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Dr. Placebo — Half Quack and Half Savant

• November 28, 2011 • 8:25 AM

The placebo effect’s ability to influence human healing and human behavior is well documented, but we must be careful to make sure this fakery does no harm.

[Cue the drum roll] Ladies and gentlemen, introducing tonight, the magical, the amazing, the astounding, the one, the only [cue the cymbal] — DR. PLACEBO!! Performing sleights of hand that will amaze you, entice you, and lure you into miracle cures that will release you from your hard-earned cash. Come see never-before effects. Well, maybe always-seen effects. Step right this way …

OK, perhaps I’m more cynical than skeptical here, but given the successful selling of sham products such as balance bracelets and homeopathy, it’s important that we learn to think critically about one of the most powerful forces in medical research, the placebo effect.

Much has been written on the placebo effect — and an exciting new take is on the way from Miller-McCune — so our focus here is to critically investigate the role of these fake treatments and beliefs in our daily lives and how to use our skeptical skills in dealing with them. It’s important to realize that even when placebos have a positive impact, the effects can be short-term and end up masking more serious symptoms, preventing people from seeking reliable and effective treatments.

Simply stated, a placebo (Latin for “I will please”) is a substance or procedure given to a control group when used in scientific research designs to compare with an equivalent group receiving the real treatment or pill. In medical research, the look-alike treatment is often a sugar pill that does not have any real effect on the illness, allowing comparisons to be made between the actual medicine and the fake one.

It’s fairly common that about a third of people in the control group receiving the placebo report positive changes or lessening of symptoms. Sometimes recipients of the placebo claim negative side-effects (the “nocebo” effect), such as headaches or nausea. Surprisingly, some patients say they have positive outcomes even when told outright that they were receiving a fake treatment!

The power of the mind and its psychological impact has been a common explanation for how the placebo effect works. But continuing research also points to important physiological and neurological brain changes with placebo treatments. Indeed, with real treatment and medicines, some part of the cure can be attributed to patients’ expectations that the substance is working. Recent evidence suggests that placebo medicines are showing more effectiveness that the real pills, again illustrating some powerful physiological responses of patients to social, psychological, and biological expectations.

Headache relief seems to attract lots of placebo products, including one that simply required rolling on a wax-type substance and another by slowly moving a red light across your forehead. The red light should instead remind you to stop with these treatments and save your money, since in most cases, headaches will go away on their own with time and relaxation.

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SKEPTIC'S CAFE
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Consider too some non-medical situations where the mind has power over the reality. We know, for example, that people will often claim they are not as full after eating food labeled as healthy or low-fat, compared with foods labeled as an “indulgence” or high in calories. Here the placebo principles can result in people eating more unhealthy foods when they are not satisfied after finishing their better-for-you foods.

In an unusual study from New Zealand, university students who were told they were drinking vodka and tonic, but were really sipping a tonic-only placebo, not only acted drunk but also demonstrated worse eyewitness accounts and were more easily swayed by misleading information. Perhaps they would be willing to buy some fake red light treatment for their fake hangover and fake headaches!

Pricing can also have an impact on placebos, as Dan Ariely illustrated in Predictably Irrational. Researchers sold some students at a university gym a caffeinated soft drink at full price and another group bought it at a two-thirds discount. After finishing the beverage, and because of the caffeine, all students said they felt less tired after their workout. However, the group paying the higher price reported less fatigue than the discounted price group, even though they bought the exact same product. When tested with a problem set of anagrams to solve, those students who paid full price for the caffeine drink performed 28 percent better than the group who paid a discount for the drink. And all students performed even better when told the ads for the drink emphasized scientific studies showing the product improved mental functioning. Even in this experimental situation, the full-price group continued to outperform the students who received the discounted price.

Dr. Placebo, you’re amazing. Not only do you have power over fake medical treatments, you enhance the effect of real medicines, you contribute to our experiences when imbibing alcohol-based and caffeinated drinks, and you help people believe advertisers’ hype.

But do us critical thinkers a favor: because your name is a Latin word, remember the other Latin phrase that guides medical ethics and skeptical inquiry: Primum non nocere, “First, do no harm.” Save your effects and tricks for when it is helping people to feel better and to act more responsibly.

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Peter M. Nardi
Peter M. Nardi, Ph.D, is an emeritus professor of sociology at Pitzer College, a member of the Claremont Colleges. He is the author of "Doing Survey Research: A Guide to Quantitative Methods.”

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