Recently, I watched a video about chiropractic care that did an excellent job showing that it was at least of limited value. But several times it dismissed placebos as useless. This was done in passing. And that’s typical: people don’t think about placebos. They just have it in their minds that they don’t “work” and that is the end of it.
This was one of many such examples. And each one of them annoys the hell out of me. I’ve mentioned this before, but I figured it was time to write an article about it that I can link to.
Why Do Placebos Exist?
The word “placebo” dates back to 1785, but its exact meaning has been different. It has generally had a negative connotation, but the assumption that a placebo was useless really started after World War II and the rise of double-blind drug tests.
But it is strange that people should equate a placebo with a useless drug. After all, if placebos were worthless, why would it be necessary to use them in drug tests? If there was no effect, scientists could just test the drugs and see if they did more than nothing.
This is not how drug tests work, however. Instead, drugs are tested to see if they work better than a placebo. Clearly, we don’t want to introduce a new expensive drug that doesn’t work any better than a pill filled with sawdust.
How Do Placebos Work?
The human body is an amazing and complex machine. And we have only barely begun to understand it. One thing we do understand is that we are not the rational beings we think we are. (This understanding was critical to my break with New Atheism and all its idiots who thought themselves rational while allowing the basest irrational instincts to run free with post hoc rationalizations.)
This irrationality works with many of the body’s systems to at least feel better. Take, for example, endorphins. They exist in the body for the management of pain. Someone thinking they are being given morphine (which works on the same receptors) could see their endorphin levels rise and thus get part of the effect that actual morphine would produce.
This is a real effect! Your mood is not some spiritual concept. It is based on the soup of chemicals in your body and the receptors that they are attached to. To claim otherwise is to claim that you aren’t really happy when you feel happy.
Based on this, you should understand, at least conceptually, how placebos work. And with that understanding, you should know why drug tests need placebos.
Are All Placebos the Same?
Scott Millard at Premier Research wrote an insightful article, The Placebo Problem, Part 10: The Devil’s in the Details. He writes:
A number of pill characteristics influence the magnitude of the placebo response: bigger pills are more effective than smaller ones, capsules are more effective than tablets, and having a name printed on the pill also boosts its perceived efficacy. The dosing schedule, too, plays a role: placebos given more often elicit a bigger response than ones with a single administration.
But here’s the killer: “Of all the pill characteristics, however, color seems to be the most important.” This shouldn’t be a shock. I first learned about this in the 1990s. That’s how long I’ve been ranting about this.
This is important because it shows that the placebo effect depends upon the placebo. Millard also notes:
The exact type of placebo seems to matter a lot, too. In general, sham surgery seems to be the most effective, followed by sham injection, and then an oral placebo… One study also demonstrated that a placebo laser treatment generated greater somatic sensations among participants than a placebo irritant solution.
The point here is that the effects are real based upon how the patent perceives the treatment. These have real effects on the body.
Now I know what all the “skeptics” out there will say: “I already knew this! Everyone knows that placebos have effects!”
Really?! Because that’s not how people talk about them. And I’m not referring to my relatives here. I’m referring to people who write articles and produce videos that are otherwise reasonably literate, scientifically.
I understand that people know placebos have effects. But I also know that people disregard these effects. They dismiss them the way they do hypochondria. What’s more, the “rationalist” crowd seem to think placebos only work on weak minds — not their kind of steel-trap appliances.
By this thinking, “Placebos just work in people’s minds.” That’s wrong. They work in people’s brains. And they work concretely — something I shouldn’t have to explain to “rationalists” given that humans are nothing more than big chemistry experiments.
But feel free to claim you already knew all this. Just don’t piss me off by continuing to imply (If not claim!) that placebos don’t work!