Strange and Surprising Facts About Placebos

When you research medicines, alternative medicines, even medical treatments that do not involve a physical substance, you will see reference to the "placebo effect". Statements like:



X is no better than a placebo.

Y is probably just a "placebo effect".

Treatment X is just a placebo.

Medicine X failed to beat a placebo in controlled clinical studies.



What is a placebo? What is a placebo effect? Are they real, fake, or something else? Is the placebo effect magic?  No, but placebo effects are a paradox. Merriam Webster defines placebo effect thus:



"improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used"



Placebo effect is a real effect in response to a treatment that cannot cause the effect.



A paradox.





Each instance of "placebo effect" contains the theory that this instance of the effect "cannot be due to the action of the medicine identified as a placebo". Theory is impossible to, prove. It can only be disproven - by proving what caused the effect. But, when you prove that the effect was caused by something, it is no longer a placebo effect.



Placebo effects are real. They really do exist.  The dictionary and medical textbooks agree. But, a placebo effect, as currently defined, is a  logical paradox.



Maybe we should look at the definition of a placebo? Merriam-Webster defines a placebo:



"medicine : a pill or substance that is given to a patient like a drug but that has no physical effect on the patient"



However, this is not precisely true, as evidenced by their further definitions, which say:



"a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder"



In the first definition Webster's says "has no physical effect", but in the second it says it is prescribed for the 'mental relief'' (a physical effect no doubt) of the patient. Medical authorities have problems defining physical things having a 'spirit' effect, while brain and mental effects are within their scope.



Webster's also describes a different type of placebo: "an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance".  We will come back to this type of placebo later, but for now, we will simply name it differently, as a 'clinical placebo', because it is a very different case. I will refer to the first type of placebo as 'placebo', because it matches the origin of the word placebo, which is Latin for "to please". A clinical placebo is not created 'to please' the patient. It is simply a "fake medicine".



Why would a doctor give a patient a drug that has no physical effect? A placebo is:



 placebo: a lie from your doctor. 


or, in dictionary lingo: "a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder, because the doctor believes the lie it will have a positive effect on the patient" 



Doctors prescribe placebo medicines, which they believe have no effect - in full anticipation of a positive effect. A placebo is created when a doctor lies to a patient, and possibly to themselves. White lies, useful lies. Statistical surveys have shown that most doctors 'admit to' prescribing placebos some of the time. The words 'admit to' are used because the prescription of a placebo is a lie.



What do we call it when someone does something, in full belief that it cannot work, expecting it to work, and it actually works?



A paradox



Placebos are paradoxical.  Doctors 'know' that the placebo they prescribe cannot work. They prescribe them, and they tell the patient they will work - or might work, and sometimes,  'magic happens' - they actually work. Some doctors are quite good at knowing when "something that doesn't work" will actually work. Are they magic?  Are these doctors 'witch doctors'?



Of course calling it 'magic medicine', or 'paradoxical' is not considered scientific, so instead, it is called a placebo. Placebo sounds scientific. In medical research, placebos are used in clinical studies - so they must be scientific.



Placebos can have placebo effects. Placebo effects are real. Thus, placebos are real medicines, even though they are lies.



Summary so far:



Placebos are lies. Your doctor prescribes something that cannot directly help your illness. 

Placebos can have placebo effects. 

Placebo effects are real. 

Placebos are real medicines. 



Is the naming of placebos, and placebo effects done under the theory that these are real effects, caused by something else? No. The word placebo is Latin and it means 'to please'. The doctor 'pleases' the patient. What happens when the doctor pleases the patient? Does it help the patient's body?  Does it help the patients mind?  No.



It helps the patient's spirit.



The Hierarchy of Healthicine rises from genetics and nutrients, through cells, tissues, organs, systems, body, minds, spirits, and communities.  Medicine, in theory, treats the body - which includes the mind, but not the spirits, and not the communities.



Placebos arise from the community.  Your doctor, part of your community, provides a prescription for hope. Placebos treat the spirit. A good doctor can treat the spirit of the patient, sometimes by providing hope, and sometimes even with a lie.



The positive effects of a medicine are not limited to physical effects, they can also include spirit effects. Are all non-physical effects as spirit effects? If not, what are they? Note: Not 'spiritual' effects. Spirituality is a small part of our spirits. Spiritual effects are a small part of spirit effects.



Spirit effects have physical effects. So a medicine that does not have physical effects, and only has effects on our 'spirit', leads to physical effects.  This makes measurement and distinction between physical effects and spirit effects difficult. If a medicine lifts only your spirits, and when your spirits are lifted, you feel better, take your other medicines on time, change your diet, get out and walk the dog - and your health improves.  Did the medicine have only a spirit effect?  No, the first effect was on your spirit.



It wasn't the 'medicine' that caused the placebo effect. It was the doctor's hope. The dictionary definition of a placebo is actually incorrect.. A placebo is something the doctor recommends when he has no solution to sell. It is a recommendation of hope. Prescribing a placebo is the act of prescribing hope.



Placebos lift the patients spirits. What we call 'placebo effect' is actually the of lifting the patient's spirits.  It is not the medicine that the patient takes, it is that the patient believes in the medicine. Belief has real, powerful effects.



Of course there are medicines that can depress or lift the spirits, like alcohol and caffeine. But none of these are placebos. These typically result in rebound effects, often called 'side effects' as your body recovers from them.



We can now define placebo, placebo effect, active placebo and medicine, to remove all of the paradoxes.



A placebo is a prescription given to lift the spirits of the patient. It often contains a medicine recommendation that the doctor does not believe will have any direct physical effect on the body of the patient. The spirit lift often results in positive physical effects on the patient. 



 - What's different about that definition?  It feels right. And there is no paradox.

 - The medicine prescribed is not a placebo. Nothing is a placebo in itself. It becomes a placebo only when it is prescribed by a doctor. The act of giving a prescription, creates a placebo and the placebo effect.



Placebo effects are the effects of a placebo, on the spirit of the patient, and the subsequent effects on the patient's body.  Placebo effects are 'spirit effects'. The strength of a placebo effect is determined not by the substance recommended, but by the sincerity of the doctor, and the belief of the patient. 



Note: Placebo effects are not effects of the actual medicine. They are the result of the patient's belief in the doctor.



An active placebo is a prescription that contains a something that has an effect on the patient's body, not related to the illness.  It does, as a placebo, have an effect on the patient's spirits, often a stronger effect, because the patient's spirit is lifted by the physical sensations.. 



A medicine has an effect on the patients illness, the patient's body. To a certain extent, medical prescriptions are also placebos, even if the doctor is absolutely certain they will work. If the doctor believes, the patient's spirit, the patient's "will", is more likely to believe in, and to take, the medicine. Medical prescriptions also have spirit effects on the patient. 



Medicines that are prescribed are also placebos. They have medical effects and also placebo effects. Even the wrong medicine might have a positive effect, due to the strengths of the placebo effect. Medicines can have positive medical effects, when the doctor is wrong.



Once we correctly define placebo and placebo effect, there are no paradoxes.



Even self-medication can have a placebo effect. A patient chooses a self-medication because of a belief that the medication can have a positive effect. The act of choosing and using the medication lifts the patient's spirits. Self-medication can be based on previous experiences, or it might come from other people in the patient's community.



There is an interesting technical issue.  The prescription of a placebo is still a lie. A white lie. If the doctor tells the patient what he believes to be the truth, then the 'placebo prescription' will not work. The doctor doesn't tell the patient he is prescribing a placebo - he says "I'm prescribing a medicine.", knowing himself that it is a placebo.  The nurse, the pharmacist, and others might not know that it is a placebo, or a spirit medicine.  They don't need to know for it to work. And if they know, and they tell the patient, it might be less effective.



Placebos are not 'physical things'.  They can lift the spirit, because they are imaginary things - rising above the physical realm. Placebos are real aspects of medicines, they have real effects and they can even have side effects - effects that were not intended by the doctor. All medicines have the attributes of placebo, when they are actually prescribed.



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To this point, we have not discussed Clinical Placebos.



Clinical placebos have a different definition, and should not be confused with the real placebos. Clinical placebos are null medicines, not real placebos. They could be named 'fake placebos', but I believe the term 'null medicine' or simply Clinical Placebo is more accurate.



Clinical placebos only exist in a clinical trial, and only when a 'test medicine' is being tested in a clinical trial.



Clinical placebos do not require the doctor to lie to the patient.  When clinical placebos are used, the doctors are not allowed to lie to the patient, rather - they tell the patient that the doctor does not know if the patient is receiving the 'medicine being tested', or a clinical placebo.



Clinical placebos are not designed, nor delivered, to improve the spirits of the patient.



Clinical placebos are actually designed to eliminate the real placebo effects from the mathematics of clinical studies. However, this theory is weak and problematical, because, even though clinical placebos are not real placebos -they sometimes have placebo like effects.



Clinical placebos are not 'prescribed', they are 'administered'.



Clinical placebos are not given in the best interest of the patient. They are administered to assist medical scientists gain knowledge for future use.



Doctors who administer clinical placebos want the clinical placebo to fail. If the clinical placebo fails, and the 'medicine being tested' works, then the clinical trial has been a success.



Clinical placebos are very, very different from a placebo from your doctor,  A placebo from your doctor is an honest attempt to provide effective medicine for your condition.  A clinical placebo is an attempt to determine if a specific medicine provides some statistical benefit.



Clinical Placebo Effects - are still a paradox. We can understand that a normal placebo lifts the patients spirits, and results in better health. But clinical placebos are not designed to lift the spirits of the patient. But the fact is that clinical placebo effects also exist. Why? Because we don't understand. When we do understand, this paradox will also fade away.



So...When you read statements like:



X is no better than a placebo.

Y is probably just a "placebo effect".

Treatment X is just a placebo.

Medicine X failed to beat a placebo in controlled clinical studies.

Ask "Are you talking about a real placebo, or a clinical placebo?"

to your health, tracy

Tracy is the author of two book about healthicine: