All Placebos are not created equal (2021)

Something I never see discussed (though if you have resources on the subject, please share them with me) are the very real and important difference between believing and wanting to believe and feeling better about something without the something itself being better.

When I feel like my symptoms have improved, that is factually distinct from my symptoms having improved. Ok, so far so obvious. But it is also factually distinct from me really feeling like my symptoms have improved. It may very well be that I'm just not sure and that I subconsciously lean toward giving the benefit of the doubt as a tie-breaker for my own uncertainty. And then I can feel better about that without the underlying symptom improving, and that is definitely factually distinct from the symptom improving.

The impact would obviously be age-related, since age equals exposure to factors like social influence, introspective knowledge of the limits of self evaluation, and so on.

And it is not the same thing as a placebo effect improving the symptom itself. I can be experiencing the exact same amount of pain but wishy-washy on the evaluation, but people report on the placebo effect as though it means I experience less pain. But maybe I'm just less frustrated by the pain, or less inclined to admit the pain to myself or to others, or less inclined to trust myself. Maybe believing feels good, so I want to do it.

There's a common misconception about placebos that they are merely a "reporting/statistical effect", but this is inaccurate. The placebo effect can have measurable effects on things that are not subjective. Wiki cites (in response to a controversial study claiming to have found the placebo effect is not "real") : "...the existence of placebo effects seems undeniable. For example, recent research has linked placebo interventions to improved motor functions in patients with Parkinson's disease. Other objective outcomes affected by placebos include immune and endocrine parameters, end-organ functions regulated by the autonomic nervous system, and sport performance." [1] And that should not be taken as an exhaustive list of examples - placebos can show objectively measurable improvements in a vast array of domains. It's certainly real.

The evil twin of the placebo, the nocebo, has even more dramatic proof of its realness: "there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ('pointing the bone')". [2] This could also largely explain why elderly married couples tend to follow each other into the grave in short order - dying of heartbreak, perhaps not being an entirely rhetorical expression.

[1] - https://en.wikipedia.org/wiki/Placebo#Effects

[2] - https://en.wikipedia.org/wiki/Nocebo#Ambiguity_of_anthropolo...

> The implications of this are pretty serious - the placebo effect in the United States has actually become quite a lot stronger over time, meaning that drugs that once would have been approved may not be now - because their performance relative to that of placebo is less convincing.

> Weirdly, it seems like this is only happening in the United States, whereas other countries haven’t seen particularly large increases in the effect size of placebos.

Any theories for this?

I have a theory why placebo works: It may be caused by the "Selfish Gene".

When my sub-conscious believes the body is dying it decides it's for the best of the whole gene-population that the individual in question stops fighting for resources and for reproductive opportunities in the world. It would be wasteful to use scarce resources for me, not from the viewpoint of me the individual, but from the viewpoint of the gene-population.

But if I do believe the doctor's pill will cure me soon, then the sub-conscious "thinks" that it must be more true than not, because who can we believe more than the experts? So it's time for it to NOT give up my fight for the survival of the fittest, but to help me do it.

In other words if my subconscious believes I am dying soon, it would not make sense (from the viewpoint of the gene-population) to take away scarce resources from other individuals who are NOT dying soon.

The "Selfish Gene" is in fact the most unselfish thing there is, it is guided by what is best for all of us.

Would anybody more knowledgeable in the topic help me understand the results of the first graph? Paper is here: https://sci-hub.se/https://psycnet.apa.org/doi/10.1037/hea00... (I haven't finished reading it) Seems the authors claim it's statistically significant, but does it matter if it's clinically significant? 1mm difference seems pretty small, and they conclude that it suggests that it 'can harnessed to improve treatment outcomes'. I'd have understood if the conclusion were that effects exist at all, but not if the claim is that it's useful for something else.

This comment contributes nothing, but I find the title jarring. To make it more obvious, "All doctors are not men" vs "Not all doctors are men".

There are so many misconceptions in this article.

Placebo effect is not getting stronger over time. We are getting better at controlling for all other factors: regression to the mean, self reporting related biases, the effect that people change their behaviour when they are being observed, etc.

Placebo effect is not "mind over matter" it just all the peoples behaviours, biases and life that is happening while they are getting treatment.

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A reminder: The Placebo Effect is a reporting/statistical effect, not a physical effect. It's not saying that there is an effect on your body from believing that some intervention is working, but that in a trial where people believe an intervention is working there is an effect on the data.