Skeptic: Examining Extraordinary Claims and Promoting Science Skeptic: Examining Extraordinary Claims and Promoting Science

top navigation:

Wednesday, May 20th, 2009 | ISSN 1556-5696

eSkeptic: the email newsletter of the Skeptics Society

Share this eSkeptic with friends online. Subscribe | Donate | Watch Lectures | Shop



So much has been written and said about the placebo effect that we thought we should put our SkepDoc on the trail of finding out what is fact and what is myth about placebos and their effects. You will be surprised by some of Dr. Hall’s findings. Be sure to check out the relevant books and the Skeptic back issue that we‘ve highlighted in the article which are available at Shop Skeptic.


The Placebo Effect

by Harriet Hall, MD

Jane D. was a regular visitor to our ER, usually showing up late at night demanding an injection of the narcotic Demerol, the only thing that worked for her severe headaches. One night the staff psychiatrist had the nurse give her an injection of saline instead. It worked! He told Jane she had responded to a placebo, discussed the implications, and thought he’d helped her understand that her problem was psychological. But as he was leaving the room, Jane asked, “Can I get that new medicine again next time instead of the Demerol? It really worked great!”

What’s going on here? What is the placebo effect and how does it work?

The term “placebo effect” is unfortunate; it leads to misunderstandings. Placebos themselves don’t have any effect. They are inert: that’s what placebo means. The word placebo comes from the Latin for “I please.” You can think of it as the opposite of “I benefit.” What we really mean by “the placebo effect” is not some mysterious effect from giving an inert treatment, but the complex web of psychosocial effects surrounding medical treatment. Those effects occur with effective treatments too, not just with inert treatments.

Mark Crislip, MD, thinks the placebo effect is a myth. “I think that the placebo effect with pain is a mild example of cognitive behavioral therapy; the pain stays the same, it is the emotional response that is altered … Ain’t no such thing as a placebo effect, only a change in perception.”1 He’s correct in saying that the placebo effect does nothing to change the pain signals in the nerves. But most people think the change in perception is the placebo effect and is worth pursuing.

There is a big difference between pain and suffering. A woman’s labor pains hurt, but with a joyful end in sight she may not suffer as much as a man who has milder pain sensations but is worried that his injured leg may need to be amputated. Some people say that morphine doesn’t relieve pain so much as make you not care about it. The experience of pain and the meaning of pain for the patient matter as much as the strength of the pain stimulus. If the placebo effect can do anything to divert the patient’s attention or help him reframe the meaning of his pain, his altered perception can reduce his experience of suffering.

Beecher Says Placebos Are Powerful

In 1955, Dr. Henry Beecher published a seminal paper entitled “The Powerful Placebo” in the Journal of the American Medical Association.2 He reviewed studies that compared an active treatment to a placebo, and found that on average 35% of patients improved with the placebo. So any study that doesn’t have a placebo group for comparison is likely to give a false positive result. The placebo-controlled trial is now one of the cornerstones of medical science. It’s not enough to show that Miracle-mycin works; we have to show that it works better than a dummy pill that looks like Miracle-mycin but only contains sugar.

Beecher’s paper has been widely cited as evidence that 35% of patients respond to placebos, but that’s not really what it showed. He wasn’t measuring the placebo effect in isolation — he was actually measuring a combination of the placebo effect, the natural course of disease, and other factors. The patients who apparently responded to placebo included patients who showed improvement for other reasons. Reasons like spontaneous improvement, fluctuation of symptoms, regression to the mean, answers of politeness, experimental subordination, conditioned answers, misjudgment, etc.

Hrobjartsson Says Placebos Are Powerless

To tease out how much of that 35% should be attributable to placebo, we need to know how many patients might have reported improvement without any treatment. In 2001 two Danish researchers, Asbjorn Hrobjartsson and Peter Gotzsche, published a paper entitled “Is the Placebo Powerless?” in the New England Journal of Medicine.3 They reviewed studies that included a no-treatment group, and they compared the improvement with placebos to the improvement with no treatment. They “found little evidence in general that placebos had powerful clinical effects.”

For studies with a binary outcome (improved versus not improved) there was no significant difference between the placebo and no treatment groups. For studies with continuous outcomes, there was some apparent effect of placebo; but not so for objective outcomes that could be measured by someone else, such as blood pressure, but only for subjective outcomes that depended on self-reports, such as pain. They weren’t even sure about that, however, because the effect was greater in smaller trials, indicating possible bias.

An excellent guide to the confusions and contradictions of alternative medicine written with clarity, integrity and authority. ORDER the book

But Placebos Do Work, Don’t They?

It’s hard to reconcile a study like this with what we know about placebos from experiences like the case of Jane D. They do seem to work, and they seem to work very dramatically at times.

In a study of pain after dental surgery, patients were given either intravenous morphine or a saline placebo. If they were told that the saline was a powerful new painkiller, they got just as much relief as the patients who received morphine. In another study, all patients were given morphine for post-op pain, but only half were told they were getting it. The patients who didn’t know they were getting it only experienced half as much pain relief. In a study of acupuncture for post-op dental pain, there was no difference between the “real” acupuncture and placebo “sham” acupuncture groups, but when they asked patients which group they thought they were in, they discovered that those who believed they were in the “real” group reported significantly more pain relief than those who believed they were in the “sham” group — regardless of which group they were actually in!

We not only know placebos “work,” we know there is a hierarchy of effectiveness:

  • Placebo surgery works better than placebo injections
  • Placebo injections work better than placebo pills
  • Sham acupuncture treatment works better than a placebo pill
  • Capsules work better than tablets
  • Big pills work better than small
  • The more doses a day, the better
  • The more expensive, the better
  • The color of the pill makes a difference
  • Telling the patient, “This will relieve your pain” works better than saying “This might help.”

In one study patients were given the same aspirin in either a brand name bottle or an unlabelled bottle; it worked better if it was labeled as a brand they recognized. Our pharmacy used to stock two different brands of allergy pills that were made in the same factory and were identical except that one was green and the other was blue. When a patient said it wasn’t working any more, we’d switch him to the other brand and it would start working again.

Along with placebo effects, there are nocebo (“I harm”) effects. People getting inert treatments often report new symptoms. A friend of mine stopped taking her homeopathic sleep remedy because she thought it was causing side effects. (Homeopathy is the ultimate placebo because its remedies usually contain nothing but water.) In the Women’s Health Initiative study of postmenopausal hormone treatment, when the treatment was stopped, 63% of the women taking hormones reported withdrawal symptoms, but so did 40% of the women taking a placebo. If we tell patients a treatment may cause nausea, they are far more likely to report nausea than if we don’t mention that possibility.

The placebo effect is mainly subjective. Placebos don’t work on patients who are asleep or unconscious. You have to know you’re being treated. Placebos don’t keep women from getting pregnant. They don’t cure cancer, heal broken bones, or do anything you can measure objectively. They work for more elusive complaints like headache, depression, itching, shortness of breath, tension, indigestion, and other symptoms that require us to accept the patient’s self-report of what he is experiencing.

That doesn’t imply that those symptoms are not real. Some misguided doctors have tried to use placebo response as a test to diagnose whether a patient is really sick or not. That test doesn’t work, and even if it did it would be unethical.

Some researchers believe that placebos can have objective effects. When doctors painted warts with an inert dye and told patients the wart would disappear when the color wore off, the warts disappeared. Patients with newly implanted pacemakers improved even before the pacemakers were turned on. Asthmatics’ airways dilated when they were told they were getting a bronchodilator. Colitis patients treated with placebo not only reported feeling better but actually had less inflammation of the intestines visible on sigmoidoscopy. Patients with ulcers healed faster when given two placebo pills instead of one.

Harvard University medical researcher Herbert Benson believes that the placebo effect yields clinical improvement for 60–90% of diseases, including angina, asthma, herpes simplex, and ulcers. Studies that have not been replicated have suggested that the placebo effect can influence things like swelling, movement disorders, temperature, pulse, blood pressure, cholesterol, blood sugar, and exercise tolerance.

So far the evidence for objective placebo effects is weak. Another hypothesis is that the placebo effect is only subjective, but that these subjective effects can indirectly lead to objectively measurable effects. For example, if you are in pain and the placebo effect decreases your perception of that pain, you might expect your pulse and blood pressure to drop. If you are asthmatic and are wheezing, any psychological factor that reduces your anxiety level or helps you relax might indirectly ease your breathing symptoms and even allow your constricted bronchi to dilate. In this view, the placebo effect doesn’t really cause objective effects, it allows you to have a different experience of your symptoms and it is that different experience that indirectly affects your physiology. Semantic quibbling, perhaps.

Placebo surgery is another controversial subject. Forty years ago, a young Seattle cardiologist named Leonard Cobb conducted a unique trial of a procedure then commonly used for angina, in which doctors made small incisions in the chest and tied knots in two arteries to try to increase blood flow to the heart. It was a popular technique — 90% of patients reported that it helped — but when Cobb compared it with placebo surgery in which he made incisions but did not tie off the arteries, the sham operations proved just as successful. The procedure, known as internal mammary ligation, was soon abandoned.4

In a more recent study, sham arthroscopic surgery was compared to real arthroscopic surgery for knee osteoarthritis. The patients who had only a skin incision got just as good results. One patient who was told he had the sham procedure still refers to it as the surgery that cured him.

Some people question whether studies like these really show that surgery has a placebo effect. Maybe the surgery was unnecessary and patients would have improved anyway.

Skeptic vol. 3. no. 1 includes a special section on pseudomedicines such as homeopathy, therapeutic touch, and other “alternatives.”
ORDER the back issue

How Could It Work?

If the placebo effect is real, what might the mechanism be? We can’t just write it off as delusions of hyper-suggestible patients. There’s evidence that several things might be going on. The main hypotheses are: expectancy, motivation, conditioning, and endogenous opiates.

  1. Expectancy is an established psychological phenomenon. It even affects vision: we are more likely to see what we expect to see. Wine tastes better if the price is higher. Kids like fast food better if it comes in a McDonald’s wrapper. If we expect to feel pain we are more likely to feel pain. If we are told to expect a strong painkiller, we’re more likely to get pain relief.
  2. Motivation, the need or desire to improve health or get relief, has been shown to contribute independently to the placebo response. Patients who are strongly motivated to get well are more compliant and follow health advice more conscientiously. And patients who are more compliant about taking their placebo pills regularly get a stronger placebo response.
  3. Conditioning is what Pavlov did to his dogs. People learn to associate pills and medical treatments with relief of symptoms. The body even learns physiologic responses: dogs salivate when injected with morphine; after they become conditioned, injecting a placebo makes them salivate, although not as much.
  4. Endogenous opiates are pain-relieving chemicals produced in the brain that mimic the effects of opium-like drugs (morphine, etc.). There is some evidence that when patients respond to placebos, their brains produce more of these chemicals. Imaging studies have shown activation of opioid receptors in the brain when people are told that a placebo is a painkiller. And there is evidence that giving a drug that blocks the effect of narcotics can also block the placebo effect.

Dopamine levels increased in the brains of Parkinson’s patients after taking a placebo; and patients who said they felt better released higher levels of dopamine. In another brain imaging study, researchers had patients play a game and estimate their chances of winning. The same reward areas in the brain lit up in subjects who thought they would win as in patients who were most convinced that the placebo painkiller would work. Another study of patients who preferred either Coca Cola or Pepsi found that brand information was processed in a different part of the brain than taste from blind taste tests. We may be seeing clues about how the brain handles anticipation, expectation, optimism, previous experience, or who knows what. There may be genetic differences or differences in dopamine receptor responsiveness. Brain imaging is a blunt tool, and it’s too soon to know what these studies mean, but it’s a promising avenue of research.

Can Animals Respond to Placebos?

Believers in homeopathy and acupuncture tell us that animals respond to those treatments and animals can’t respond to placebos, so that must mean those treatments are effective. But the veterinary literature accepts the reality of placebo response in animals, and there are plausible explanations:

  1. They can develop a learned physiologic response to a drug and then respond similarly when a placebo is substituted.
  2. They respond to attention and care from humans.
  3. Human owners can experience the placebo effect for their pets by perceiving a response where there really is none.
  4. Since animals can’t talk, we have to interpret an animal’s behavior as indicating relief of pain; this may not always be accurate.
What About Ethics?

Some people don’t even want to know whether a treatment is a placebo or not. If they feel better, that’s all that matters to them. In Snake Oil Science: The Truth About Complementary and Alternative Medicine, R. Barker Bausell argues that the primary benefit of alternative therapies is a placebo effect, often enhanced by ritual and impressive pseudoscientific jargon.

If we can give patients a placebo and relieve their pain, what’s wrong with that? If a little white lie benefits the patient, why not lie? The answer is that it’s unethical for doctors to lie to patients or prescribe ineffective treatments, and because deception undermines the doctor-patient relationship in the long run. Also, as Bob Carroll of The Skeptic’s Dictionary points out, “the placebo can be an open door to quackery.”5

Based on Carroll’s website (skepdic.com), the Dictionary is the definitive short-answer debunking of nearly every thing skeptical. A must for every bookshelf. ORDER the book

In a recent study in Denmark, 48% of doctors reported prescribing a placebo at least 10 times in the last year, including antibiotics for viral infections and vitamins for fatigue. Specialists and hospital-based physicians were less likely to prescribe them. A 2004 study of physicians in Israel found that 60% reported using placebos for reasons like “fending off” requests for unjustified medications or calming a patient.

What if doctors were honest? If they told patients a treatment was a placebo, would that destroy the placebo effect? Maybe not. After clinical trials, patients who were told they’d been taking the placebo have asked if they could keep taking it. In one study patients were told one pill was inert and would only serve as a “dose extender” (i.e., a placebo that would allow a lower dose of the effective pill); patients accepted it and were able to lower their dose. What if a doctor tells a patient a treatment is not supported by any scientific evidence but some people believe it has helped them? Placebos raise ethical dilemmas on which doctors do not agree.

In a recent court case, the proponents of a particular form of quackery known as Q-rays admitted their device was bogus, but argued that since the placebo effect was effective they were justified in selling it. The court disagreed.

Is there any ethical way doctors can use the placebo effect to help their patients? Yes, of course. They already do. The placebo effect is an integral part of every doctor-patient interaction. Good doctors have always gained their patients’ trust and given them hope and reassurance.

What’s effective is not the placebo, but the meaning of the treatment. We enter into a human relationship with a caring person who offers to help us. We may be given a token of that caring in the form of a prescription. We may have a conditioned response to expect improvement because we have been helped in the past. We get a story, a narrative that explains why we feel sick and what we can do to get better. We get hope, support, human warmth, touch. All these factors might lead to an actual physiological response in which our pulse rate drops, we relax, our stress hormones decrease, and other changes facilitate healing, or at least comfort. One study supposedly showed that patients recovered faster if their window looked out on trees rather than a brick wall; even if they didn’t recover faster, wasn’t it nice to give them a view? Even if we can’t document a quantifiable effect on patient outcome, the quality of life is important.

Effective treatments have placebo effects too. A substantial percentage of the effects from antidepressants may be placebo effects. Morphine works even better if your doctor tells you it’s strong.

We can’t isolate placebo effect from conventional medicine — it gets us thinking the wrong way. As the neurologist Robert Burton says, “Even given our advanced state of medical knowledge, much of routine medical care — from treating backaches to the common cold — relies primarily upon reassurance and hope, not disease- specific treatments … we need to reconsider how to facilitate the placebo effect with minimal risk and cost, and without deception.”6

References
  1. ^ Crislip, Mark. “The Placebo Myth.” Science-Based Medicine, July 3, 2008. <http://www. sciencebasedmedicine .org/?p=158>
  2. ^ Beecher, HK. “The Powerful Placebo.” Journal of the American Medical Association, Vol. 159, No. 17. 1955.
  3. ^ Hrobjartsson A, Gotzsche PC. “Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with no Treatment.” New England Journal of Medicine. 2001; 344:1594–1602.
  4. ^ Talbot M. “The Placebo Prescription.” New York Times magazine. Jan. 9, 2000.
  5. ^ Carroll R. “The Placebo Effect.” The Skeptic’s Dictionary. <http://skepdic.com/placebo.html>
  6. ^ Burton R. “Why ‘Placebo’ is Not a Dirty Word.” Salon.com. August 1, 2008. <http://www.salon.com/env/mind_reader/2008/08/01/placebo_effect/>

The Great Psychic Detective Challenge

photo of Benjamin Radford

Check out Benjamin Radford’s books, articles, film, and a board game at www.radfordbooks.com.

This week, Derek talks with paranormal investigator Benjamin Radford. Recently, the host of the pro-paranormal Skeptiko podcast challenged Ben to look into a “best case” psychic detective claim — supposedly a “slam dunk” that proves that paranormal detectives are real.

Is it true that skeptics just never research or comment on cases that are not in their favor? Ben put some detective work of his own into the case put forth by Skeptiko


our next lecture at Caltech…

Thank God for Evolution
How the Marriage of Science & Religion
Will Transform Your Life and Our World

with Michael Dowd

Sunday, June 7, 2009 at 2:00 pm
Baxter Lecture Hall (map)

The Reverend Michael Dowd is one of the most inspiring speakers in America today. His lecture/sermon is based on his bestselling book, Thank God for Evolution: How the Marriage of Science and Religion Will Transform Your Life and Our World, which has been endorsed by 5 Nobel Prize-winning scientists and dozens of other scientific and religious luminaries across the spectrum. Since April 2002, he and his wife, Connie Barlow, an acclaimed science writer, have lived permanently on the road sharing a sacred view of evolution with religious and secular audiences of all ages, as America’s evolutionary evangelists…

READ more about this lecture >

READ about our other upcoming lectures >


Thinking Digital — The TED of the UK

In this week’s SkepticBlog, Michael Shermer shares his experiences at the Thinking Digital conference in Newcastle Upon Tyne, the UK’s version of TED.

READ the post and comment on it at Skepticblog.org >

While you’re there be sure to read the blog posts of the other Skepticbloggers: Brian Dunning, Kirsten Sanford, Mark Edward, Phil Plait, Ryan Johnson, Steven Novella, and Yau-Man Chan.

34 Comments »

34 Comments

  1. Arne Fischmann says:

    Did somebody conduct a thorough review of the “Hrobjartsson A, Gotzsche PC”?
    I have no faith in articles from Dr. Goetzsche anymore since I reviewed his cochrane-review about mammography screening, including reading all the relevant and cited original papers. There were so many flaws in his paper that I was able to spot which influenced the outcome of the metaanalysis, that I could not believe the cochrane-Database is still willing to hand out this review. It looked as if Dr. Goetzsche had made up his mind before and then fit his criteria to meet his outcome.
    So if someone with a research in medicine/biotechnology background could do a review (I do not have the time currently) it might be helpful for proponents of the placebo-effect.

    And keep on the good work with eSkeptic – THANK YOU!!!!

  2. Charles Williams, MD says:

    Dr. Hall discusses expectancy as a cornerstone of the placebo mechanism. I am now retired from surgery, but during my career span, I experienced the gradual onset, leading to universality, of the practice of “informed consent”. Two of my professors, trained at the Mayo Clinic when there was only one Mayo Clinic, said that during their training period no written consent was ever obtained from surgical patients. It was assumed that if the patient had traveled to Rochester, MN and ponied up the fees, he had demonstrated confidence in the Mayo doctors to render the best care possible. The reputation of the Clinic in those days was renowned and there were few complaints. Since the concept of informed consent, surely a more ethically sound approach, it seems patients are much more likely to experience the problems or poor outcomes described to them as “possible”; there can be no doubt that doctors are sued by their patients far more since the advent of informed consent. It appears that this aspect of the placebo effect damages both doctors and patients. Is there an argument against informed consent?

  3. Mike Newdow says:

    Dr. Hall writes, “Some misguided doctors have tried to use placebo response as a test to diagnose whether a patient is really sick or not. That test doesn’t work, and even if it did it would be unethical,” and follows this immediately with, “Some researchers believe that placebos can have objective effects. When doctors painted warts with an inert dye and told patients the wart would disappear when the color wore off, the warts disappeared.”

    That juxtaposition is interesting.

    I’m not sure why researchers are permitted to do what is “unethical” for physicians. More importantly, I’m not convinced the former is unethical. Every test and intervention has positive and negative predictive values. Seeing the response to a placebo is one such test.

    • Don says:

      The issue with ethics revolves around deceipt. Deceiving a patient about their treatment is unethical. In a research study, however, the patient would already be informed about, and given consent to, the possibility of a placebo treatment.

      • anand jha hatni says:

        To certain extent various problems don’t require medication at all,it’s the psychologocal perception that makes the persion feels that he/she requires some treatment,though scientifically one may not require so. Under that condition the onus goes on the experienced doctor who dare practice placebo effect to determine the exclusive cases whether one requires such or not. so under this circumstance doctor needs not to reveal the same as that may mar the very purpose of this psychological treatment.

  4. Jeff says:

    The more publicity about this the better. I recently discovered that Petco is actually selling homeopathic “remedies” for pets. The thought of all those animals suffering non-treatment is disturbing to say the least – so much for the homeopaths’ “do no harm” mantra. Our FDA does not regulate homeopathy to any great extent either, possibly because it’s too much like a religion to a lot of people. As in the reluctance to prosecute faith-killers and the like, the First Amendment is once again being stood on its head to avoid government “entanglement” with religion.

    By the way, the word placebo means “I will please.” It is the future tense of placere.

  5. kennwrite says:

    Now what if a good portion of saline or sugar-based placebos were effective because there was still some as-of-yet undiscovered beneficial effects from sugar and salt? That’d really skew the placebo effect argument, wouldn’t it?

    • kapil says:

      yes,kennwrite you are very much right and i altogether agree with you

    • Deepak says:

      Hi Kennwrite, If this was the case that sugar and salt had some unobserved medical benefits, then probably people would not need to visit a doctor for the prescription, would they? I am assuming that most people take salt and sugar in their diet everyday.

      • Marie says:

        While I agree with the article, I have to wonder about the one lady with the migraines. She received pain relief from the saline solution. I assume this was an IV. I get migraines when I dehydrate, and my doctor has many times given me a saline IV and a pain killer. While the pain killer may (or may not) have given me a little immediate relief, I believe the hydration may actually have helped more.

        Or maybe it was totally the placebo effect with me. Who knows!

  6. Mike R says:

    Good lord but can we get a better representative to talk about phony psychic detectives than this Ben Radford guy? If he stammered and stuttered and said “you know” one more time, I was going to psychically slap the hell out of him! He was being bitch slapped the entire time I managed to listen to the tape, which was only about 3 minutes or so. Representatives like this put our educational efforts in reverse. Please, please, please, get a Shermer or Randi to appear and perhaps try to undo some of the damage. This was painful and embarrassing.

  7. Mike R says:

    Talking about the placebo effect, I do not believe the issue revolves around deceipt. The Hippocratic oath says, in part, “first do no harm”. Is there harm in telling a patient his wart will disappear if painted with some harmless dye, and then it does in fact go away? No. The harm is in charging people for a treatment you know to be worthless. The harm is in the purposefull misrepresentation for personal gain, in my opinion.

  8. Garry Platt says:

    Over Easter I read a fascinating book by Ben Goldacre called ‘Bad Science’. It explores just what is bad science, how to spot it and examines claims made by both researchers and none academics based upon poor data or no data at all. Within the book there are sections dedicated to the odious Dr Gillian McKeith (‘The internationally acclaimed Holistic Nutritionist’ – I can’t say that phrase without laughing), Homeopathy, Fish Oils for enhancing learning and the great United Kingdom MMR Vaccine debacle, all these and more are referenced. But one particular section gives a fascinating insight into the workings of the human mind and body and the placebo effect..

    Let me quote the following section from the book, (page 81):

    “Moerman examined 117 studies of ulcer drugs from between 1975 and 1994, and found, astonishingly, that they interact in a way you would never have expected: culturally, rather than pharmacodynamically. Cimetidine was one of the first ulcer drugs on the market, and it is still in use today: in 1975 when it was new, it eradicated 80 per cent of ulcers, on average, in the various different trials. As time passed, however, the success rate of cimetidine deteriorated to just 50 per cent. Most interestingly, this deterioration seems to have occurred particularly after the introduction of ranitidine, a competing and supposedly superior drug, onto the market five years later. So the self-same drug became less effective with time, as new drugs were brought in.

    There are a lot of possible interpretations of this. It’s possible, of course, that it was a function of changing research protocols. But a highly compelling possibility is that the older drugs became less effective after new ones were brought in because of deteriorating medical belief in them. Another study from 2002 looked at seventy-five trials of antidepressants over previous twenty years, and found that the response to placebo has increased significantly in recent years (as has the response to medication), perhaps as our expectations of those drugs have increased.

    Findings like these have important ramifications for our view of the placebo effect, and for all of medicine, since it may be a potent universal force: we must remember, specifically, that the placebo effect – or the ‘meaning effect’ – is culturally specific.”

    • Melissa B. says:

      I think I’ve read that ulcers, or at least some of them, are caused by bacteria. So another explanation for your ulcer example is that the ulcer-causing bacteria developed resistance to the first drug. I have no idea if this is actually the case, but it could be an alternative, objective, explanation.

      • Rune I. says:

        Yes, infection with Helicobacter pylori is associated with stomach ulcers, but cimetidine which Ben Goldacre is writing about is not an antibiotic and does not kill the bacterium; it lowers acid secretion in the stomach. So antibiotic resistance cannot explain this.

  9. D. Pared says:

    You should have included a part for prayer, certainly one of the most used placebos. As with the others, sometimes it works and sometimes it doesn’t.

  10. bernard says:

    I remember reading a study that most people that go to a doctor, there is little the doctor can do for them. Often though they demand drugs and treatment that are expensive and sometimes dangerous. A placebo is a non dangerous and often cheap way of satisfying them

    Also many medical problems are self inflicted eg smoking, excessive eating, not sleeping enough (As a suffer from that, I can assure you it can real hurt your life), depression etc. Sometimes a placebo does work. Here is an interesting case.

    http://www.thesun.co.uk/sol/homepage/news/article2439766.ece

    • Gord says:

      Many doctors do just that, but the “placebo” is an actual drug which, presumably, won’t hurt them. Is it unethical to prescribe an “unnecessary” medication?

      Also, I don’t think it’s correct to say that depression is a self-inflicted problem.

  11. Vanderpoel says:

    Advertising is the biggest and most accepted placebo of all.
    Donʻt we all feel better with “Change you can believe in”?
    We are sold to believe what the marketers need you to believe. Linguistic programming works for politics, pyramid schemes, derivatives, religion, miracle cures and yes, placebos.
    Thatʻs a good thing. We donʻt like our diets without baloney.

  12. Slida says:

    Causing someone’s emotional response to something to change is an effect, isn’t it?

  13. anomdebus says:

    I am reminded of an experiment conducted by the nutritionist Mehmet Oz. There are three groups: men drinking water, drinking sugar water and swishing sugar water in their mouths. The amount of work done by each group over the course of a day is compared. The results ended up that the sugar drinkers got an early lead, but were later over taken by the swishing sugar water workers.

    The hypothesis was that the body anticipated getting a boost of energy and released some of its own.

    Note: I do not necessarily endorse this study as valid, but find it interesting..

  14. Jake says:

    The fact that the psychiatrist told Jane she’d gotten a placebo smacks of major irresponsibility to me, stemming not so much from a desire to clarify the situation for her, as from the doc’s idiotic mistrust of anything “non-scientific,” even if it works.

  15. Fall Guy says:

    Lets talk about the theft of Billions of dollars the drug co. make and the dr’s kickback on this sham, even if the “I love being sick crowd” and the deceived feel they benefit it is still a rip-off, a con, and no different than any other crime. Just one more reason why Health Care cost too much and the Dr., Drug Co., Hospital corp CEO’s are laughing at us and the Law Makers who believe them.

  16. mobiaxis says:

    If I could only get my wife’s doctor to advise her that her NSAIDs have the side effect of extreme sexual desire…

  17. marianasoffer says:

    Some doctors belive that the placebo effect is mainly or purely physical and due to physical changes that promote healing or feeling better. So, what is the explanatory mechanism for the placebo effect? Some think it is the process of administering it. It is thought that the touching, the caring, the attention, and other interpersonal communication that is part of the controlled study process (or the therapeutic setting), along with the hopefulness and encouragement provided by the experimenter/healer, affect the mood, expectations, and beliefs of the subject, which in turn triggers physical changes such as release of endorphins, catecholamines, cortisol, or adrenaline. The process reduces stress by providing hope or reducing uncertainty about what treatment to take or what the outcome will be. The reduction in stress prevents or slows down further harmful physical changes from occurring. The healing situation provokes a conditioned response.
    http://singyourownlullaby.blogspot.com/2009/06/placebo-effect.html

    • Yo says:

      Your detailed comment very nicely explains how our mental and emotional states directly affect our bodies. In general, we are naturally inclined to healing. I really like how Dr. Hall makes the connection between the placebo effect and conventional medicine. I also agree that what we need to do is minimize cost and deception both in conventional medicine and the alternative/wholistic healing field.

    • Aj says:

      You are assuming in your point that touching and caring are equivalent to sugar pill and that they would count as placebo, but they are not, there is copious evidence tht touch itself has beneficial health effects. Which brings up a more serious ethical problem with placebos. If the care is really the reason for a benefit from placebos, doctors are hurting patients by keeping them in a medical setting when so many patients would do better spending that time and resources with loved ones.

  18. Susie Hartsog says:

    Our state of mind sometimes draws us to believe that we actually need to take medication to become “sane” once more. It is entirely wrong to take such actions of course, as it will lead to serious side affects. Insomnia, health problems, addiction, lack of emotion, and feeling completly useless. Taking drugs without the consent of a doctor or psychiatrist is very dangerous, and you could be found in the next body bag.

  19. I canshakeit says:

    Way to be very blunt at the end of your comment.
    It’s like ‘thud’. I like it. :D

  20. I SAY says:

    Article mentions about Placebos not effective when used during sleep or coma so it’s about hope and reassurance.

  21. jrm2532 says:

    THE PLACEBO EFFECT
    Friends,
    The simple answer to this placebo effect has been with us since 1875. It is this textbook on spiritual healing, entitled,”Science and Health with Key to the Scriptures”.

    The Holy Bible, interpreted by our Pastor Emeritus, Mary Baker Eddy, in “Science and Health with Key to the Scriptures”, explains “the way” Christ Jesus taught some humble fishermen, how to spiritually heal those who came to them with faith, that their ills and torments can be healed by Christ power, and how these ex-fishermen then taught this mental Christ sent method of healing to the world. Now, all can be taught divine healing.

    All along it has been faith that does the healing, not the medicine. It is the presence of God’s love that heals each and all of us, whether or not we know or acknowledge that divine Mind is the healer.

    Most commercials have the statement in small print, “results may vary”. Doesn’t this tell you immediately that faith in the drug or the doctor did the healing. This is truly a beginning of great significance. But now one need not EVEN take the pill at all, and learn to heal mentally, because it was our Father all along that did the healing.

    This comforting book can be found in Christian Science Reading Rooms throughout the world, in numerous languages. I am 86 years young and have never tasted a drop of medicine or been in a hospital bed. Join me in a happy way of living.
    Jay

  22. jenny haskins says:

    “All along it has been faith that does the healing, not the medicine. It is the presence of God’s love that heals each and all of us, whether or not we know or acknowledge that divine Mind is the healer.”

    Of course, religion of the biggest placebo of them all!!!

    All that’s needed is “faith”!

  23. Aj says:

    When parents point to a tight correlation between a child’s autism and a vaccination, doctors are quick to say that they only seem related but that there us another explanation – that satistical studies show they are not related. (The studies I’ve seen more specifically ruled out mercury in vaccines.). But when a doctor sees a patient improve after taking a placebo, they can attribute it unquestioningly to belief in treatment, despite the knowledge that many things like regression to the mean or the natural course of the a disease, etc, could be the cause, and despite the statistical work demonstrating overwhelmingly that placebos don’t work better than doing nothing at all. Some want to believe the placebo effect explanation so much , they have created a bizarre twist to explain that belief in treatment is the reason for observed improvements: saying that placebos “work” even when patients know they are getting a sham treatment. Ho boy. It appears the power of placebos is as much in the mind of medical practitioners as in the patients’.

  24. Loris says:

    I suggest that you all watch a video lecture by a physicist named Tom campbell. He as recently written a 900 page book (available for free on line) called My big T.O.E. (theory of everything) the double slit experiment.. The observation problem.. Entanglement.. If you think you live in an objective reality your most likely mistaken..reality is subjective.. Virtual. What Plank, Einstein, Bhoar and others discovered back in the 1920′s has yet to be accepted by the mainstream high priests of the mercantile science’s….It took nearly 200 years to move from a flat earh model (once science proved otherwise) to what we know today… “Tom Campbell in Spain” on google video is a lengthy 13 + hours of lecture.. See if it doesnt explain what was once unexplainable from the mistaken view point of an objective model of reality…..

get eSkeptic
our free newsletter

Science in your inbox every Wednesday!

eSkeptic is our free email newsletter, delivered once a week. In it, you’ll receive: fascinating articles, announcements, podcasts, book reviews, and more…


Popular Articles
on skeptic.com

Here are the articles that people have been sharing over the last few days.

Carbon Comic

Carbon Comic (by Kyle Sanders)

Carbon Comic, which appears in Skeptic magazine, is created by Kyle Sanders: a pilot and founder of Little Rock, Arkansas’ Skeptics in The Pub. He is also a cartoonist who authors Carbon Dating: a skeptical comic strip about science, pseudoscience, and relationships. It can be found at carboncomic.com.

Help the
Skeptics Society
at no cost to you!

Planning on shopping at Amazon? By clicking on our Amazon affiliate link, which will open the Amazon Store in your Internet browser, the Skeptics Society will receive a small commission on your purchase. Your prices for all products remain the same, yet you’ll provide essential financial support for the work of the nonprofit Skeptics Society.

amazon.com

See our affiliate links page for Amazon.ca, Amazon.de, Amazon.co.uk, iTunes, and Barnes & Noble links.

Browse by Topic

FREE PDF Download

The Science Behind Why People See Ghosts

The Science Behind Why People See Ghosts

Do you know someone who has had a mind altering experience? If so, you know how compelling they can be. They are one of the foundations of widespread belief in the paranormal. But as skeptics are well aware, accepting them as reality can be dangerous…

Reality Check

Reality Check: How Science Deniers Threaten Our Future (paperback cover)

How Science Deniers Threaten Our Future

The battles over evolution, climate change, childhood vaccinations, and the causes of AIDS, alternative medicine, oil shortages, population growth, and the place of science in our country—all are reaching a fevered pitch. Many people and institutions have exerted enormous efforts to misrepresent or flatly deny demonstrable scientific reality to protect their nonscientific ideology, their power, or their bottom line…

FREE PDF Download

Top 10 Myths About Evolution

Top 10 Myths About Evolution (and how we know it really happened)

If humans came from apes, why aren’t apes evolving into humans? Find out in this pamphlet!

FREE PDF Download

Top 10 Things You Should Know About Alternative Medicine

Top 10 Things You Should Know About Alternative Medicine

Topics include: chiropractic, the placebo effect, homeopathy, acupuncture, and the questionable benefits of organic food, detoxification, and ‘natural’ remedies.

FREE PDF Download

Learn to be a Psychic in 10 Easy Lessons

Learn to do Psychic “Cold Reading” in 10
Easy Lessons

Psychic readings and fortunetelling are an ancient art — a combination of acting and psychological manipulation.

Copyright © 1992–2014 Skeptic and its contributors. For general enquiries regarding the Skeptics Society or Skeptic magazine, email skepticssociety@skeptic.com or call 1-626-794-3119. Website-related matters: webmaster@skeptic.com. Enquiries about online store orders: orders@skeptic.com. To update your subscription address: subscriptions@skeptic.com. See our Contact Information page for more details. This website uses Google Analytics, Google AdWords, and AddThis tracking software.