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Key concepts about placebo I wish every reader understood 

 •  • 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 a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

One of the hardest parts of my job is The Redundancy Problem: topics that I need to cover to some degree on many pages around, and then also keep that coverage up-to-date. It’s a content maintenance nightmare for me.

For example, suppose I’ve made the same point about placebo 27 similar-but-different ways in 27 different books and articles (which I probably have)… and then something about that point changes! Maybe some new evidence changes my mind about it. Maybe I just think of a much better way to make the same point! Now I’ve got 27 updates to do … 😬

That kind of word-juggling act is a major part of managing would not believe how many hours I’ve logged over the years with lots of text editor windows open at once, painstakingly comparing similar text, feverishly copying and pasting, trying to fit the same key points into each passage, or checking to make sure obsolete information is purged from all of them. It can get really dizzying! No joke, this is one of the main reasons I have an array of three 27" computer displaysshow — because I need a lot of virtual desk space for that kind of editing!

So, whenever possible, I just re-use the exact same text. It feels a bit like cheating, but it’s just the only sane thing to do. And so I do it, if a passage is legitimately relevant in many places, and doesn’t need any modification to fit in.

There are several points about placebo that qualify, things I wish every reader was aware of, but I can’t expect everyone to go and read about it in detail either. I need to summarize them frequently. And so I’ve created a short chapter about placebo that can be reproduced, verbatim. Any time I want to change it, I just edit a single file, and the text is automagically updated everywhere. Magic! Working smart, not hard!

And here it is …

Key points about placebo

A placebo is relief from belief: people often feel better simply because they believe they have been treated. More precisely, it is the appearance or illusion of a treatment effect that is not actually attributable to a biological treatment mechanism. It’s a fascinating phenomenon, but its “power” is over-hyped.

This is a standard section in most of my books, summarizing several key points about placebo that are important context for a thorough discussion of evidence-based treatment options. I do not support any of these points here — for readers who want to know more, there’s a more detailed article about placebo.

Is it okay to pay for a placebo?

Many people claim to be happy to pay for a placebo. As long as it works, who cares how? And placebo can work! So why not? This is an extremely common sentiment.

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 the benefit. And there are very strict limits to what placebo can do. And paying for things is never completely harmless.

Treatments with unknown efficacy but some plausibility and low risks are the least objectionable placboes to pay for. 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.

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.”

Cartoon by Loren Fishman,

Above all, what I want readers to take away from this is that placebo is not therapy. It’s mostly just an over-rated curve ball that accounts for an awful lot of temporary “success” stories.

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