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Is it okay to pay for a placebo?

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Even when people begin to accept that a treatment is probably bunk — homeopathy is a good example — they often still protest that they are happy to pay for a placebo. As long as it works, who cares how? And placebo can work! So why not? This is basically the medicinal version of Pascal’s wager (erring on the side of faith). If the stuff actually works, great. If not, at least there’s the placebo consolation prize.

I have no problem with people paying for a placebo as long as their eyes are wide open. But … the wider your eyes get, the less likely you are to benefit from a placebo (despite the “open label” hype). And there are very strict limits to what placebo can do … and paying for things is never completely harmless, because that money could be used for other things … and trying to use a placebo gets a lot more problematic when something really medically serious comes up.

Comic strip of a man standing in front of shelves full of bottles and boxes. On the left, the products are labelled “Placebos.” On the right, they are labelled “Fast-acting, extra-strength placebos.” The caption: “Hmm, better go with these.”

Where I have the least objection to “paying for a placebo” is for treatments in the grey zone: unknown efficacy but some plausibility and low risk. I’ve tried many such treatments, knowing full well that any effect I enjoy is probably just placebo (or regression to the mean, or natural recovery)… but it might be an actual effect, and I’m willing to pay a little for that chance. But, for me, the plausibility has to be there.

It ain’t there with homeopathy. And lots of other things where people are banking on getting at least a placebo.

This post was added to my main placebo article.

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