Let’s Explore The Alleged Placebo Effect

The concept of the Placebo Effect is very much ingrained in our culture. I remember years ago watching an episode of M*A*S*H that included successful use of placebos (especially interesting since “The Powerful Placebo” was published in JAMA in 1955, meaning these Army doctors must have been much ahead of their time, since the Korean War cease fire was in 1953).

Not only do we take for granted the Placebo Effect, but some alternative practitioners are willing to accept the Placebo Effect as the mechanism by which their patients report improvements following alternative treatments. There are studies purporting to show the best forms for placebos in terms of size, shape and inconvenience for the user – ordinary little white pills being the least impressive, and injections the most.

But even if we take the originally published claim, 35.2% of subjects reported improvement, that’s quite a bit less than half of the population reporting success, with approximately 2/3 not reporting the effect. And even proponents acknowledge that each subsequent administration of a placebo will be followed by less reported improvement.

In addition, the Placebo Effect has a little-known twin – the Nocebo Effect, in which the patient reports feeling worse after being administered a placebo. How the worsening from receiving a do-nothing treatment can be distinguished from worsening from not receiving treatment is a puzzle to me.

Some researchers report that following administration of placebos, they can document changes in heart rate, blood pressure, and even chemical activities in the brain. But, all kinds of things, including just the passage of time, can result in variation in blood pressure or heart rate, and of course, every bodily activity – including thought – causes changes in the chemicals in the brain. Brains do ALL their work by moving chemicals and electrical signals around. And of course, someone administered a placebo can’t report changes in brain chemicals. Patients given placebos can report “feeling better”. Even patients who are informed they are receiving placebos report improvements, which placebo proponents take as evidence that the placebo-activity is doing something, as opposed to the recipients just wanting to tell the nice medical personnel that their medical-style effort was not in vain.

I think that the entire Placebo Effect is what happens when human beings who are being attended by nice medical personnel, want to tell these nice medical personnel some positive result of their efforts. Simple as that. Placebos affect things that patients report, or things that vary naturally and continually, such as blood pressure, but do not cause actual measurable changes of bodily realities such as white blood cell count or the size of a fibrous mass.

One of the main reasons I believe that there really is actually no Placebo Effect/Nocebo Effect is that there is no such thing as recreational placebos. Think about this – recreational drug use is entirely motivated by the effects of the drug on the individual’s experience of feeling, thinking, noticing or not noticing certain things. The person smoking weed wants to feel relaxed, jovial and maybe increased pleasure in consuming food (especially chocolate). The person who uses ecstasy expects to feel energized, increased enjoyment of dancing and music and emotional closeness with fellow users. The person who drinks alcohol wants to “let loose”, enjoy social activities and camaraderie. The person consuming LSD wants to see moving geometric hallucinations, feel deep emotional connection to fellow trippers and to the universe, and focus deeply on music and art.

One would think that a user with knowledge of the expected effects could could easily reproduce these effects  once the brain has experienced the effects of stimulation of certain brain receptors that a specific drug would interact with – the mellowness, the exhilaration, the fractal-type patterns moving across the floor. The experienced recreational user knows precisely what effects are being sought, effects that are specific to brain functions. One would think that if swallowing a sugar pill could actually reduce pain or lower blood pressure or nausea or anxiety, that creating a change in mood, or generating hallucinations of a familiar style, would be not only possible, but could render the War on Drugs entirely moot. And yet, I can report some observations from my college years, that cause me to be entirely skeptical of the claimed Placebo Effect.

Traveling in England as a student, I met some guys who told me they made easy money selling bits of paper that looked like acid tabs to people waiting outside concert venues. They knew they had 1-2 hours to do their selling and get away from the venue before the unhappy customers would come looking for them. They didn’t do this at any event they planned to attend themselves, even at large venues.

While in college, some students I knew, when unable to procure acid for the weekend, would attempt to trigger flashbacks. These attempts – several different attempts over the course of 2 years – consisted of sitting together in a candle-lit room, playing music and discussing topics that had been of enormous interest during previous trips, and completely failing to trigger even the mildest flashbacks in any of the disappointed participants.

Another incident from college was one Friday when a usually-reliable source sold acid to several different groups of friends – groups who didn’t know each other – and within 2 hours, all of that day’s customers returned to complain about the lack of effect and demand refunds.

I have one more example. A fellow student hiking on a Gulf of Mexico beach discovered a bundle that appeared to be marijuana dumped during an aborted delivery. The weed looked and smelled like good product, but when smoked by the finder, produced no high. This was such a curious result, the finder decided to run some informal experiments. The first experiment was to give some to people without telling them the history of the weed (which was quickly nicknamed Anti Dope). No one reported getting high after smoking Anti Dope. The next test was to give some to people who were already high – and these people reported that they came down from the high they were already experiencing up to the point when they were (unknowingly) given Anti Dope. The most interesting thing was that, over two years I know of, not one person given Anti Dope reported getting high.

There is exactly one place in medical science where placebos are not only useful, but crucial: randomized double-blind placebo controlled study. In studies following this design, the subjects are divided into two groups, only one receiving the actual medicine, device or surgery being tested. The “control” group is subjected to an experience, a pantomime, indistinguishable in all ways from the way the subjects receiving the active measure are treated. The “double-blind” part means that neither the subjects nor the personnel interacting with the subjects know which are receiving the active measure.

Can anyone provide data that could disprove the “I want to say I feel better” hypothesis of placebo? Wouldn’t Occam’s razor push us to seek a way to find reliably measurable data to support the belief in this alleged mechanism? Any hypothesis other than “placebo is just a set of encouraging remarks to nice medical personnel” would have way more moving parts, also difficult-to-detect moving parts, while just voicing an upbeat comment is completely compatible with observed data.

sources

Wiley library placebo effect
https://onlinelibrary.wiley.com/doi/full/10.1111/opo.12315

alt med claims of placebo success
https://jonbarron.org/article/success-placebos

acupuncturist by training placebo proponent
https://harvardmagazine.com/2013/01/the-placebo-phenomenon