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Comment by tinco | Hacker News Reader

Not necessarily. A placebo might perform as good as a regular drug in clinical trials, where there is a 50% chance of it being the real thing and there is significant personal interaction with researchers. Also for some reason people always assume that if there is a clinical trial with humans involved the real drug will probably work very well.

In real world scenarios however drugs might be bought with _no_ personal interaction with professionals at all. Furthermore people are very sceptical of the long-term effects of any psychology related drug. In this case the placebo's might perform a lot worse than the actual drug, which may have an actual noticeable effect.

The placebo effect is effective, cheap and safe, and might be present in both the placebo and the tested drug. But the placebo can't be sold as medicine. And the tested drug might still work without the placebo effect.

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Ultimately, I understand it as this.

Especially in terms of psychological effecting drugs

If the people getting the placebo get better (in the case of psychological drugs.. feel better) as often as those on the actual drug, then it's quite likely the drug is doing nothing and both sets of patients are getting better because the belief of taking a drug that makes them better is causing them to get better.

(apologizes for the confusing paragraph)

And hence, the drug is deemed worthless and thrown out, time to get on with a trial of another drug.

"it is quite likely the drug is doing nothing"

The only way to be sure that the drug is doing nothing is to repress the placebo effect as much as possible.

There are people dying or suffering that could be helped with drugs that failed the placebo test. (Some of them could even have been helped with the placebos themselves)

But if the placebo effect is caused by human interaction, would this suggest that the best therapy is simply one-on-one counselling rather than a new chemical? In other words, we need to help people change their way of thinking more so than mess with the chemistry of their brain.

Yes, but one-on-one counselling is expensive and error-prone. In an ideal world everyone had access to a doctor that has the time and spirit to treat all of his patients with dedication and positivity.

In the real world enrollment to medical schools is heavily throttled and doctors in cities have many more patients then they can cope with.

There might be enough psychiatrists and other therapists, but they are not believed to be able to cure physical pain (even though they are), which renders them less effective. This is why these therapists rely so much on these medications that seem to have little effect over placebos.

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