Bad science Medicine Pseudoscience Quackery Skepticism/critical thinking

Placebos without deception: Misinformation that never dies

He’s ba-ack! Longtime “integrative medicine” apologist and exaggerator of the “power of placebos” Ted Kaptchuk is promting misinformation again in an op-ed in The New York Times.

Since yesterday’s post about William Makis and “turbo cancer” appears to have gone over like the proverbial lead balloon, garnering exactly zero comments as of this writing, something that hasn’t happened in a very long time, I thought I’d move on to something that I haven’t discussed in a very long time—2016, as far as I can tell). (Maybe my readers are burned out on COVID-19 and antivax misinformation. I know that I am, at least a little bit.) Fortunately for a blogger looking for a different topic, The New York Times op-ed page yesterday served up a stinker of an article promoting a false narrative often used to justify alternative medicine and “integrating” quackery into medicine (“integrative medicine” or “integrative health”). It’s even by an old “friend” of the blog, an “integrative medicine” researcher and placebo promoter named Ted Kaptchuk, and the article promotes a very old quack narrative about placebos. However, since I haven’t written about this particular narrative about placebos in a long time, I thought that it would be worth applying a bit of the ol’ Insolence to the article, which is entitled No Better Than A Placebo.

Interestingly, the title shows up differently in different contexts. For example, one headline that I saw was Placebo Effect Is Powerful (which is more in keeping with Kaptchuk’s usual message and seen in some previews for social media), while another was Decongestant Placebo Medicine. The latter headline likely derives from the recent finding by the FDA that the decongestant phenylephrine is no more effective than placebo., a revelation that is actually not new news (we’ve known for at least 20 years that phenylephrine is pretty useless), but for some reason this year the FDA finally decided to weigh in. Likely a New York Times op-ed editor took note of these stories about phenylephrine and decided that now would be a good time to publish another credulous op-ed about the “power of placebos” to add to previous ones in 2021, 2018, and even earlier—back to at least 2010. Only this time, instead of just quoting Ted Kaptchuk, as is the NYT’s usual practice, they decided just to let him spin his tale however he wanted. And spin it he does!

First, Kaptchuk takes the recent stories about phenylephrine and uses them to introduce placebos in a manner that sets up his argument:

An advisory committee for the Food and Drug Administration recently concluded that a popular oral decongestant sold over the counter was no better than a placebo. The agency now faces the question of whether to pull medications that use the ingredient, phenylephrine, off store shelves.

The news spurred shock and anger over how long ineffective medicines have been for sale. But amid the criticism, there were also some who lamented the possibility that their favorite cold medicine would be taken from them. In their view, it may not work, but it still does something for them.

See where this is going? The exact same argument is often used to support alternative and “integrative” medicine modalities that are known to be completely ineffective, some of them (like homeopathy and reiki) being scientifically impossible; that is, unless huge swaths of long-understood and well-supported science are found not just to be wrong, but spectacularly wrong. The argument goes something like this; Sure, homeopathy and reiki do nothing that is distinguishable from placebo effect, but it’s the placebo effect—or, more properly, placebo effects—that matters. Reiki, homeopathy, acupuncture. However, all the other alternative medicine quackeries whose effects are indistinguishable from the nonspecific effects of placebos might not have specific effects that cure disease, but they’re “harnessing the power of placebos”—Deepak Chopra is particularly fond of this claim—and using the power of the mind to heal, all in order to do the patient good.

That background being established, Kaptchuk then appeals to authority, namely his authority, to assert without evidence that the placebo effect is “powerful” in some situations:

I’m a researcher who studies the placebo effect, and in some situations, it’s powerful. That said, oral phenylephrine sold over the counter should be removed from the market; despite some people’s love of phenylephrine cold medicines, there’s no evidence that the drug even provides placebo benefits. In clinical trials reviewed by the F.D.A. committee, phenylephrine and a placebo affected patients’ perceptions of nasal congestion equally, but the existing trials do not tell us to what extent people felt better because of placebo effects or because their colds simply resolved on their own.

Next up, Kaptchuk attacks what he sees as the key objection to “harnessing the power of placebos” without actually (yet) defining placebo effects. That objection is that you have to “lie to patients” by telling them that what you are giving them is effective, with the white coat of physician authority adding emphasis and credibility to the lie:

This controversy highlights the perplexing messages that imprison placebos in general. In research settings, placebo responses are powerful but a nuisance, as they make detecting a drug’s superiority over a placebo difficult. And in clinical practice they are powerful, but they often require deception, making them unethical. But can placebos ever come out of the shadows and become a legitimate component of health care? My research suggests so.

Longtime readers familiar with Ted Kaptchuk should have already guessed—and guessed accurately—where his placebo narrative in this op-ed is going. As I used to say a lot before the pandemic, before more general topics of alternative and “integrative” medicine were crowded out by COVID-19 conspiracy mongering and antivax misinformation, it is unethical to lie to patients. It is true that, say, 75 years ago it was considered much less unethical (or even ethical) to prescribe placebos. However, as I have also pointed out many times, that was an era in which medicine was much more paternalistic and it was considered acceptable for the physician to decide alone what was good for the patient. These days, the doctor-patient relationship, although by no means totally free of paternalism, is much more collaborative, and in general that’s a very good thing.

It is ironic how promoters of alternative medicine who argue for “harnessing the power of placebos” with woo like homeopathy, reiki, and acupuncture also often argue that they support “empowering” patients even as they support the more paternalistic model of healthcare in which they can tell patients that ineffective medicine is actually highly effective in order to “harness the power of the placebo effect.” Of course, they often don’t believe that quackery like homeopathy, reiki, and acupuncture are ineffective, but you get the idea.

Kaptchuk, being a Man of Science, bristles at such comparisons and supports the idea that is it unethical to deceive patients, even to “harness the power of placebo.” As a result, for a very long time he has been spinning a narrative about placebos that I like to call “placebos without deception.” This NYT op-ed is nothing more than that same narrative tarted up, updated, and spun based on recent news stories about the FDA conclusion about phenylephrine in order to resurrect it and make it seem new.

First, though, Kaptchuk defines placebo effects as “health improvements initiated from the rituals, symbols and behaviors involved with healing.” As Steve Novella notes, this is not quite right. A more accurate definition would be subjective improvements in symptoms initiated from the rituals, symbols and behaviors involved with healing or, as Dr. Novella phrases it, “apparent or measured ‘health improvements,’ if you include subjective symptoms as health improvements, which is reasonable but needs to be explicitly stated,” further noting that apparent “improvements may not be real” and “may entirely be illusions of how health outcomes are being measured.” Known phenomena that can contribute to placebo effects and be other reasons for apparent subjective improvements in health symptomatology include illusory effects like regression to the mean.

Kirk: Here it comes.
How Ted Kaptchuk likely views his placebo narrative against skeptics: “Here it comes.”

Then, no doubt Kaptchuk views his unleashing of his “science” and arguments the way Admiral Kirk viewed his upcoming counterattack in The Wrath of Khan, “Here it comes”:

Fifteen years ago, in the middle of my career as a placebo researcher, I had a crisis. My ultimate research goal had been to harness the power of placebo to relieve unnecessary suffering. But my early experiments always involved telling participants that they might receive or were receiving real medications when they were not. Placebos were tainted by trickery. I began to question the conventional dogma that placebos work only if patients don’t know they’re placebos. Could I instead be honest? My colleagues thought I was nuts.

I wonder why.

Kaptchuk on placebos
How Kaptchuk views his telling of the placebo narrative: “It’s coming through now, science nerds.”

If “Here it comes” is the set-up, no doubt Kaptchuk also fantasizes that the following paragraph is what arrives after he warns skeptics, “It’s coming through now”:

As it turns out, placebos can work even when patients know they are getting a placebo. In 2010 my colleagues and I published a provocative study showing that patients with irritable bowel syndrome who were treated with what we call open-label placebos — as in, we gave them dummy pills and told them so — reported more symptom relief compared with patients who didn’t receive placebos. (These placebos were given with transparency and informed consent.) In another blow to the concept that concealment is required for placebo effects, my team recently published a study comparing open-label placebos and double-blind placebos in irritable bowel syndrome and found no significant difference between the two. A medical myth was overthrown.

Nope. A medical myth was born, namely the myth that placebo effects do not require deception. What do I mean? Let’s go way, way back to 2010, which was the first time I ever wrote about the myth of “placebos without deception,” namely because that was when the first of Kaptchuk’s “placebos without deception” studies hit the news. The idea is that the “power of placebos” can be harnessed even if you tell the patient that they are receiving a placebo and that his study showed just that. However, as I pointed out at the time, that narrative is not…quite…correct. From the study itself, here’s how the subjects were recruited to test “open-label placebos” on irritable bowel syndrome:

Participants were recruited from advertisements for “a novel mind-body management study of IBS” in newspapers and fliers and from referrals from healthcare professionals. During the telephone screening, potential enrollees were told that participants would receive “either placebo (inert) pills, which were like sugar pills which had been shown to have self-healing properties” or no-treatment.

Before potential subjects were even randomized to different groups in the study, they were told about how “powerful” placebo effects can be:

Patients who gave informed consent and fulfilled the inclusion and exclusion criteria were randomized into two groups: 1) placebo pill twice daily or 2) no-treatment. Before randomization and during the screening, the placebo pills were truthfully described as inert or inactive pills, like sugar pills, without any medication in it. Additionally, patients were told that “placebo pills, something like sugar pills, have been shown in rigorous clinical testing to produce significant mind-body self-healing processes.” The patient-provider relationship and contact time was similar in both groups. Study visits occurred at baseline (Day 1), midpoint (Day 11) and completion (Day 21). Assessment questionnaires were completed by patients with the assistance of a blinded assessor at study visits.

As I pointed out at the time, not only did Kaptchuk et al deceive their subjects to trigger placebo effects, but they might very well have specifically attracted patients more prone to believing that the power of “mind-body” interactions. While it is true that patients were informed that they were receiving a placebo, that knowledge was tainted by what the investigators told them about what the placebo pills could do. After all, investigators told subjects in the placebo group that science says that the placebo pills they would take were capable of activating some sort of powerful “mind-body” healing process. I pointed out that in most clinical trials, investigators tell subjects that they will be randomized to receive either the medicine being tested or a sugar pill (i.e., placebo). This, patients are told, means that they have a 50-50 chance of getting a real medicine and a 50-50 chance of receiving the placebo. In explaining this, investigators in general make no claim that that the placebo pill has any effect whatsoever and, in fact, are explicitly told that it does not. In contrast, Kaptchuk et al explicitly deceived their subjects for purposes of the study by telling them that the sugar pill activated some sort of mind-body woo that would make them feel better. True, they also told the subjects that they didn’t have to believe in mind-body interactions. But did it matter? I doubt it, because people with authority, whom patients tend to believe (namely doctors) also told subjects that evidence showed that these placebo pills activated some sort of “mind-body” mechanism that was described as “powerful.”

Back to the op-ed, in which Kaptchuk claims that many more studies since his original 2010 study show that he was correct:

Currently, more than a dozen randomized trials demonstrate that open-placebo treatment can reduce symptoms in many illnesses with primarily self-reported symptoms such as chronic low back pain, migraine, knee pain and more. These findings suggest that patients do not have to believe, expect or have faith in placebos to elicit placebo effects. So what’s happening?

I was curious about the specific studies to which Kaptchuk refers. This being an op-ed, of course, there are no links. (There wasn’t even a link to Kaptchuk’s original 2010 study! WTF, NYT?) I note that the 2010 study was not the only study by Kaptchuk about “placebos without deception,” either. He published one in 2014 of “open-label placebos” for migraines, which had exactly the same huge problem. Indeed, the script said things like, “Our second goal is to understand why placebo pills can also make you pain-free.” Note the assumption. The script didn’t say that placebo pills might decrease your pain. It said that they can make you “pain-free.” In 2016 he was co-author of a study on low back pain with—you guessed it!—the same problem but even worse. As I pointed out at the time, they used the same talking points from the IBS study, plus clips of happy study participants to prime the patients that placebo effects can be “powerful.” Again, people that patients tend to believe, doctors and nurses and other health care professionals, telling them that sugar pills could invoke powerful healing effects.

Are there any more recent studies? Doing a bit of PubMed searching, I found a number of studies of “open-label placebos,” most of which with Kaptchuk as a co-author. One thing that I’ve notices is that in the more recent articles it is much more difficult to find out exactly what subjects randomized to the open-label placebo arm are told. This study, for instance, says nothing more than that open-label placebo (OLP) recipients were told that they were receiving a “novel mind-body intervention” and that the “script for the OLP group is similar to our previous OLP.” Basically, perusing a number of these studies, I find that they all have the same problem in that they basically characterize placebos as being something like a “mind-body intervention” or being able to have significant effects on symptoms. In other words, “placebos without deception” are not. They’re just placebos, but with subtler deception. This 2023 study, which used open-label placebos with methadone treatment (!) for opioid use disorder, for example, even did this:

As in previous studies,25 a script was used as a conversational guide to emphasize 4 points: (1) a brief description of the positive impact of placebo in RCTs; (2) the automatic nature of placebo responses, with a description appropriate for lay persons of the neurobiological and psychological (conditioning) mechanisms of associative learning; (3) the lack of a requirement of belief that the placebo would work; and (4) emphasis on the criticality of placebo consumption (Supplement 1 and eTable in Supplement 2). Participants then viewed a video of a television news piece that described scientific studies of OLP interventions to treat irritable bowel syndrome.45

See what I mean? The researchers primed the open-label placebo group to believe that placebos work! Same as it ever was!

I’m going to conclude now as I concluded then by saying: There is no such thing as “placebos without deception.” However, because it is now widely agreed that deceiving patients is unethical except under very limited and specific circumstances, promoters of ineffective quackery that only appears to “work” because of placebo effects need to give the appearance of removing the deception in order to sell the narrative that placebos are valid medical treatments. That’s all it is, though. Appearance, nothing more. Placebos don’t work without deception, Ted Kaptchuk’s research notwithstanding, his op-ed in the NYT notwithstanding.

Although I believe, as Steve Novella does, that Ted Kaptchuk is well-meaning, but misguided—e.g., a true believer—the placebo narrative that he is promoting is harmful. I also believe that some of the other people promoting the placebo narrative are less well-meaning.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

50 replies on “Placebos without deception: Misinformation that never dies”

I wondered about the lack of replies on the last post as well. Thought something was wrong with the site.
Somehow this placebo story reminds me on an Australian commentor on Science Based Medicine.

A number of potential commenters on the Makis article probably said their piece when it was first posted on Science-Based Medicine.

Well Igor has decided to add his usual stupidity to the Makis article. And of cause he did here as well.

The comment system has been wonky for a year or two now. Mostly I just put up with it.
For instance, I’m pretty sure I posted my comment on my thread this morning (MDT) but it showed up at 2:52 PM (EDT?).
The current recent comments list shows 3 comments on the Turbo Cancer thread by NumberWang, Renate and DB. But when I click on one of them, the thread opens with only a quote link comment and the comment by Igor. And the newest comment is the first of 3 that Orac has made on this thread.
I’m typing this on my Windows 11 laptop with Chrome. Same result on my S22 with Chrome and my iPad Pro with Safari (iOS 17.0.3).

And when I opened this computer to cross-check, the latest comments were on the Midwit thread. And this article wasn’t listed. A refresh didn’t change anything.

I’m pretty sure I posted a longer comment a couple weeks ago that never showed up. It was only in response to one of Igor’s statements that actually got me curious enough to check something, so no big deal.

Also even for comments that are shown, once there get to be a fair number of comments, the link stops scrolling down to the actual comment. You have to take what it gives you and scroll down from there.

Not sure what you can really do with WordPress. And of course Disqus has its own set of quirks.

Anyway, I just thought I’d share these things since they seem pertinent.

Yes, the commentsystem seems to have some problems. In the past I could just comment and my name and e-mail where present. Now I have to provide them every time I post. No possibility to remember my settings. And my replies sometimes don’t turn up immidiatly, but after some time. That’s why I once had repeated a comment.

Yesterday evening I tried to post a reply to Igor when there were only 2 posts and got a “server error” notice.
I retried about 20 minutes later = same error.
Third try 30 minutes later = same error.
I gave up.

I’ve been interested in Kaptchuk’s stuff since Orac first pointed me to it years and years ago. It makes for a nice discussion piece in research to talk about placebo, but overall Kaptchuk is just a bit too biased for it to be useful research. This statement nails just how ridiculous Kaptchuk has become: “That said, oral phenylephrine sold over the counter should be removed from the market; despite some people’s love of phenylephrine cold medicines, there’s no evidence that the drug even provides placebo benefits.”

This is insane, absolutely and completely insane. There’s nothing more to be said about it, it should be the very end of Kaptchuk’s academic career, it’s just so ridiculous. He’s really gone so far as to just be imaginative, and when something isn’t “his” placebo, he dismisses it, while absolutely worshiping the placebo testing that he does, because it seems it’s “his” magic placebo.

How can academia tolerate this insanity to publish in anymore peer-reviewed publications? How can it not take action against his past publications and finally question the results?

Priming has long been an issue in social science research. (Not that I can say how common it is, just that it happens.) It’s usually well after publication that it becomes known that some priming may have affected the results. I’m not aware though of any academics getting sacked or studies withdrawn. Classic example, Bandura’s Bobo Doll experiments, which are still widely cited.

Arguably, the simple fact that participants know they’re in a study — even they’re told next to nothing about it — primes them to some degree toward something, including possible placebo effects.

I see what you’re saying. My point is that these “placebo without deception” studies appear not to have even tried very hard to reduce the likelihood of priming. In fact, arguably, showing videos of news reports about Kaptchuk’s IBS study likely did more to no prime subjects than just the script alone.

garnering exactly zero comments as of this writing, something that hasn’t happened in a very long time

Just checking that it wasn’t a infrastructural problem… Seems odd no one said anything, even the trolls.

Seeing no comments here too, I wonder if the comments are not working somehow. Let’s see…

The reason why placebos do not work is that they are administered in a too small dose.

That 100mg placebo should be changed to 500mg placebo.

And also be given three times as a booster placebo, for greater effect.

Yesterday I was out walking and Science Friday came on from September 29.
Normally it’s a somewhat useful overview of recent scientific research.

But then they jumped into an interview about the power of the placebo effect! Having read your previous articles, I immediately started wondering, “what’s going on here?”

And guess what?

They were interviewing Ted Kaptchuk!

I saw the headline in the NYT and knew immediately that it was TK. I told my daughter that Orac would be blinking himself to a short circuit and was delighted to see this post. NYT is way too gullible.

Totally forgot to add to my previous reply: placebos are designed to protect against severe disease or death.

Therefore, if you are still alive to complain about your placebo that did not help, the placebo saved you and you should stop complaining. (and if you died, you are not here to complain anyway)

Placebos save lives!

Is it a concern to you that at times I cannot tell when you are posting your honest thoughts on a topic and when you are being sarcastic?

Vaccines are not placebos. They are beer than placebos. This is the point of RCTT

I’m missing something that I assume is trivial but still — Im missing something.

So this

Before randomization and during the screening, the placebo pills were truthfully described as inert or inactive pills, like sugar pills, without any medication in it. Additionally, patients were told that “placebo pills, something like sugar pills, have been shown in rigorous clinical testing to produce significant mind-body self-healing processes.

and this

During the telephone screening, potential enrollees were told that participants would receive “either placebo (inert) pills, which were like sugar pills which had been shown to have self-healing properties” or no-treatment.

a) What is the difference between an inert pill and “no-treatment”? I’m not sure what they were comparing the placebo with
b) For the first item: if subjects were told that the placebo had the “rigorous testing…” stuff, again: what were they tested against?

I guess I’m not sure of this: when the claim is that his placebo groups had significant improvements, compared to what?

As I said, I’m sure whatever I’m missing here is simple, but it’s been a loooooong week.

The experimental group received a sugar pill. The control group didn’t get anything.

As Orac points out, the experimental group was also explicitly told that the “placebo” was shown to be effective in clinical tests in “triggering self-healing”; despite claims that they were properly informed that they were receiving a placebo, they were actually in effect being told that they were being treated. The control group was explicitly told they weren’t receiving any treatment at all.

The experimental group received a sugar pill. The control group didn’t get anything.

Thanks gdave, I knew whatever I was missing was trivial. I had it in my mind that the other group was receiving some real drug and so was wondering what was said about it.

Thanks for setting me straight without laughing at me (at least not openly laughing).

Of experiments intended to illustrate a preconceived truth and

convince people of its validity: a most venomous thing in the

making of sciences; for whoever has fixed on his cause, before he

has Experimented, can hardly avoid fitting his Experiment to his

cause, rather than the cause to the truth of the Experiment itself.

Thomas Spratt, History of the Royal Society

Stole this from Crislip as it seems appropriate here. I always think of Colquhon’s analysis that placebo is just a statistical artifact and is mainly regression to the mean. That all this has to be restricted to subjective self-reported symptoms is a big tell as far as I can see.

The placebo effect, empathetic person(s) regularly apply Vicks VapoRub to children with congestion. Child recovers and associates Vicks VapoRub with empathy and healing. The cycle continues…

Integrative medicine is saturated with empathy. In my opinion, the psychological power of integrative medicine is in the empathy effect, not the placebo effect.

@ Orac,

Few comment post: Dr. William Makis: Promoting the nonsense that is “turbo cancer.”

Human beings fear turbo cancer. Alleamit is designed to inhibit turbo cancer. Let’s talk about this?

Let’s talk about this?

Turbo cancer doesn’t exist, so who would want to talk about it?
Oh, mjd, crank supreme. That explains it.

mjd, you’re the clown who referred to turbo cancer, and you’re the clown who continues to hype monumentally worthless crap. Suck it up.

“…Vicks VapoRub with empathy and healing…”

Go rub some on your fanny. Trust me. Scientific stuff happens…

Cold resolves by itself, and placebo is credite,. Same applies to SCAM.
“Scientific consensus asserts that allergies are a maladaptive immune response. At Alleamit, this much-maligned immune response is under investigation to inhibit cancer. Our patented skin cream uses specific allergens to activate the body’s natural immune system to disrupt the cancer microenvironment. The vision is to create cancer therapy that is inherent and patient-friendly.”
This is positive dangerous, if truthful Allergic response is aseparate immunological phenomenom.

Igor: “The reason why placebos do not work is that they are administered in a too small dose.”

It’s certainly true that larger tablets, and larger numbers of tablets, sometimes produce a larger placebo response. As do colorful tablets (over plain off-white ones). Injections are stronger inducers of placebo response than pills, and hands-on manipulation (acupuncture, chiropractic) are stronger yet.

But the best inducer of a placebo response is endorsement by a respected authority figure. Kaptchuck’s priming of his subjects by enthusiastically telling them that placebos can have significant effects clearly overpowered his presumably low key mention that the placebo tablet is inert.

But getting a (usually) subjective positive effect out of a sham presentation doesn’t justify the inherent dishonesty of handing out inactive pills, especially if there’s a charge for the sham service.

Many things have a similar placebo effect, for example prayer helps people feel better. (there is nothing wrong with that really)

Prayer doesn’t…studies show it’s no better than chance and if people know they are being prayed for, they do worse.

Prayer doesn’t…

It doesn’t help the person being prayed for, no. I could believe that the person doing the praying might feel better for having done it, sort of a soothing feeling because they can’t do anything useful. I’m sure this isn’t what igor, the guy who believes in all sorts of things which are completely at odds with reality, meant.

I am agnostic and I do not pray, however I meant prayer by the person hoping to feel better – not prayer for others

Two thoughts:

I’ve been telling patients to go get Sudafed from behind the counter practically since it was locked up. I also suspect the phenylepherine makers were pushing the idea that pseudo was super dangerous to those with cad, htn, etc.
Acupuncture and all that stuff…if it means the person wants less opioids, great! That’s a placebo effect I’ll take any day and twice on Sunday!

As a long time reader of the Smithsonian magazine, despite residing in the antipodes, I used to get some amusement from the ads for pharmaceuticals included. In the small print there would be a list of side-effects reported in the trials for both the active arm and the placebo arm. The number and tupe of side-effects reported in the placebo arm would often be surprising. I took the position that people in a pharmaceutical trial were expecting side-effects from a drug and so reported the same even if in the placebo arm.

Also, the package insert tells me something like “12% of patients who received the drug had X side effect; 7% of patients who received the placebo had that side effect,” and sometimes the side effect is something like headache or tiredness. What’s missing is, what percentage of people not taking part in the study had the side effect over the same period? What are the chances that, of 100 random people, none of them have had a headache in the past week?

Yeah, exactly. “Upset stomach” or some variation is on practically every med. most people have some gas or bloating throughout the week medications or not.

@ Igor Chudov

You write: “That 100mg placebo should be changed to 500mg placebo.”

First, where did you find that placebos were administered in 100 mg doses? If you found such a study, what was mg of studied medicine? Placebos are given so that subjects cannot distinguish from studied medicine. So, if subject given 500 mg injection of medicine, then, of course, placebo would be same amount. As for a 500 mg placebo, let’s assume placebo used in study with some medicine injected in veins. Please name a medicine that is quickly injected that is 500 mg. So, if subject given 500 mg injection, then, of course, placebo would be same amount.

I believe he was attempting to make some kind of joke about vaccines not working? Like he’s implying that he believes the effectiveness of vaccines at preventing illness is all in people’s heads and that a placebo administered in the same way would prove just as effective as actual medical treatment due to the power of positive thinking and the ability of ones state of mind to determine the outcome of an illness.

No shortage of studies showing and it’s a requirement for FDA approval anyhow that a vaccine must outperform placebo on trials.

“… activating some sort of ‘mind-body’ healing process…”

Yes, a placebo liberates the Qi to balance out its equilibrium OR decreases stress and worry so healing energies ( l’elan vital?) can do their work OR allows the subjects’ positive emotional responses to fix problems OR it lets go and lets g-d intervene…

Alt med/ woo has many descriptions that mostly incorporate mysticism or un-researchable options like these but- like the study quoted- usually involve lying, mis-direction or mis-information- there’s no other way.

Idle thoughts…

As Orac’s regulars try strenuously to counter alt med/ anti-vax on the net, I Iearned ( via @ doritmi Xing Ben Collins and Brandy Zadrozny) that The Epoch Times is the fourth most subscribed “newspaper” in the US and that it’s hiring experienced, right leaning journalists to spread its garbage rather than Falun Gong religionists. When I read alt med/ anti-vax/ rightwing BS, I often see them quoted as a valuable surce.
Remember the good old days when it was only Jake Crosby writing there?

Formerly exclusively alt med health sites now seem more attuned to politics following the Alex Jones model for fear mongering with tall tales and then selling the audience supplements. Or prepping supplies/ plans for leaving cities. NN,, The Highwire etc.

The Simpsons, of course, is a universe unto itself where everything comes up eventually.

In one memorable episode, the dreaded “Osaka Flu” hits Springfield, and a desperate mob is shown chanting to Dr. Hibbert: “Give us a cure! Give us a cure!”

Hibbert chuckles (he always chuckles) and says “But this is a viral disease! Anything I give you would be a placebo!”

The crowd goes wild — “Where can we get some of these placebos?” In the ensuing fracas, a truck full of beehives is knocked over, and bees fly everywhere, inducing panic. One guy gets stung — -“OW!! OW!! — I mean .. I feel better!”

I may have missed it but why don’t these people have 2 placebo groups, one where they are primed to think placebos can unleash some magical power within and the other where subjects are given the neutral presentation of placebos?

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