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That word “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.

The podcast Hidden Brain recently did an episode about placebo, and it predictably perpetuated the idea of “placebo without deception.” The purported power of honest placebo is that people feel better even when they are candidly told they are getting a sugar pill. This claim is based mainly on an overhyped 2010 study (Kaptchuk), which I have been griping about for years. The flaw is obvious once you get it: the placebo had an effect in spite of telling patients that they were getting a placebo because the researchers exaggerated the power of placebo. Of course it’s still going to do something if you pump up the subjects’ expectations of what placebo is capable of! Expectation of efficacy is the active ingredient in all placebos. All they did was create the same old expectation with a new kind of lie: “sugar pills are potent.”

Does it seem unlikely that people would believe that lie? The show featured a patient who was a perfect example of the power of that gullibility. She was prescribed sugar pills for her irritable bowel syndrome as if they were medicine: “these are sugar pills, but they will help you.” And they did. In clip after clip throughout the show, she spoke of her placebo pills as if they were medicine, demonstrating over and over again how she believed in their “power” despite being fully informed that they were sugar pills. But it got surreal when she reacted to the prescription being withheld: she was quite worried about what would become of her without her sugar pills! •facepalm•

It was like fingernails on a chalkboard listening to the placebo-without-deception claim get uncritically reported — yet again — and by a well-produced and prominent show with a reputation for good critical analysis. But this topic gets mishandled constantly by practically everyone, because placebo is one of the most misunderstood popular topics in all of medicine (though surely there are even worse examples, like vaccination say). Which is why I was inspired to make this meme:

A meme. Face of Inigo Montoya from the movie The Princess Bride, captioned: “You keep using that word ‘placebo.’ I do not think it means what you think it means.
For some taming of placebo hype, see Placebo Power Hype: The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.

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