If a placebo treatment can do good, how much good will it do when combined with a little real medicine? That’s what I call an enhanced placebo: a treatment that seems much better than it is, because a small but real medical benefit makes it easier to believe in. Empty promises can and do reassure patients all the time, but even just a little genuine relief is more reassuring — it may prove that relief is possible to a patient that has lost hope, which can be just about as good as actually fixing anything.
One lesson to take from this is that snake oil is always much more marketable and pernicious when a little real medicine is included, exaggerating its effectiveness and generating more passionate testimonials. But enhanced placebos will make any partially effective medicine look better — which helps us to make sense of the huge, murky gray area between outright quackery and rare true cures, where real biological effects and the hopes and fears of patients are hopelessly entangled.