
What if the Placebo Effect Isn’t a Trick? - sajid
https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html
======
jonawesomegreen
I listened to an episode about the placebo effect on the "Only Human" Podcast
awhile back. Its truly fascinating, and has made me question the power of the
mind in a way I hadn't before. It also has some really interesting ethical
problems, is it okay for doctors to lie about placebo treatments if it
actually helps?

> Kallmes performs vertebroplasty, a surgery he has helped to develop and
> standardize, that involves injecting medical cement into the fractured bone
> to stabilize the fractured area and relieve pain. He says he gets great
> results from his patients, and teaches the method to other doctors at
> conferences.

> But here’s the thing: he has no idea why vertebroplasty works. So a few
> years ago, he decided to test it against a placebo. Kallmes found that
> pretending to perform vertebroplasty – making it seem like he was injecting
> a needle into the spine but without the cement – had similar effects. About
> 40 percent of both groups experienced immediate relief from pain after the
> surgery. He published his results in the New England Journal of Medicine.

[https://www.wnycstudios.org/story/real-doctors-fake-
medicine...](https://www.wnycstudios.org/story/real-doctors-fake-medicine-
placebos)

~~~
BurningFrog
> _is it okay for doctors to lie about placebo treatments if it actually
> helps?_

Let's sharpen the question: What if the lie _is_ the treatment?

It sounds to me like the 40% who the placebo helps for have a different,
mainly mental, problem than the 60% for whom it doesn't.

~~~
da_chicken
Nope. Placebos can work _even when you know it 's a placebo_:
[https://www.health.harvard.edu/blog/placebo-can-work-even-
kn...](https://www.health.harvard.edu/blog/placebo-can-work-even-know-
placebo-201607079926)

~~~
psychometry
I wonder how much of that effect is due to subjects not understanding what a
placebo. Would the effect remain if the study population was other physicians
or scientists?

~~~
da_chicken
I think it's relatively unreasonable to assume that when the study says that
participants are informed that they're taking a sugar pill that the
participants don't understand what that means, nevermind assuming that no
effort at all was made by the administrators to address this fairly obvious
issue. If the entire point of the study is testing whether or not patients
still benefit when they understand that they're not taking any medication, it
seems self-evident that they would be required to ensure their test subjects
understand that they're not taking any medication!

~~~
thedailymail
From the article, the guy who ran the study apparently still has reservations
on this point: "And he can even be disparaging of his own work, wondering, for
instance, whether the study in which placebos were openly given to irritable
bowel syndrome patients succeeded only because it convinced the subjects that
the sugar was really a drug."

------
Joe-Z
To counter some off the off-the-cuff comments here:

These researchers (specifically molecular biologist Kathryn Hall) seem to have
found a link between an enzyme called COMT and response to placebo treatments.
That is, people with a genetic pre-disposition for lower COMT-production will
respond less to placebo effects and MORE to actual drugs whereas for people
with higher COMT-levels the opposite holds true.

I think this is a fascinating finding and does a lot to do away with hand-
waving explanations of the placebo-effect as 'it's all psychology' (just look
in the comments here).

Unfortunately the article ends with a kind of esoteric tone of one of the
researchers, in that he believes it would be unfortunate if we did away with
the rituals and warmth and caring involved in more esoteric practices
completely. I don't really get that: If we figured out why the placebo effect
works and we can very effectively treat patients depending on their genetic
pre-disposition that's awesome!

~~~
danieltillett
The patients that respond to the placebo are the bane of pharma companies
developing a new drug. More than one drug trial has failed because the placebo
arm has responded. It is so bad that in some trials they will run a pre-trial
where everyone gets the placebo and the responders are excluded before the
main trial starts.

It would be interesting to see what else COMT levels are correlated with
especial religious and social beliefs.

~~~
Joe-Z
>It would be interesting to see what else COMT levels are correlated with
especial religious and social beliefs.

Very interesting indeed! Maybe it's my 'I'm such a rational thinker'-pride,
but I guess I'm in the group that doesn't respond strongly to placebo effects.
I'd be more than happy to pop a social-wellbeing pill in combination with
whatever pill I need to treat my condition. As opposed to Mr. Kaptchuk’s view
that it would be a shame if we lost this dependency on other humans and their
empathy for healing.

------
billyjobob
Whoever thought the placebo effect was a ‘trick’?

It’s well established that the mind controls the brain which controls the
body. (And the other way around, too). A physiological problem in the mind can
cause a chemical problem in the brain which can cause a ‘physical’ problem in
the body. Or heal a problem in the body.

Quotes around physical because mind and body are both physical. If doctors are
surprised by this it must be because they are still clinging to some form
Cartesian dualism.

~~~
abnry
The placebo is based on belief. You give a sugar pill to someone and they
believe it is something more. That's "tricking them."

And yes, I do think most doctors in Western medicine cling to a form of
Cartesian dualism. It's somewhat tempered, but the mind body connection is
vastly underexplored.

~~~
dwighttk
From the article:

>You don’t even have to deceive the patients. You can hand a patient with
irritable bowel syndrome a sugar pill, identify it as such and tell her that
sugar pills are known to be effective when used as placebos, and she will get
better

~~~
read_if_gay_
I can't point to a source but I remember reading somewhere that the effect is
significantly weakened if you tell patients it's just a placebo, although it
doesn't vanish.

~~~
Sean1708
FWIR it's more about their expectation of effectiveness, if they believe the
placebo will be effective then the placebo will be more effective.

------
collyw
I find it unusual that many people will dismiss the placebo effect yet will
happily accept that stress can cause lots of negative reactions
physiologically. They seem like two sides of the same coin to me.

------
turingcompeteme
> the rituals embedded in the doctor-patient encounter that he thinks are
> fundamental to the placebo effect

> “Medical care is a moral act,” he says, in which a suffering person puts his
> or her fate in the hands of a trusted healer.

I have a friend who is a naturopath, and this is basically what she believes
her job to be. Almost more of a therapist at times, a friendly ear to confide
in.

The average experience with doctors isn't always that pleasant. It feels
clinical and rushed, and very non personal. They are concerned with symptoms,
not the actual person in front of them. They don't really listen, as a
therapist would. And it's not their job too.

Contrast that with an alternative healer. They will sit and talk and listen
and empathize with you for an hour. For a person in pain, it might be the
first time they have ever felt like someone actually understands and cares.
It's not surprising that they feel better afterwards. I think that goes a long
way to explain the popularity of fake medicine.

~~~
srtjstjsj
How does that explain the popularity of shelves full of fake pills at GNC and
Walgreen's?

~~~
gameswithgo
I imagine those are popular because for many problems there are not yet any
real solutions.

Got a cold? A muscle tear, connective tissue damage? weird back pain?

There are no definite solutions to those. And ever smart HN person who think
they know the solution to that, only knows a thing that they believed worked
for THEM and won't necessarily work for ME and may not even have worked for
them, it just got better with time and they think it was their special cross
fit routine because of chronological fallacy.

------
gcthomas
The 'placebo effect' seems to be wholly the effect of the sum of biases and
psychological effects on reported outcomes in the placebo (non-treatment) arm
of medical trials. It doesn't mean there is an 'actual' effect, it is just
that reported benefits by patients is affected by the situation. 'The nice
doctor gave you pills, and trying to be helpful you might respond more
positively when asked if you are any better.' Or 'patients with a temporary
flare up in their condition were invited onto a trial, and - lo - they got
better even without the active treatment.'

Placebo just refers to the bundled biases and other uncontrolled-for
influences. It is not a real thing that can be used to make anyone actually
better. Whenever there is a physical measurement that can be made about some
affected body function, the placebo effect mysteriously disappears.

~~~
virgilp
I don't know about that. There's also the nocebo effect [1] that is rather
well known. You make it sound like "placebo" is purely a bias thing, but AFAIK
both placebo & nocebo effects, though presumably psychogenic, can sometimes
induce measurable changes in the body.

[1][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401955/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401955/)

~~~
gcthomas
Don't you think it is intriguing that the placebo effect only gets reported
for non-specific subjective complaints, and not physically measurable ones?

~~~
gameswithgo
This article lists a few physically measurable changes caused by placebo:

[https://www.medicalnewstoday.com/articles/306437.php](https://www.medicalnewstoday.com/articles/306437.php)

------
david927
It gets quite strange:

 _A prominent placebo researcher, Dr. Fabrizio Benedetti, was able to show
just how peculiar the placebo effect really is. After inducing pain in
participants for seven days whilst treating them with morphine, Benedetti
secretly switched the pain medication to salt water. Luckily for him, the
participants’ reports of pain went unchanged. Then things got weirder.
Benedetti didn’t want to stop there, so he [secretively] gave the participants
a morphine blocker and, bizarrely, the participants found that their pain
returned, suggesting a form of biochemical reaction to the salt water
placebo._

So you give people morphine and it works (to block pain). Switch it secretly
with salt water and it still works. Secretly add a real morphine blocker and
it no longer works. Bizarre.

~~~
minor3rd
> suggesting a form of biochemical reaction to the salt water placebo.

I know this was a quote from the article, but... Does it really suggest that?
Isn't it possible something else is going on?

~~~
bergoid
Could it be that this morphine blocker is blocking endorphins?

[https://en.wikipedia.org/wiki/Endorphin](https://en.wikipedia.org/wiki/Endorphin)

------
maltalex
The headline reminds me of my high school math teacher that would say that the
difference between _tricks_ and _methods_ is that _methods_ are _tricks_ that
have been used more than three times.

By the same token, it's only a _trick_ as long as the underlying mechanism is
unknown.

------
empath75
I had a really hard time with medical anxiety after my dad almost died from
pancreatitis suddenly. Stomach pains, heart palpitations, numbness in various
places. I was convinced I had 10 different fatal diseases. I wasn’t making up
symptoms. I had real pain, a chronic cough, and real pvcs that showed up on
ekgs. It took a lot of doctors and a lot of tests to convince me that I was
okay. And then i started to understand that all of my symptoms matched a
single disease— “anxiety”. And I started focusing on letting things go and not
thinking about it and avoiding triggers like caffeine and all of my symptoms
just ... stopped. A miraculous cure of like 10 different things I was utterly
convinced I was dying from. Even the pvcs and my non-stop post nasal drip
stopped almost entirely.

The body is fucking weird.

~~~
athenot
"Scared to death" is not just an expression, as your case perfectly
illustrates.

There's a general tendancy to discount the matters of the mind when treating
the body, but both are very much connected and usually for a good reason—at
least from an evolutionary perspective. In the US, there's often a stigma
associated with just admitting weakness. Support exists but it's not always
easy to come by.

It helps a lot if you can find a Primary Care Physician who has at least some
notions of psychology and can help bridge that gap—and if needed, recommend
the help of specialists regarding our thought processes. (In your case, it
sounds like you were on your own to figure this out: glad it worked out,
though!)

------
seanwilson
What's the most impressive placebo effect recorded in a study? Is it always
limited to mild pain relief?

For stories like this, people always predictably discuss how ethical it is for
doctors to knowingly prescribe placebos for stories and how different
interventions have different impacts.

If placebo alone can't cure anything and only gives mild pain relief, I'm
surprised nobody mentions it's overhyped.

~~~
kevinmchugh
I'm still reading the submitted article, but with the many relevant useful
comments of `tokenadult in mind:
[https://hn.algolia.com/?sort=byPopularity&prefix=false&page=...](https://hn.algolia.com/?sort=byPopularity&prefix=false&page=0&dateRange=all&type=comment&query=author:tokenadult%20placebo)

> Placebo effects are strongest for patient self-reported subjective symptoms
> (classically, pain) and weakest for objective clinical signs measured by
> experienced observers.

~~~
seanwilson
Do you have a specific example of a very strong placebo effect though that's
beyond patients reporting mild pain relief?

My point is people seem to discuss placebo with an implied assumption that the
effect is so big it's worth e.g. discussing the ethics of prescribing it. If
it's only giving mild pain relief I don't see why it's that interesting.

~~~
JoeAltmaier
All of Homeopathy? It operates on the principle that a cold when untreated
will last 2 weeks, but with placebos will only take 14 days.

~~~
aagha
Ugh. It's so disappointing to see this comment from someone who clearly didn't
read the article.

And you're misrepresenting Homeopathy--that's not the principle on which it
operates.

------
mudil
I believe that placebo-like effects extend to other areas of life, outside of
health. Tell people that they are victims of some historical injustice or
discrimination and such, and these victim's beliefs will keep people from
advancement to their best capacity. They genuinely can't advance. Similarly,
in situations of domestic abuse or sexual abuse: whatever happens on
psychological or biochemical level, keeps these people down, genuinely unable
to properly recover or move on.

Seems to me that attitude is 90% of success in this world...

------
08-15
Does anyone know of a study that finds an _actual_ placebo effect?

As far as I can tell, there are two distinct effects, and both are
meaningless. The first "placebo effect" is observed everywhere, and is simply
reversion to the mean. Nobody studies a treatment on healthy people, because
treating people for a condition they don't have makes for a very expensive
study. But some of those people get better spontaneously, and some weren't
even sick, but had the right symptoms. Their improvement without actually
being treated was originally called the placebo effect.

The other "placebo effect" is the one where treatment with a placebo
(preferable an expensive placebo labelled "forte" and administered by the
chief of medicine) is more effective than no treatment. But that effect only
happens where the only way to measure the outcome is by asking the patient. A
human is a very unreliable instrument. A human may report that the irritable
bowel is gone because he doesn't take the symptoms as seriously anymore after
the treatment, or maybe because he just wanted attention and there had never
been an irritable bowel.

So, does anyone know of a study that finds a placebo effect that isn't
explained by "bad instrument" aka. self reporting?

~~~
svachalek
Reversion to the mean is _not_ the placebo effect. The placebo effect is what
you're calling the "actual" placebo effect, and in many cases produces
objectively measurable results, which is why they need to account for it in
drug trials: you compare both the drug and the placebo to the control group
and see if the drug exceeds the placebo. As far as I know, practically every
such drug trial validates that the placebo effect is real.

~~~
08-15
You're wrong, at least according to Wikipedia. But I don't want to argue
semantics, I just want _one_ study that shows a measurable (not self-reported)
effect. Just one. Please?

~~~
jose_zap
[https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/](https://www.ncbi.nlm.nih.gov/m/pubmed/1286471/)

Retrospectively analyzes patients who got placebo, vs natural course patients.
Placebo group fared better in physical exercise compared to the natural course
group.

------
nradov
Has anyone studied whether there is an opposite anti-placebo effect? Like if a
patient lacks confidence in their doctor and doesn't believe that a real
medicine will actually work, is it less likely to be effective?

~~~
aurbano
That sounds like the _nocebo_ effect maybe? From the Wikipedia page [1]:

> A nocebo effect is said to occur when negative expectations of the patient
> regarding a treatment cause the treatment to have a more negative effect
> than it otherwise would have.

[1]
[https://en.wikipedia.org/wiki/Nocebo](https://en.wikipedia.org/wiki/Nocebo)

------
pella
_" Open label placebo: can honestly prescribed placebos evoke meaningful
therapeutic benefits?"_

 _" Results from small clinical trials suggesting that placebos can be
ethically and effectively used in clinical practice warrant further study,
argue Ted Kaptchuk and Franklin Miller"_

BMJ 2018;363:k3889 doi: 10.1136/bmj.k3889 (Published 1 October 2018)

[http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-...](http://media.virbcdn.com/files/01/147bb1aea3d8c05b-Kaptchuk-
MillerBMJOLP2018.pdf)

"Key messages:

\- Placebo pills in randomised trials can significantly benefit patients’
subjective symptoms

\- Using placebo pills clinically is an ethical challenge as prevailing wisdom
asserts that deception or concealment is required

\- Recent small randomised trials suggest that openly prescribing placebo can
evoke meaningful therapeutic benefits

\- More research is required to determine the role for open label placebo and
the conditions in which it is effective.

"

------
TuringTest
From what I have understood, the Placebo effect is the most thoroughly studied
medicine, with millions of real test cases.

~~~
stevenwoo
Nobody investigated the why like this - the two scientists followed most
prominently in the article possibly found a genetic marker for high and low
responders to placebos, partly because those two had the background and
experience with placebos working in acupuncture from professional work and
treatment and the expertise to investigate.

------
hyperpallium
It isn't a trick. It's why pharmaceutical trials have a placebo control, not a
nothing-control.

There's been studies done on the effect of different placebos: bigger pills,
with bigger markings, administered by professionals in professional settings
etc work better.

My pet theory is that, since almost all medicine merely assists the body's own
healing (e.g. a plaster cast doesn't heal the bone), the belief of safety and
being looked after is enough for your body to switch resources away from
dealing with a threat towards healing. (You can't afford to heal while your
attacker is still around.)

A placebo signals safety.

~~~
obruchez
IIRC, it was more or less the idea developed by Dylan Evans in "Placebo: Mind
over Matter in Modern Medicine".

------
breatheoften
I would love to see some more advanced psychological manipulation experimental
results for medicine ... “I proscribe you to not take this pill twice a day.
By that I mean, here’s a bottle of pills which have been shown to alleviate
your ailment, however I believe your case is best addressed by you deciding
not to take this medicine. Therefore, twice a day, please follow these
directions: remove a pill from the bottle, place it in your hand, look in the
mirror and then put back in the bottle and close the lid.”

Many Trippy effects are possible.

------
gbuk2013
I'm currently reading "The Biology of Belief" by Dr. Bruce Lipton and feels
very relevant.

------
xutopia
Can anyone help me figure out if I'm of the variant of the rs4680 allele that
is most placebo respondent if I have my 23andme results (I am variant G)?

~~~
Beefin
A;A = placebo more effective G;G = placebo less effective

~~~
xutopia
Thank you!

------
api
I had a psychologist tell me about a case once where a person had a condition
(I forget which, I think it was mild diabetes) but only when they were living
at home with their family.

They tested positive for this condition. It wasn't all in their head. But then
again it was in some sense. They spent time away from their family and their
condition would stabilize to the point that they'd no longer test positive. I
asked about things like diet and sleep and the guy telling me the story said
that this was of course the first thing they checked and the person's diet and
sleep habits hadn't changed.

The psychologist who told me this story wasn't particularly "woo-woo" and was
personally blown away by it. He said you can find other cases like this in the
literature.

Anecdotes like that aren't proof, but they're interesting in that they agree
with some of this placebo effect research. It looks as if the brain has more
influence over the body than we realize or understand.

~~~
raincom
VS Ramachandran's _Phantoms in Brain_ (p.224): "A second example of a genuine
anomaly is multiple personality dis­ order or MPD, which in my view may turn
out to be just as important for medicine as continental drift was for geology.
To this day MPD con­tinues to be ignored by the medical community even though
it provides a valuable testing ground for the claims of mind-body medicine. In
this syndrome-immortalized by Robert Louis Stevenson in Dr. Jekyll and Mr.
Hyde-a person can assume two or more distinct personalities, each of which is
completely unaware, or only dimly aware, of the others. Again, there have been
occasional reports in the clinical literature that one personality can be
diabetic while the other is not, or that various vital signs and hormone
profiles can be different in the two personalities. There is even a claim that
one personality can be allergic to a substance while the other is not and that
one might be myopic-or nearsighted­ whereas the other has 20/20 vision."

------
TangoTrotFox
Something interesting is that numerous studies have shown that a number of
psychotropics, including the monstrosity that's fluoxetine/prozac, perform at
levels that is hardly better than placebo. In many cases the difference is not
statistically significant. This [1] paper/article provides an overview of a
variety of data. It also goes into how these sort of drugs manage to get
approved in spite of negligible performance. The paper gives the example of
vilazodone/viibryd. That drug went through 5 trials. They showed absolutely 0
effect. In some of the trials the placebo outperformed the drug. Undeterred,
the company continued running trials. In the next two they managed to show a
very small effect, probably similarly to how if you flip a fair coin enough
eventually you'll get heads 10 times in a row 'proving' the coin isn't fair.
Anyhow those two trials showing a minuscule effect were enough for the FDA
which now states, _" The efficacy of VIIBRYD was established in two 8-week,
randomized, double-blind, placebo-controlled trials."._

I find this just completely fascinating. That prozac shows a negligible effect
over placebo in blind studies is even more interesting to me because of the
side effects. It has some really serious side effects - you'd know if you were
getting the 'real' stuff, at least if you were allowed to communicate with the
others who were. And the prozac brand alone was, at its peak, reaching profits
of $2.6 billion a year. This creates a nasty incentive for pharmaceutical
companies to target 'drugs' at conditions that can be treated by placebo.
Because in these cases, you can always prove the drug works, without actually
having to go through all that nasty work involved in creating a drug that
actually works.

[1] -
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/)

------
ekianjo
It's important to note that placebo effect does not work at all on stuff like
infectious diseases. There are clear categories of diseases where your
psychological state will have absolutely close to no influence on the outcome.

~~~
jobigoud
You also can't use a placebo for euthanasia, it doesn't work. You also can't
suicide by overdose with a placebo. (plot point in a short story I drafted a
while ago).

------
david927
FDA Approves Sale Of Prescription Placebo

[https://www.theonion.com/fda-approves-sale-of-
prescription-p...](https://www.theonion.com/fda-approves-sale-of-prescription-
placebo-1819567087)

------
msamwald
It's important to understand that if a clinical trial shows some improvement
in the control group that received placebo, this does not need to be due to
some placebo 'effect' at all.

The status of patients usually changes all the time. If the control group had
some minor improvement in some endpoint, this might be due to wide variety of
reasons. For example, the disease might just get somewhat better by itself.
This does not necessarily imply that this was due to patients that were given
placebo experiencing a placebo effect. They might just as well have gotten
better without the placebo.

------
boomboomsubban
A hundred and thirty comments and zero uses of the words "gene" or "genetic."
Nobody else thinks evidence connecting the presence of a gene with
susceptibility to the placebo effect is interesting?

------
celticninja
I believe that the placebo effect is significant enough that I have told my
wife that if I ever become ill then she should discuss the possibility of
giving me a placebo treatment with a doctor without my knowledge. Although it
works when people know it is a placebo it seems to work better if people don't
know. So for example, if I get ill and they aren't sure what to do, give me a
placebo and tell me it is medicine for my illness, whatever it is, and see how
that goes. If it works dont ever tell me it was a placebo. Its got to be worth
a shot.

~~~
consp
So basically homeopathy?

~~~
celticninja
No. If you don't understand the difference between placebo and homeopathy I
suggest you do some reading into them both.

~~~
consp
/s is apparently non optional these days...

They both have non working components (or no working components whatsoever)
and solely rely on the placebo effect for providing any form of relief (if
any).

A proper placebo is on the other hand only used in medical testing.

So please explain to me what you think I should read about? Since you are
suggesting I read something.

------
breatheoften
It seems to me that the medical profession already has enough bias to defend
the fruits of their own research and claim ownership over a capacity to offer
that which cannot be achieved through other means.

The idea that a placebo is as effective as some intervention is not evidence
of efficacy of placebo — it’s evidence of lack of efficacy of the
interventions ... if what you have to offer can’t beat doing nothing, then you
shouldn’t be charging for it ...

~~~
mario0b1
It makes sense, but is it always true? Especially with antidepressant drugs.
There are lots of studies like 'Placebo patients had the same result as
patients on drug X', but how do we find out if X is not needed for everyone?
How do we get our minds to cope with the thought of X being useless? I am not
really sure. Only my feeling says that i would love to get lied to in this
situation

~~~
breatheoften
Could we use a range of placebos in order to better control for the effect of
statistical outliers? I feel like the uniformity implied by “placebo=sugar
pill” might not be rich enough to account for the range of effects that might
be at work ... I actually agree that the belief that something effective is
being done could play a real role in actual healing — but I don’t think it’s
been shown by any of these studies that this manner of belief can be
meaningfully packaged into a one size fits all sugar pill...

------
driverdan
I'm surprised no one is commenting on how poorly this article is written. It
lost me at paragraph four.

Paragraphs three and four completely misrepresent the placebo effect. They
suggest that it cures problems. That's not what it is. It changes
_perception_. Mental effects, like pain, are what placebo changes. It never
cures underlying physical problems.

~~~
matt4077
I'm surprised you blame your lack of reading skills on the New York Times.

Because a problem that isn't perceived is, almost by definition, no longer a
problem.

Look: this is basically the tree-in-forest-noise debate. And your chosen
interpretation actually isn't completely without merit.

But what _is_ illegitimate is to deny even the existence of other
interpretations, and then use that ignorance for yet another tiresome and
shallow attack that does not even have the self-awareness to recognise how
preposterous it is to believe two dozen words could somehow expose this writer
as a complete fraud while the entirety of the _Time 's_ editorial leadership
missed it.

------
sveit
A great book on this topic is Suggestible You by Erik Vance. He addresses some
of the scientific basis of the placebo effect.

~~~
gnclmorais
This book was so effective on changing my views about placebo effect. I very
much recommend it.

------
gypsy_boots
For anyone interested in further reading on the topic of the placebo effect,
I'd recommend the book 'Cure'[0] by Jo Marchant

[0]:[https://www.amazon.com/Cure-Journey-into-Science-
Mind/dp/038...](https://www.amazon.com/Cure-Journey-into-Science-
Mind/dp/0385348177)

------
tryonqc
From The Secrets of Consulting by Gerald M. Weinberg

> _The First Great Secret of the Medical Profession: 90% of all illness cures
> itself with absolutely no intervention from the doctor. Each of us, after
> all, is the direct descendant of innumerable unbroken lines of survivors_

------
Beefin
For anybody curious, the placebo gene + variation is COMT (A;A). I build a
gene reporting tool to help with this if you have 23andme it should work:

[https://gene.meports.com](https://gene.meports.com)

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joaomacp
I am amazed by this.

I've also read if a parent gives some home treatment (e.g. a warm cup of milk)
to a kid and caringly says that it'll cure his cold, the immunity of the kid
actually increases, effectively curing the cold with love.

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rednerrus
Is there some way for us to administer a mind-altering drug that induces
suggestibility and alter the way we think about our diseases as a way to
combat them?

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kopo
That was one good read.

Scanning the comments, surprised no one has brought up religion.

Specifically why religions, all religions, need rituals. Not just
narratives/imagery/a priest class etc.

Rituals, to the scientist or non believer look totally meaningless and crazy
even, but to the believer it's a fundamental part of the dance that renews
faith. Faith in what? Faith in the fact that tomorrow will be a better day.

Visit a cancer hospital and for a lot people that is still the best medicine
on offer. I like this Ted Kaptchuk dude and it's good to see the work he has
done.

~~~
yakovdk
Some scientists are religious, so ritual may be meaningful and sensible to
them.

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l0b0
Something else that could make the placebo effect seem real: Only publishing
positive results. There seems to be this unspoken agreement that once the
efficacy of a treatment is shown in scientific studies there is no placebo
"factor" contributing to it helping people. But of course after a successful
study the placebo effect of that treatment is _stronger,_ because it convinces
even more people (doctors, sceptics) that it's effective.

Consider umpteen variants of the same treatment being tested, and one of them
showing strong results
([https://www.xkcd.com/882/](https://www.xkcd.com/882/)). That medicine then
surfs on its own placebo effect until its efficacy is refuted (if that ever
happens) by another study or it's replaced by something with a stronger
result.

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narrator
Isn't meditation exploiting the placebo effect since it is merely an exercise
of the will that distinguishes it from non-meditating?

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abductee_hg
[https://sciencebasedmedicine.org/placebo-myths-
debunked/](https://sciencebasedmedicine.org/placebo-myths-debunked/) 'nuff
said.

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thoughtexplorer
I'd be curious to hear HN's thoughts about this in relation to the chronically
ill, such as those featured on Netflix's Afflicted series
([https://www.netflix.com/title/80188953](https://www.netflix.com/title/80188953)).

> Wi-Fi and electricity trigger Carmen's strange symptoms. Jamison hasn't left
> his room in two years. Bekah lives in a van in the desert to avoid mold.
> Star has been diagnosed with a dozen different conditions.

How much of it is real, how much of it is the mind making it real?

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sbhn
The placebo effect isn’t a trick.

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mannykannot
"What if the placebo effect isn't a trick?" \- then it will surely be
patented.

~~~
yitchelle
Nice idea - Those who is paying a royalty for it is literally paying for
nothing.

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benrapscallion
The beauty of placebo effects is that like weight loss or quitting smoking,
the health benefits are pleitropic, suggesting that we are impinging on
fundamental health-promoting biological pathways.

