All Placebos are not created equal

There was supposed to be a big study of it jointly between the FDA and pharm companies, but the results were never published. I have this fuzzy memory that the FDA arranged something where the pharm companies would basically open their data vaults under the condition that nothing would be publicly released.

The speculation was, at least with antidepressants, that when antidepressants were first gaining traction, that people were unfamiliar with them and skeptical of the idea that a pill would decrease depression, or would do so without lots of side effects etc. As time went on, the theory goes, people developed this schema that "pill equals feeling more happy, less depressed" and so the placebo effect increased. So the increase in placebo efficacy had more to do with changing culturally mediated expectations (marketing?) than anything else.

Or at least that was the theory last time I read about it in any depth.

This stuff is fascinating to me for all sorts of reasons really and I believe it's really understudied.

There's some analogous debates in the psychotherapy literature, for what it's worth. The problem there is that therapy has been shown to work in all sorts of ways, but different types of therapy don't really have differential efficacy, espcially when you control for publication bias etc. But designing a "behavioral placebo" is really difficult, in part because it's so transparent, but also because at some point a behavioral control starts to look like a therapy. You can use drug placebos as controls, but that's not really the same.

My guess is the implications of placebo effects extend far beyond medicine into all sorts of other things, into psychosocial phenomena etc. E.g., what about a placebo for quality of living increases? Relationship satisfaction? Etc.

Case in point: hundreds or thousands of people died from COVID-19 because hospital protocols didn’t accommodate rolling patients.

Think about that - beyond the covid tragedy, how many sick people are suffering from pressure sores for want of aides to perform basic care protocols. It’s gross… the president of the local hospital chain here was whining on TV about the lack of nurses. He makes $15M/year and cut nurse salaries by 25% in 2019.

As far as distinguishing mechanisms, for any drug that doesn't have a perceptible side effect (drowsiness, euphoria, numbness, etc), it seems the only assumption required is that the effect is due to some chemical property. That doesn't require much understanding to make a meaningful distinction.

It is linked to the study here: https://pubmed.ncbi.nlm.nih.gov/21531671/

This is a bit of an extrapolation from the study. The study just says that real reiki and sham reiki (placebo) work just as well at improving cancer patients comfort, and are better than doing nothing.

Now if there is an actual study that compares the efficacy of typical "rushed" care vs a more "holistic" approach by doctors vs alternative therapies, I would be very interested.