Even when we know they’re “fake,” placebos can tame our emotional distress | Hacker News Reader

Even when we know they’re “fake,” placebos can tame our emotional distress

nautil.us

213 pointsakeck160 comments

It is said that a visitor once came to the home of Nobel Prize–winning physicist Niels Bohr and, having noticed a horseshoe hung above the entrance, asked incredulously if the professor believed horseshoes brought good luck. “No,” Bohr replied, “but I am told that they bring luck even to those who do not believe in them.”

Anytime I find a horseshoe I throw it in the trunk of my jeep, never had an accident since ... knocks on wood.

Reminds me of this quote: "Do not be ashamed to speak nonsense! You only have to be attentive to your own nonsense." (Wittgenstein, Miscellaneous Remarks (Vermischte Bemerkungen))

One of my favorite Civ VI quotes:

> "I don't believe in astrology; I'm a Sagittarius and we're skeptical." - Arthur C Clarke

On the subject of luck:

https://quoteinvestigator.com/2012/07/21/luck-hard-work/

I’ve heard Zizek repeat this a lot in his talks but has never been able to find a reliable source for this claim

Somebody else searched, and Bohr did seem to say it, but he was quoting a neighbor at the vacation home.

https://backreaction.blogspot.com/2011/12/advent-calendar-21...

Reads like the setup of a short story. In the final act the horseshoe would be physically important, either to help the protagonist¹ and make their point or hurt them² and disprove the claim.

¹ E.g. it contains an inscription which provides a vital clue.

² E.g. it falls on their head.

I like the 2nd ending, but when they're taken to the hospital for horseshoe-induced head trauma, an early-stage brain tumor is discovered & operated on, thus ultimately saving their life.

plot twist, why you assume they want their live to be "saved"

Sounds like Nagito from the game Danganronpa.

He is the "ultimate lucky student", and this kind of "bad luck turning into good luck" scenario almost defines him.

no creo en brujas, pero que las hay las hay.

this one is so good

Another source of "magical power" is old nails, driven then extracted.

Some cultures drive them into idols. Hundreds. Like Pinhead the cenobite.

I think it's the focused will it bore. When it was beat upon. Like a horseshoe in that way.

Maybe the will leaves a mark.

The key thing we should update on, as a society, is that placebo effects are huge (often as large as the treatment effects established for drugs in RCTs), and through specific actions, the placebo effect can be maximized.

In fact, it used to be part of a medical doctor's training to take on the mantle of an authority capable of producing placebo effects, back when they had little else to give.

The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect.

It's hard for people to do this to themselves, deliberately -- like turning the knob on a pressure cooker while you're inside the cooker... But obviously being credulous helps a lot!!

There is actually a literature on this, but it's adjacent to the medical journals:

Daniel Moerman describes himself as a medical anthropologist. He wrote a book called “Meaning, medicine and the ‘placebo effect' “.

https://www.amazon.com/Meaning-Medicine-Placebo-Cambridge-An...

> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect.

Isn't it risky? Saying "everything will be fine" or "this will definitely help" with authority when you know the probability can have consequences, and in the end patients will stop believing you.

It's perhaps less "everything will be fine" and more "whatever happens, you're in good hands". A certain confident assertiveness, even when there's nothing to be confident about. I've not had the experience some have, with physicians pretending to be mini-gods. So far, the ones I've met have been quite willing to admit they have no idea what's going on when that's the case.

That can be done in a way that leaves you feeling like you have support and practical things to do in the meantime, or it can leave you feeling lost. A friend who is a nurse who works in hospice has some critical things to say about the bedside manner of some of her peers. When there is nothing to be done, but how nothing is done can still matter a lot. Sometimes it's simple as despair leading to self-neglect that leads to more rapid worsening of illness. That effect seems to be related to the placebo effect.

I'd actually assume it should be more "everything will be fine." You specifically broadcast the reaction you want to get from folks. Someone down thread posted the video to the nocebo effect. It really is far more effective than makes sense.

Problems are legion, of course. Is it something inherent to the people that are impacted by this? Would make some psychotic disorders interesting evolutionary defenses.

And, of course, there is no reason this has to be limited to medical behaviors. Teaching and coaching can be more effective for some people, if you tell them what you are doing is going to be effective. This actually tracks remarkably well with how so many advocates for different techniques all lead with usually over the top assertions on how what they are doing will work. Often more so than on why it would work.

that's because "everything will be fine" or "this will definitely help" sound unrealistic. the message needs to be more subtle and believable.

but what is the risk? the only situation where the believability of a doctor suffers is when the patient doesn't heal at all. we do read about cases where people go from doctor to doctor because nothing works, until they meet that one doctor who has the right insights and finds a treatment that actually does work.

how often does that happen though and how does that affect the doctors or the patients?

>the only situation where the believability of a doctor suffers is when the patient doesn't heal at all

If you investigate the medicine they prescribe you and find out it's a placebo, you might stop believing the doctor about the other cures they sell you.

When a doctor gives me homeopathy I will not return.

It’s an interesting gray area because the effects of placebos are empirical and reproducible in rigorous trials.

If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth.

>If your doctor tells you “this pill helps many people with your condition ”, they’ll be telling the truth.

That's actually a really good wording.

I was talking to a psychiatrist friend of mine about placebo effect and he told me that it definitely can make a big difference. But I asked him if he ever just gave placebo pills to patients and he said no because he felt that would be unethical. I didn't really think to ask whether it would really be unethical if it might help.

If you could know ahead of time that it would work, I think it would be different. But you can't know that, right?

They wont be telling truth. Placebo effect is not effective in 100% of cases.

What this will do over time is that people will learn that doctors advice is optional - it might be necessary and good to take pill, because only antibiotics work on this sickness. And a lot of other advice will be optional to follow.

> Placebo effect is not effective in 100% of cases

There is no medicine that is effective in 100% of cases.

Chemotherapy does not 100% fix your cancer.

Covid vaccine does not 100% mean you won’t die from covid.

Antibiotics is not 100% either. There are resistant bacteria.

But you are correct that doctor’s advice is optional. No doctor can force pills down your throat or force you to do surgery, even if it means you will die tomorrow. You still have a choice to just do nothing and die

And quite literally, no one ever said to me that covid vaccine means 100% chance of being covid proof. Same with chemotherapy. Same even with antibiotics - it was always given to me with "if the issue does not go away after finishing them, come back".

> But you are correct that doctor’s advice is optional. No doctor can force pills down your throat

You know full well this is not what I am talking about.

Yes. What it does is that over the course of life, people will learn to not trust what doctors say.

> The thing you really want to do, and every doctor should aim for, is to stack the placebo effect on top of a well-established treatment effect.

Psychologist Alia Crum does research into this area.

“Harnessing the Power of Placebos” by Alia Crum (Video, 2016) https://youtu.be/WcQnSW1wpGA

She's great! I totally should have mentioned her. Stanford magazine covered her work last year:

https://stanfordmag.org/contents/better-believe-it

I first encountered her work through Andrey Huberman's podcast:

https://www.youtube.com/watch?v=dFR_wFN23ZY

Harvard is researching this too:

https://www.health.harvard.edu/mental-health/the-power-of-th...

"It's hard for people to do this to themselves, deliberately"

i'd say much like tickling yourself. For some reason it doesn't work.

Open placebo studies are super interesting to me. One of the difficulties of pharma is proving efficacy over placebo... because placebo is a very strong factor! I feel like we could, as a medical community, leverage placebo to improve health outcomes much better than we do today. Why not? It seems the only reason not to is some weird Victorian notion about the capital-T Truth.

> some weird Victorian notion about the capital-T Truth.

Only if neither the patient nor insurance are paying for it. Otherwise that's just straight up grift.

If a doctor gives you a placebo, you only get the placebo effect. If a doctor gives you medicine, you get the placebo effect plus whatever extra benefit the medicine provides.

We already are leveraging the placebo effect, unfortunately we are also doing it in a negative way by highlighting side effects.

> the placebo effect plus whatever extra benefit the medicine provides.

Plus, the act of noticing those extra effects can give you another placebo effect on top, e.g. if the medicine has some noticeable effect, the placebo can get stronger, or cause other effects to accompany it.

Of course there is also consciously learning to leverage the effects of the medicine, which is a non-placebo~

For some medications those side effects can be severe though - I think there's some rationale in actually purposefully leveraging the placebo effect without giving the patient a medication that could harm them.

The side effects are also influenced by the placebo effect. Maybe they'd be less problematic, but they'd still exist.

We already have witchdoctors for that. I don't need my medical professionals trying to deceive me.

It's one thing if they tell me that a cup of tea helps some people with migraines, and is another thing if they're selling me sugar pills

Well, to be honest - that's kind of a uniquely American problem. Lots of places in the world don't have free pharmacare but only in America is the cost going to be so incredibly significant that the profit motive is strong enough to encourage charlantry.

I'm speaking from a non-American perspective.

Apparent post is advocating deceit, not for a profit motive but for patient benefit. This is what I disagree with.

I'm not saying anything about the profit motive. I'm saying that doctor should not lie and trick patients.

I mean, this might have been the case when standards of medical practice were so bad that the homeopathic hospital was one of the safest places to be because whilst the medical care there was purely placebo, that was better than a doctor with unwashed hands attempting crude surgery.

But modern treatments are evaluated based on having demonstrable net positive effects above and beyond placebo.

Close. If a doctor gives you a placebo, you can only get the placebo. No guarantee you will get anything, of course. You could also get the negative side effects of the real medicine, without any cure.

> One of the difficulties of pharma is proving efficacy over placebo

I guess that could be true in a very specific subset of medicine, but I cannot imagine that is true in general. As others are mentioning, the placebo effect already is part of the medicine, except in cases where the patient is medicated while in coma or things like that.

Do you have evidence to support your claim?

I think they mean it in the sense that when developing a new medicine whose degree of efficacy is unknown, you can't just test the medicine and show benefits. You need to test the medicine and separately test a placebo version of the treatment and show that the medicine (+the inherent placebo effect) is more effective than the placebo effect alone.

Ok but then the choice of words is not appropriate. It’s not “difficulty”. It’s just due diligence.

Needing to do the due dilligence is part of the challenge of doing pharma correctly, and thus, its difficulty.

That the work is necessary doesn't make it not part of the challenge.

How are you defining "difficulty" here?

I guess my point is that difficulty is a relative thing. It depends on the task and on the individuals performing it.

Paying people to do the testing properly and, collecting and organizing the results. Making all those schedules. Making sure that the math needs is solid. Founding volunteers. Etc. All of that. It costs a bunch of money.

In the abstract, it could be said that it is a difficult process. I would not would not be able to organize it.

But for the people who are involve in those tests, and that have done that kind of thing hundreds of times, that is not a difficulty. It's routine.

If we are going to define "a difficulty" that way, then anything that a big company does is "a difficulty".

I would absolutely consider many or most of the mandatory tasks of keeping a company, any company, running are the difficulties of having a company, regardless of how difficult any individuals at that company consider those tasks to be.

Yes, successful pharma companies are good at overcoming the challenges involved, some of which you listed. The point is that being able to do so is necessary for that success, and thus, an obstacle.

I think we already do. When you buy a bottle of decongestant with phenylephrine, you're just buying a bottle of placebo, and this is the most commonly purchased type of decongestant.

Thinking about this ticks me off every time it comes up.

For those unaware, phenylephrine should never have passed FDA trials. It was whisked through almost certainly at the behest of Johnson and Johnson to provide a replacement for the very effective psuedoephedrine, which happened to be a relatively easy methamphetamine precursor.

Then, for J&J to have the gall to market phenylephrine as "Sudafed" was just the cherry on top. I wasn't aware of all that at the time, but the first pill out of a box of new Sudafed was so ineffective compared to the previous pill from the old stuff that I had to look it up.

Wow. I had no idea, I've been taking that for years. It's in every single OTC cold and flu medication with painkillers.

I found this to be a good read/overview:

https://www.science.org/content/blog-post/uselessness-phenyl...

There was a famous study where the patients were told they were receiving a "pill with no medicine in it." It still resulted in measurable improvement.

The short version is that we do use it in some cases where there's a lack of other options. E.g. I can walk into the major pharmacy down the street and buy "earache medicine", which is (almost literally) just water. My insurance won't pay for something like acupuncture right now, but if I were undergoing cancer treatment, suddenly things like that would be partially covered in the name of "pain relief".

This treatment works well for irritable bowel syndrome. Not for everything, of course.

This reminds me of the "homesickness prevention pills" my mom sent with me to sleep away camp.

They were just unlabeled M&Ms, and I knew that, but I'll be darned if those things didn't cure the homesickness right up!

they reminded you that your mom cares about you. they are special because you didn't just buy them yourself, but your mom sent them to you as a gift.

just like when my grandma made me cookies.

This is so wholesome

I'd bet the same applies to both old social and religious rituals - but sugar pills are well-suited to and culturally accepted by modern scientific study. So nobody's likely to study mailing a paper-based note of apology (to the friend you're distressed over hurting), nor praying to $Deity (who you might not really believe in), etc.

What makes you think that? https://onlinelibrary.wiley.com/doi/full/10.5694/j.1326-5377...

My dad used to joke about how placebos helped my mom and older sisters many body ache complaints. I just thought severe pain was normal until I was diagnosed with autoimmune, MS and a few other things. Doctors told me for years it was just in my head and that I just needed medication for anxiety.

Proper medication and diet changes resolved pain and anxiety.

My mom and sisters all have same issues. Dad and doctors gaslight them and me for decades.

The highlight when I was in the ER coughing up blood. ER doctors explaining how I was faking it since my blood work was normal. Until chest X rays came back. Then doctor also went pale.

This is an illustration about not just placebos but how delusional people are.

These are doctors who were taught to be investigative and logical yet they were so delusional they have to say that you were faking the blood that you were coughing up.

A lot of "logical" people like to rag on cults or religious groups but what they don't understand is that delusion is pervasive. Most humans lie to themselves extensively and you dear reader, are likely not an exception.

Take for example the armies of people who told me AI won't ever take over their jobs and chatGPT is just a stochastic parrot. There is merit to both sides of the debate, but I guarantee you a lot of the hostility against AI comes from delusional lies people tell themselves to cover up a possible future trivializes their job skills. Not trying to start an argument on AI here, but I bring this topic up because it's the most current example of mass delusion I can think of. You have to bring up the current delusion to show people how strong the capacity to lie to oneself is.

The more I talk to people in my life (friends, family, mentors, teachers, etc) the more this story seems to repeat itself. People who have a somewhat uncommon issue, and are forced to go from doctor to doctor until one finally recognizes the problem and knows what to do.

I think that we have a couple problems. One is that we just don't have enough doctors to give thorough care to each person. They're under too much time crunch to really investigate. The second is that the human body is hopelessly complex and I'm not sure humans will ever be able to be good at diagnosing problems with it effectively.

Until we develop real gAI and much better imaging techniques, I'm not sure we will ever solve this problem in a satisfactory way.

How did they think you can fake coughing up blood? Fake coughing, sure, but blood?

I know hypochondria exists, but I think doctors should start out by taking patients seriously and gather some actual proof that a patient's real problem is hypochondria before dismissing their complaints.

Blood was earlier in morning. Urgent care wouldn’t see me. Was super pale. ER figured I was faking or that I was confusing muscle pain for something serious. This was actually the second time I went to the ER. First time they didn’t xray and sent me home.

Placebos are a ripe topic. Specifically of interest to me, is that it is clear that placebos can work even when you know they are placebos for "solving" things; this implies that they can also work for making things worse.

And letting that sink in is terrifying. Just telling people that they are going to do worse on something can, in fact, cause them to do worse at said thing. Even if the reasons are completely wrong.

That is, placebos aren't limited to cures.

The nocebo effect.

"This video will hurt" - CGP Grey https://youtu.be/O2hO4_UEe-4

Thinking of how this fits in to conspiracy theories and general thoughts on public policy are... less than pleasant, all told. I personally take it as a good reason to have even more patience and empathy for folks; but I don't get that impression from everyone else. :(

There's a famous incident on Australian TV where a TV presenter is told about how well a placebo works, and he assumes its a brandname or drug name and asks if they could be made available on the Pharmaceuticals Benefit Scheme (the national subsidy for expensive pharmacy cost sharing) and what's holding back GP's from prescribing them.

Certainly made me laugh but if you catch your wind its a bit of a Yogi Berra wisdom moment: if we did routinely prescribe placebos then they might actually help reduce the cost burden of real drugs with comparable efficacy, which are subsidised.

There's a great episode of NPR's Hidden Brain about the placebo effect called "All The World's A Stage—Including The Doctor's Office".

https://www.npr.org/transcripts/718227789

For years (decades, actually), I've been a believer in the idea that deliberately and systematically harnessing the placebo effect will be the biggest medical development of the first half of the 21st century.

However, I've become aware of studies and claims that actually the placebo effect itself is an illusion caused by poor statistical understanding and poor study design (sometimes necessitated by the study matter).

At this point I am deeply unsure what to make of things.

Warts are an immune system that hasn't identified an intruder yet. There are plenty of folk remedies that are basically about tricking the brain into telling the body to get on with it. One involves tracing it and burning the paper.

The last wart I had (when I was younger) I got mad (and angrier) at it one day and started trying to cut it out. I'm certain there were bits of it I missed, but it was gone in a week. I decided I had finally had enough and my body got the message.

     Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment.

     Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?”

     He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.”[1]

[1] Matthew 17:18-20

The twist: The pill was a form of deception. It contained only lactose, sucrose, and glucose; it was a placebo.

Sugar is not chemically inert. It actually takes the edge off pain and general misery.

I wish they would stop publishing results indicating that "We believe sugar does absolutely nothing whatsoever in the body, so if you consume sugar pills, clearly any reaction to it is complete bullshit made up by your mind because you believed in it."

OK, but the amount of sugar in a pill is tiny. It's presumably not a piece of hard candy, but rather mixed with standard pill fillers.

I don't think that's enough to take the edge off of anything.

It's presumably an amount you could look up if you genuinely want to argue this for some reason.

"Sugar pill" is a generic term for an inactive substance. It doesn't contain a meaningful amount of sugar, and similar effects are present using other substances. How would we test diabetes medicine if the only options were either medicine or sugar?

Trying to claim the placebo effect is from taking a tiny amount of sugar is silly. If sugar alone was curing things, the US would basically never get sick.

No, placebo is a generic term for a presumably inactive substance. I quoted the article. They gave people sugar in this case.

And lactose, along with fillers. Why do you think it was the tiny quantity of sugar not the tiny quantity of milk?

Lactose is just another form of sugar.

Yeah, I should have highlighted the fillers instead of the lactose, I realized my mistake shortly after posting. It's really not the point, claiming the tiny amount of sugar is the cause is ridiculous. This one experiment didn't test multiple placebos, but other's have.

> In one placebo group, people were told by a friendly, trustworthy, and empathetic researcher that the videos had a physiological impact that activated “early conditioned emotional schemata through the color green.”

> “It was a fake idea, a fake rationale behind it,” Gaab said. “And it worked, people loved it.” It worked as well as a group psychotherapy treatment Gaab and his colleagues used with study subjects a few years earlier.

Were people explicitly told that it was a fake idea at the outset, and went along with the ruse?

Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work? Or do I need to receive “Problem X pills” from some authority in order to see a placebo effect?

I had always assumed that a key component of the placebo effect is not knowing whether you’re receiving the treatment or the control.

Nope. you'll still get a benefit when you know. (https://www.apa.org/monitor/2011/03/placebos - sorry, don't have a real link handy)

Being completely serious here. Go to any store selling homeopathic medicine and pick something off the shelf. Maybe it's placebo or maybe it works.

Just make sure to do your own research first, some things are actually toxic or interact with medications. :)

> Can I buy sugar pills and tell myself “these pills will help with problem X” and have an expectation that they will work?

I've been told that this is the basis for magic, and that the answer is yes. Better still is to come up with a ritual that transforms them into problem-X pills, something symbolic of problem X. With practice, your magic might even become stronger (because you have prior experiences that make you believe).

Question for those that welcome the placebo effect: does it worry you that if placebos can affect you strongly, that fact is a sign that you are broken in some fundamental way?

I mean, you have emotional distress, and straightforward ways of dealing it do not work, so you have to pay some authority figure to prescribe a placebo. Does that not make you want to investigate how deep your brokenness goes?

(Actually, I think that the placebo effect is not strong enough and does not apply to enough real-world situations to be worth paying much attention to and that there are just a lot of bad studies in some fields.)

> research published this year from Gaab and his colleagues showed even taking imaginary pills could reduce test anxiety

I'd be curious how effective it is versus deep breathing, or any other anxiety-calming practice. The mind is extremely susceptible to the power of suggestion, but I'm not convinced there's anything special about a "placebo" versus ordinary mindfulness.

I'd like to see a placebo study where they have 2 placebos:

1. This medicine will cure your muscle pain, but it has very bad side effects: Insomnia, depression, back pain, knee pain - but don't worry only a small percentage of people see these issues (like 1%)

2. This medicine will cure your muscle pain, and has no side effects, in fact it will make you happy and help you sleep better.

An interesting aspect of placebo is that supposedly the strength of the effect has been increasing in the last decades. So much so that quite a few approved medications would likely not get approved anymore, because their effect would not be strong enough compared to the placebo effect.

That doesn't make sense. If the approval process were happening now, the new trials would have the drug benefit from the higher placebo effect.

The placebo effect getting stronger as the population of earth increases is probably the most compelling evidence for us living in a simulation.

I find this hard to believe, only because it would be stupidly hard to measure this in an unbiased manner across generations, and the replication crisis is just so rampant.

I've read up a bit about this topic, but is there any books or recommendations that really cover the idea of what is popularized as the "mind-body connection + placebo effect"? There's obviously the best sellers / self-help crap in the world and even books on back pain being healed from this general "placebo" effect or at least the new awareness of it.

I've noticed this personal effect to be a constant theme in my life. I'm a chronic overthinker (OCD perhaps) and when I become aware enough of said "placebo effect", my problems go away and new ones take their place. Maybe that's just life, but there's such a strong power to placebo I'd love to learn more about.

Irving Kirsch, psych professor at Harvard, wrote a book called "The Emperor's New Drugs" which argues that antidepressants are basically just placebos. I haven't read the book but I have seen a lot of interviews and articles on his research and it's pretty damning.

Thank you. Very interesting!

I have read this book, and can confirm, it is extremely interesting and pretty damning.

I'm frankly surprised it hasn't had more of an impact; it really does seem like SSRIs are causing a lot of harm to a lot of people in the form of side effects, and the scientific evidence seems to point strongly toward them being no better than any other active placebo. Yet, they continue to be prescribed in ever-increasing numbers.

Well, to be blunt, it's because there are billion dollar pharmaceutical companies that want to keep making money off of these drugs, with around 20% of adults taking anti-depressants at any given time.

Look into John Sarno's work for stuff on mind-body connection

Thanks, I've already read much of his work. I was more interested in any studies on placebos from a psychology perspective.

Makes me think about the "ASMR" effect and how some videos center around intentional stuff or just alternative medicine. It's like you know these crystals aren't doing jack but it's still relaxing on some level.

Well crystals are used for the pizeoelectric effect and involved in a lot of modern technology in relation to the EMF spectrum. So, there's at least "ammo for justification" even if that's all it takes for placebo's to be activated (Shepherd: I don't care what you believe in, just believe in something!)

Same with aromatherapy. I know it's crap, my partner knows it's crap, but hell if I don't sleep like a baby if she sprays our pillows with a Lavender scent before going to bed; I sometimes take a bottle with me when I travel, and it knocks me out better than any amount of melatonin or sleep medication could achieve. I'm sure it's just association by now, but it works.

The book "Bad Science" has wonderful discussions and examples of the placebo effect as it relates to medical research. Highly recommended.

I've tried to internalize an understanding that placebo effects are real and can be large, with the expectation that this understanding should increase placebo efficacy without sacrificing my commitment to truth (that is, I don't seek out woo, but I do expect some woo is actually a real, strong placebo effect and I'd like to be able to replicate it myself sans-woo.)

Part of the "mind over matter" aspect of the human body is that a deliberate act is sometimes enough to get things moving. That act in increasing the number of times of day you think about your predicament and the depth of attention you apply to it.

While there's a lot of promise in harnessing that, it's also the source of a lot of superstition.

This is going to sound stupid, but I've always wondered if one day we just find out that sugar pills do have medicinal value.

I take an "anti-stress" "natural" "medication" most nights when I want to go to sleep. I know it's basically just flavored sugar but it knocks me out and I'm asleep in 5 mins.

Who needs melatonin when I've got this placebo ritual that works just as well with no side effects?

I always thought this too, "sugar" pill never sounded neutral. Maybe it should be a "water" pill.

But then we reserve the term "water pill" for pills that make you pee, gahh.

Naming pills is hard. (Let's not even talk about the risks of off-by-one errors here.)

Yeah I've known this for a while, I suffer from anxiety and obsessive compulsive disorder and am well aware that my compulsions are total placebo and have no connection to my obsessions but still find they calm the anxiety almost completely. I think people are just drawn to ritual, be it religion or placebo/quack medicine or OCD.

If the placebo effect comes down to the power of suggestion, then hypnotism is potentially a valid form of treatment.

It works better if you believe in it. Feels like hardcore skeptics are doing themselves any favours by completely discounting the power of their mind to affect the environment (their body) which it is connected to.

I wonder if the placebo effect can extend to learning, where you imagine taking a placebo that helps relieve your stress about having to learn something new after a long time.

If anyone is familiar with research and reading at the intersection of placebos/psychology/learning, it would be great to read!

Well, not quite what you are asking but, it has been shown that asking some demographic questions prior to testing can alter some outcomes (specifically Black students' math scores) [0] although other papers find no difference when looking at other factors such as asking about gender prior to physics tests [1], this is known collectively as "Stereotype Threat."

So given that "Stereotype Threat" is a thing, I would absolutely believe that you can apply the placebo effect to learning as well.

[0] https://onlinelibrary.wiley.com/doi/full/10.1002/ets2.12046

[1] https://arxiv.org/ftp/arxiv/papers/1602/1602.07648.pdf

That’s super interesting, thanks.

I would kind of start to think about formative vs summarize questions but unrelated questions you get right could

Until I can find the link to the study, anecdotally I have found that sharing a message about adult learning prior to learning can also have have a positive effect - which sounds similar to the above.

Humans evolved in a world of arbitrary danger. That we evolved an affinity for coping mechanisms to the extent they have undeniable physical manifestations seems likely.

There is a very interesting book "you are a placebo" discusses the placebo effect. The author cured himself by practicing it.

regular strength placebo / extra strength placebo

For some definition of “we” and “know”.

This argument always bothers me a bit, because words are almost always used with "some" definition.

I was trying to highlight that these words and the definitions you choose do a lot of lifting there. What's "we", or rather you or I, are you only your conscious mind which 'knows' something, or are you also the subconscious that doesn't know that at all? I'm certainly more we than I but I say I because it's easier and doesn't require tons of explanations. Recently I discovered that I've gotten a slight needlephobia. I'm perfectly fine with needles. I'm willing to give you my blood or get my shot, I don't have a problem with needles. But if you come close to me with a needle and I'm aware of it and believe that you'll stick it into me, I'll just shut down my conscious mind. But I obviously don't. But I absolutely do. Which one of those am I? Which one 'knows' something about placebos? Which one is affected by illnesses and medication the most?

And what do you actually 'know' there? Do you know it doesn't contain any medication? Do you know that it usually still has a good chance of helping you? How is it fake if it has an effect? Do you 'know' that you don't 'know' how or why it works exactly? But does that make it fake, or does that make it surprising that it works? I know how basically nothing about how anything works, but it still works, and that's not surprising to me.

But I'm lazy (all of me) and I didn't want to write all of that, so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything.

> so I apologize for having abbreviated my thoughts to that sentence that I agree doesn't really say much and could be applied to anything.

I can't tell if this is sarcasm or not, but in any case, thank you for the clarification.

No sarcasm, I made too many assumptions about the shared context, and I got it wrong. My initial sentence would've been fine if this would've come up with a friend because we share the context and he would've understood what I meant. But with "the world at large", not only do I not share that specific context necessarily, I'm not even sharing the cultural context most of the time, and without those it's just something that's neither here not there and could be commented on pretty much any thread with other words from the title.

This is why I keep my mouth shut when I run into somebody who is into crystals or homeopathy or some other pseudoscientific thing. As long as their "solution" isn't likely to cause additional harm, and they're not being overly greedy re: how much money they're making, then the hope they're selling is real even though it might be of dubious justification.

I guess it depends on the illness. If it's an actually-treatable disease, maybe not totally rude to suggest (non-?)alternatives, haha.

Placebos can also work in reverse - if you strongly believe a medication or procedure is harmful then you will be harmed by it.

That's why it's entirely unethical to force a medical product on a population.

Take for example the mRNA covid vaccine. Let's say it did what they claimed at the start and stopped transmission 100% without ever causing a side effect. Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit.

People who believe a vaccine is dangerous but take it to save their job will get harmed whether it caused a side effect or not. The emotional distress alone can be debilitating. If the mind is so powerful it can strongly affect health outcomes, how could anyone think it's ethical to punish someone for making their own medical decision?

Because their emotional distress and placebo effects don’t outweigh the benefit to everyone else of having them vaccinated. And requiring vaccination to keep your job is not a punishment, any more than we punish people with epilepsy by saying they can’t drive. It’s an attempt to reduce the risk to society posed by their medical state.

what's more, the distress is not caused by facts but by misinformation and people deliberately causing a scare.

car traffic is more dangerous than the vaccine yet rarely is anyone experiencing distress over that.

> Even then, the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit.

That's ridiculous -- of course benefits can outweigh psychological side-effects. Usually you'd want those benefits to accrue to the person suffering the side-effects, but living in a civilized society means accepting that sometimes the good of the many outweighs the pain of the few. If a vaccine for a deadly, highly communicable disease can completely stop transmission then I think it's perfectly ethical to require everyone to accept it or isolate from those willing to do so.

> That's ridiculous -- of course benefits can outweigh psychological side-effects.

I understood the grandparent post to mean that the harm can sometimes outweigh the benefits when the vaccine is forced. Not that it's always the case.

> If a vaccine for a deadly, highly communicable disease can completely stop transmission

Are you suggesting that the COVID vaccines were able to completely stop transmission?

> I understood the grandparent post to mean that the harm can sometimes outweigh the benefits when the vaccine is forced. Not that it's always the case.

On careful re-reading I believe you're correct. Though if a hypothetical 100% effective zero side-effects vaccine doesn't pass their bar of outweighing psychological harm then it seems unlikely anything could, hence my interpretation of GP as an absolute statement.

> Are you suggesting that the COVID vaccines were able to completely stop transmission?

Hah, I wish! No, just going with the GP's hypothetical.

Parent comment seems completely hypothetical so this seems like a bit of a stretch.

> If a vaccine for a deadly, highly communicable disease can completely stop transmission then I think it's perfectly ethical to require everyone to accept it or isolate from those willing to do so.

Did you consider the law of unintended consequences?

> Let's say it did what they claimed at the start and stopped transmission 100%

This claim was never made.

No vaccine works 100%, ever.

This is called the nocebo effect, and it is well-studied. Example: https://jamanetwork.com/journals/jamanetworkopen/fullarticle.... When you think of an interesting idea like this, please don't assume you've discovered something new that the entire public health field is unaware of. A drug or treatment that had worse nocebo effects than medical benefits would not be approved.

I don’t agree that the nocebo effect can be tested in a clinical trial which only has willing participants.

If there was a person who’d rather take a bullet than the vaccine, don’t you think the nocebo affect would be stronger? My feeling is anyone who requests an exemption due to their beliefs should be given it because you can’t measure the resoluteness of their beliefs, religious or not.

I can testify to nocebo effect.

Psychiatrists cannot/will not tell patients what primary effects we can expect from a given medication: "it works differently for everyone" "brain chemistry is unique" "it'll keep you out of the hospital" etc.

The truth is that most psychotropic medications tend to induce altered states of consciousness, and yes, they can be different for different people, but these altered states are not published, touted, explained, or offered to patients or consumers of the medications. Only the adverse side effects are discussed (and if only we had a nickel for every time a prescriber told us "this has no/fewer side effects!")

Therefore, we have not been informed of any primary effect for these drugs, and thus they can have no placebo effect. We do not "know" how we are "supposed to feel" while taking them. Since many have had psychiatric symptoms since childhood, we don't know any other mood or state of mind. How can we know if these effects have receded? Brain scan? Checklist?

So we can't have a placebo effect. If we are well-informed of the side effects, we may notice some. We complain about side effects and the psychiatrist does a switcheroo and produces a second, third, fifth, tenth medication cocktail. "Just some adjustment until the benefits outweigh the risks." And they do this slowly, judiciously, one at a time, unless you land in the hospital.

Psychotropic prescription drugs that are not Scheduled are weaksauce. And they're the only ones that can be prescribed to the poor and the needy and the homeless. Unless they're in the hospital. Therefore, you crank them up one at a time until the side effects are only mildly annoying, then you keep adding more drugs as the patient complains about symptoms. Without knowing any placebo effect.

Perhaps this is one reason why psychedelic drugs are highly touted by some now. There has been much study done by recreational users of drugs. They all know how LSD will make you feel! They know how you can get on mescaline before/while you puke! So perhaps that's the answer: that formerly recreational drugs can come find a home with placebo, and primary, effects intact.

> When you think of an interesting idea like this, please don't assume you've discovered something new that the entire public health field is unaware of.

From the guidelines (https://news.ycombinator.com/newsguidelines.html):

> Please respond to the strongest plausible interpretation of what someone says

Parent didn't say they had come up with the idea or that it was novel, just that they were aware of it.

Your fallacy is implying that the harms are equal. The nocebo effect from a vaccine is not more harmful than the benefits it gives to the person and to the society.

> the emotional distress and reverse placebo effect of coercing people to take a vaccine if they don't want it still outweighs any benefit

In a very hamfisted comparison, if the expected death rate is 1% then the expected deaths are > 3 million in the US. I think this outweighs nocebos.

> Let's say it did what they claimed at the start and stopped transmission 100% without ever causing a side effect.

Lying does not help your argument.

reminds me of public apologies

Emotions are an association between "fake" and "real".

We can take advantage of this with objectivity: if you have an objective perspective on emotion itself - as a process that transfers data between imaginary thought and physical feeling - then you can alter the surrounding circumstances of emotions, and actively pursue specific thoughts that are connected to desirable feelings.

But the utility doesn't end there: you can also directly hijack the process itself.

Emotion is only truly understood from an implicit inference perspective: the explicit definition I just gave is not provable the way a mathematical theorem is. The only available evidence is from experiencing the result. It's a soft science, but it's still useful enough to construct reliable tools.

Here's my testing method: breathing.

I know that the physical act of breathing is not functionally different, whether it's intentional or automatic. I know that physically, my lungs are filtering oxygen from my environment into my blood (with a breath in), and CO2 from my blood into my environment (with a breath out). Simply breathing does not have a noticeable effect on my emotional state, save for providing a baseline of functional cardiovascular support. I can feel happiness, anger, depression, pain, euphoria, or any other physical sensation: all the time breathing in and out with the same fundamental process. These elements of the breathing process have been explicitly proven, much like a mathematical model.

So how can breathing hijack emotion? Story.

The associations that an emotion is made of are volatile. They can be changed. We all experience emotional change that is unintentional: based on the experience of our surrounding circumstances. We can also make emotional changes that are intentional: based on the experience of our own imagination: by playing out a story.

Here's an example: Imagine the feeling of ice on your skin. It feels cold to the touch, even the air nearby it. The rest of your body is comfortably warm: blissfully unaware of the chilling sensation from ice in that one place. Your lungs are not for filtering oxygen and CO2 anymore: now they draw in that sensation of cold touch, and filter out the sensation of warm comfort. Each breath in draws another lungful of chill into the bloodstream. Your heart pumps, and your blood meticulously draws out (like the CO2 before) the warm comfort from the body, to be replaced by the chilling touch of ice. Each breath out releases that warmth out into the air around you, to be scattered away in the wind. Do you feel it? Now replace the cold touch with heat. Excitement. Peace.

The Rolling Stones told us that love is, "just a kiss away"; but it's even closer than that: you can find it in a breath.

Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? Something unsettling about this for me. So much of illness wrapped up in distress. We need reassurances, however irrational the ritual that brings them. Why is there no space for this in conventional medicine?

Because it isn't quite that simple. Overprescription of antibiotics isn't usually done only for the placebo effects, but other social reasons as well. A significant subset of patients react poorly to "it's probably viral and so we probably can't do anything". As bad as antibiotic overuse is, lying to patients and fraudulently prescribing a treatment is still much worse than giving someone antibiotics in the 5% chance that something is bacterial.

I don't think that lying to patients to falsely reinforce their untrue beliefs is a solution to the problem -- it'll probably create an additional problem by reinforcing beliefs of the legitimacy of pseudoscience.

I think there’s a chance here to actually tell them the truth.

“This stuff is not studied to work. It is a placebo.” OP study says this can still be effective.

Although not as effective as deceptive placebos. I personally suspect that the subset of people for which honest placebos work well overlaps significantly with the same subset of people who already believe "pill = good" above the expert advise of their doctors.

On a 4 page list of my notes on issues and treatments I mentioned that my symptoms always got better on doxycycline for a couple of months. My ancient neuro-ophtomogist oh, you have Sjogrens. I’m like what’s that? Apparently he had seen that many times before.

Turned out he was right.

Antidepressant/SSRIs are a much bigger one. The actual experimental evidence for these drugs, contrasted against placebo, is shockingly weak. Moreso, SSRIs come with tremendous side effects. At the very least we should be making an effort to gradually phase these out of society. In reality, we've gone the other direction and floored it - with SSRI prescriptions growing exponentially.

I have seen the argument that the weak evidence for their effectiveness is entirely due to them being better placebos. What makes them a better placebo? Ironically, it is (according to this theory) that their side-effects are obvious to the patient, so those who are actually on them are more sure than the controls are that they are taking the drug under test, as opposed to the placebo being used in the trial.

SSRIs do have a studied and recorded physical effect of inhibiting serotonin reuptake, but what that actually does to someone is still not entirely understood, past "it can help with depression and/or maybe ADHD".

It's unfortunate that SSRIs have harmful long-term effects—I know some people who have been dependent on SSRIs for around a decade, and probably will be forever because of the neurotoxicity.

The main point is it's not even clear it can help with depression, at least not anymore than a sugar pill. I'm going to avoid referencing any single study since you can find a study to support practically any reasonable view. Instead I'd just encourage you to look up: 'ssri vs placebo' anywhere. The overwhelming body of evidence concludes that if there's any effect, it's absolutely negligible. And, as a previous poster mentioned, it may well simply be due to the fact that doing a double blind with SSRIs is not really possible. They have such a tremendous physical effect than any subject will absolutely know if they're getting the "real" thing.

And to be clear a placebo doesn't mean the effect of such isn't real. Mental state provably affects the body in all sorts of ways. Interestingly enough the placebo effect is often substantially stronger in Americans than in other groups as well [1]. The two main hypothesis there are that more poorly performing drugs are making it past regulators, the other is that the overwhelming amount of direct-to-consumer medical advertising creates a greater faith in the power of pills than in other countries - US/New Zealand are the only developed countries that allow direct to consumer medical ads. Or perhaps a mixture of both, like in many things.

[1] - https://qz.com/525995/why-the-placebo-effect-is-getting-stro...

There is space for placebos in conventional medicine. Doctors CAN and are allowed to prescribe placebos.

However medicine strives to maintain a separation between an actual body of scientific knowledge and placebo treatments. So, yes, while a placebo can be effective nobody is going to transcribe that placebo onto actual scientific knowledge as if it wasn't a placebo.

Right, so antibiotics work as a placebo, but am I going to put that knowledge down into textbooks that antibiotics can cure the common cold just because such knowledge effectively works as a placebo? No.

> antibiotics can cure the common cold

Antibiotics are not pure placebo. They are also given to make sure there isn't a bacteria ready to take advantage of the weakened immune system. The regular treatment for COVID also included antibiotics, for the reason I mentioned.

Prescribing antibiotics where they will be nothing more than a placebo is undesirable, but prescribing homeopathy where it will be nothing more than a placebo (i.e. in every case except dehydration) would have a number of undesirable consequences, including a predictable increase in the number of people who will turn to homeopathy when antibiotics are needed for themselves and, more importantly, for their children.

This reminds me of a cartoon (in the New Yorker?) where a patient is demanding a better placebo as the current one is not working.

> Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits?

You are comparing something that has cured many of humanity's illnesses (in fact, there's a good chance that you are alive thanks to antibiotics) with something that has the curative properties of rubbing quartz crystals or drinking blessed water.

Of course there is something unsettling about that comparison.

I’m not sure what the bias is here - maybe halo effect? - but the issue at hand is that the antibiotics are being used in a scenario where they cannot be effective. They are, in that way, a placebo to the same degree that homeopathy is, despite any other properties outside of the acute situation.

Say I have some really great tasting distilled water. Perfectly pure, exactly what I need if I wanted to quench my thirst. Now, I also have an empty gas tank.

Should I put water or flat Coca Cola in the gas tank? They are both bad, despite the separately superior qualities of the water. Or, maybe a better comparison is putting diesel in vs coke. They are equivalently bad for the engine despite one of them being used for a similar but separate situation.

Your metaphor is does not work well because water and coke are both pernicious to a car. A better one would be quelching thirst with water versus coke. Both will calm thirst, and are reasonably “neutral”. The second has pernicious effects, especially in some people (diabetes for example)

Distilled water has other uses besides drinking. It can be used in chemistry for example. You would not get good results in chemistry if you replaced distilled water with coke. “I can drink water, surely I can use coke instead of water on this chemistry experiment, because I can also drink coke” is clearly faulty logic.

And yet, that’s exactly what people do with homeopathy.

While it should always be presented as a “complement” to medicine(because it can have some mental/placebo effect in some people, in some cases), very often people take it as a substitute (the marketing word is “alternative”) to medicine. This is something that the homeopathic industry can’t help but “allow happening”. In fact they are motivated to promote that way of thinking. First it increases direct sales. Secondly, the more mixed up their product is with medicine, the stronger the placebo effect will be, and that will increase sales further.

Unfortunately the placebo effect is very limited. You can’t mend a broken arm with placebo alone. You can’t cure cancer with placebo alone. And yet people replace chemotherapy with homeopathic “remedies”. And then they die.

In short: doctors should never give homeopathic remedies, because that puts them on the same level as medicine. That will ultimately make some homeopathic makers richer, but it will also get some people killed.

I think a lot of this psychological layer has been ignored because it wasn't phenomenologically interesting to study as a science, but the important of the semantic/emotional layer is hard to ignore. A simple thought (say someone tells you something regarding your child that is not true but you believe it) can fuck up your biology down to physiological death.

Sadly, and obviously, the reverse isn't true, you can rarely cure infections through neurons triggering pathway cascades. But still.

It could be argued this is why wearing masks can be helpful, for some, even though there is no evidence they protect against respiratory viruses.

> Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence).

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

I prefer wearing my tinfoil hat :D

From the cited paper:

> The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.

Statement from the publishers: https://www.cochrane.org/news/statement-physical-interventio...

> The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.'

That's why I said there is no evidence.

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