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' “.
> 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.
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.
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.
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...