suggested outside force. Voodoo death is particularly noted in native societies, and concentration- or prisoner of war camps, but the condition is not specific to any particular culture.[1]

This still aligns with the observation that psychological state can impact blood pressure and similar heart-related physiology. This is not surprising and not indicative of anything very deep, as we know very well we can consciously control our rate of respiration which also directly correlates with pulse and blood pressure.

It isn't surprising then that, just like your heart can fail from exaggerated effort, it can also fail from psychological stress forcing the same behaviors.

The same is not true for your liver or bone marrow. You have 0 conscious control over those, and psychological factors have 0 impact on these.

re: "voodoo death", https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.52...

> Cannon stated that voodoo death resulted when all body forces were mobilized and maintained for an action which never came.

> He felt that the death was primarily due to prolonged overstimulation of the adrenals by the sympathetic nervous system. Richter, however, felt that the demise was due to a complete "giving up," a feeling of utter hopelessness and helplessness; in effect, a parasympathetic death.

> Zoological experts have observed this in the deaths of wild animals who find themselves suddenly caged in an apparently hopeless situation.

> The thin veneer of civilized intellect covering man's primitive emotions serves as an armor to prevent vulnerability to this type of influence. It is suggested that when this armor proves too thin, modern man may also succumb, albeit less directly and more slowly, than did his less sophisticated predecessors.

This stuff is fascinating to me.

PS: I have to say I'm sorry for the sometimes aggressive tone in some of our exchanges here, this is a topic that's close to heart.

I mean, even just Wim Hof is proof that you can have conscious control over things previously thought you couldn't.

You're very certain of things you shouldn't be so certain about, I'll leave it at that.

I would love to review Joe's material to be able to provide a more thorough response, but I can't afford the 100s dollars he charges.

You can find most of it for free online. And I'm not talking about pirating stuff, just tons and tons of free content, not to mention community content.

If you had any experience with what people online say about the teachings you'd understand that your ratio is WAY off. And there are MANY people that are HARMED by medical advice, there is such a thing as the "voodoo curse of the diagnosis", where trusted authority figures like doctors solemnly announce to patients they have X weeks / months to live, which creates GREAT stress in those people, exacerbating the condition => self-fulfilling prophecy.

Likewise with "your condition is incurable", etc. etc.

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