Placebo Effective Only With Some Deception

Can The Placebo Effect Really Work Without Deception? Maybe, Maybe Not

Deception is a key ingredient for the mind to manufacture a remedy out of nothing, right?

That’s how we thought the placebo effect worked since its discovery some 70 years ago, but new research is offering a different take.

A study suggests that the placebo effect may not hinge entirely on deception, but rather on the effect of being “immersed in treatment.”

In other words, if taking a placebo is part of the treatment, the mind can use it to boost treatment effects even if patients know they aren’t taking actual medicine.  

Bottom line:

the study results could be skewed by giving placebos to people predisposed to thinking they’ll work.

Quoting the researchers from the study limitations section, “The results might not be generalizable to all patients.”

The study was conducted by a team of researchers from Beth Israel Deaconess Medical Center in Boston and Instituto Superior de Psicologia Aplicada (ISPA) in Lisbon, Portugal.

Just under 100 patients suffering from chronic lower back pain were given a 15-minute explanation of the placebo effect and then divided into two study groups for three weeks.

  1. One group took nonsteroidal anti-inflammatory drugs (NSAIDs, the class of drugs that includes ibuprofen, which most were already taking before the study) and
  2. the other group was instructed to also take a placebo pill twice daily. The placebos were clearly labeled “placebo pills” on the bottle.

The results showed that patients in both groups experienced a reduction in pain.

  1. The group taking only NSAIDs experienced a 9% reduction in their usual pain level and a 16% reduction in maximum pain.
  2. But the group taking NSAIDs plus a placebo experienced a 30% reduction in both usual and maximum pain.

The placebo boost was more than three times as much for usual pain and nearly twice as much for maximum pain.

“Our findings demonstrate the placebo effect can be elicited without deception. Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered,” said lead study author Claudia Carvalho, Ph.D., ISPA.

The results are in line with those of a previous study conducted by the Beth Israel team, led by Professor Ted Kaptchuk from Harvard, showing that patients suffering from irritable bowel syndrome (IBS) can experience improvement from knowingly taking a placebo.

About 60% of patients reported less severe IBS symptoms after taking a placebo pill

These are interesting outcomes, but it’s possible the non-deception element was overstated.

Both the latest study and the IBS study were pitched to participants as “novel mind-body management” studies, which the researchers admit may have attracted people already given to thinking that “mind-body” interventions work just as well as traditional medicine.

If that’s the case, then deception wasn’t really removed from the equation.

The expectation of a result was still created for the participants (i.e. the placebo would help them) just not via traditional means.

A true non-deceptive test of placebos should remove all such suggestion-planting.

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5 thoughts on “Placebo Effective Only With Some Deception

  1. Laura P. Schulman, MD, MA

    I believe this is what I call the “contact effect.”

    Here, patients are paired with highly motivated study nurses or other providers who spend quality time getting to know the patients and giving them undivided attention, which is in itself therapeutic. The fact that they had full knowledge that the substance was a placebo gives us a hint that there was some other cause for the observed effect. Rather than making the assumption that the act of taking the placebo was in fact the cause, let’s experiment with the possibility that the effect could be due to contact with one or more compassionate caregivers. I believe this is how healing works. Drugs have specific pharmacologic actions, but as soon as you stop taking them, they’re gone. Caring human interaction can lead to durable healing. If you show me kindness and compassion, that you’re genuinely interested in my well-being, and you hand me a bottle of something that’s labeled “nothing,” when I take that pill I’m going to think of you, and I will get a rush of oxytocin and other warm fuzzy chemical messengers. I will feel better! So the agent of my change for the better is not in fact the pill, but the fact that it was given to me by a caring “other.” This is the power of the “healing relationship.”

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    1. Zyp Czyk Post author

      I’ve seen several healers throughout my life and have never felt physically better afterward. Why doesn’t this work for me?

      When I start a new medication with great hope, the placebo effect has never lasts longer than 3 days – and usually fades in 24hrs.

      I really don’t understand why can’t I get any benefit from what so many others find so helpful.

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      1. Laura P. Schulman, MD, MA

        Maybe you have low oxytocin levels. I think the bond of trust in the healing relationship hinges on the ability to trust. I’ve had a few patients who were initially “hard to warm up,” which is a term borrowed from child psychology. For some reason, that’s how some people are. Bonding with a healer depends on proper fit between healer and patient (in my practice I use the term, “partners in healing, rather than doctor/patient, because my job is to be a catalyst for your healing. My magic wand is in the shop, right next to my crystal ball). You may simply have not yet encountered the right healer for you. It follows the principle, “When the student is ready, the teacher will appear.”

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        1. Zyp Czyk Post author

          That’s strange because I’m unusually trusting and I eagerly jumped into every new therapy and treatment. I’ve only become cynical after decades of therapy failures finally made me realize I’ve wasted thousands of dollars :-(

          Even when it’s not working, I try to explain it away and keep seeing the therapist in the hopes of getting their method working for me. I feel a “loyalty” to the treatment provider and only very reluctantly finally give up.

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          1. Laura P. Schulman, MD, MA

            That’s all on the mental plane. If you don’t have a heart connection and are sticking with something simply out of “should,” then it very well might not stick. The exceptions are homeopathy and acupuncture, which work on animals as well as or better than on humans. Bear in mind that not all practitioners of these arts are created equal! There are artists, and there are OK ones, and there are….not so talented ones. And an acupuncturist who does wonders for person A might not have the magic for person B. Not standardized, which is one big beef from “Western” medical types. As if their treatments were actually standardized! Fooey.

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