The Magic Of Placebo
And the mysterious ways our minds work
Hello readers,
I hope you enjoyed reading last week’s article on the curious parallels between controlling your smartphone and your mind.
In today’s piece, we’ll be exploring the fascinating concept of placebo.
Now if you remember reading daily updates during the mad old days of Covid when everybody and their pet turtles wanted to get the latest vaccine update, you might have heard this term already.
But if you were busy and ran out of f*cks to give, that’s equally cool, because we’re about to dive into this intriguing idea using simple words only. No complex jargon or equations that give you a brain-splitting migraine- that’s rule #39 of Learning Machine.
[Old-time learners would remember that we’ve covered science topics like the evolution of exercise or the illusions we succumb to in simple words. Check those out too- I really enjoyed learning about them]
The placebo effect is the idea that sometimes our bodies are able to get better when we’re given a dummy pill i.e. the pill doesn’t actually have any medicine and is nothing but a pellet of sugar.
This must be happening because the very idea of taking a pill to cure a problem creates an expectation- and maybe our minds act based on this in a way that’s conducive to our recovery (even if the pill doesn’t contain any healing property at all).
In essence, your mind-body complex possesses the power to heal itself via a purely psychological pathway, the important point being the expectation that it has been given something and hence is supposed to improve as a result.
You may find this unbelievable but some serious stuff like angina treatments and knee surgeries have also been done successfully with placebo treatments, with patients reporting similar relief levels as compared to those who got the actual treatment!
Placebo medicines are used in medical trials to gauge the effectiveness of new pills and medicines. Essentially, any new medicine that is being proposed to treat an illness has to prove to be significantly more effective as compared to a dummy medicine- which is why they’re called placebo-controlled trials.
What’s fascinating about all this is the way our minds interact with this entire process of taking medicines/getting treated, and how they end up producing some curious and baffling effects.
Let’s unpack some research findings on this topic one by one:
Pill effectiveness: You may think that a pill works only because of the medicinal properties it contains but that’s not all. The way the pill looks, feels, is delivered, administered, and spoken about- all of these factors end up affecting their efficacy! Experiments have shown that big-brand painkillers and fancier packaging work better. 4 pills are more effective than 2 pills. And people benefit more when they’ve paid for the medical advice they sought. Even capsules worked better when they were introduced- probably because they looked more sciencey! Heck, even pill color makes a difference- for instance, it’s been observed that antidepressants are more effective when they’re given as red-colored pills. This is quite a blow to the idea that aesthetics don’t really matter and it’s all about functionality. If it applies to something as serious and no-bullshit as medicine, maybe it applies everywhere.
Effective despite our knowledge: What really blew my mind was a study in which patients were clearly told that they were being given pills that were made of nothing but sugar for treating their illnesses- and it still worked! So placebo isn’t a tool for the gullible or ignorant- it can work even if you’re well aware of the fact that what you’re being given contains 0% medicine. There’s no trickery or deceit involved in the success of a placebo- it’s just some bizarre mental mechanics that god knows who can explain.
Placebo diagnosis: Even if you simply receive a dummy diagnosis about your condition (“Yes, you have hyper-angio-blasto-plastoma and don’t worry, it’ll heal once the dorso-lateral-myo-fartium shows a ventral redressal”), it can lead to a healing effect! Those words didn’t mean shit by the way- I made that crap up on the fly. But who can tell? And that’s the fun part- we can’t decipher what the docs say when they use 17-word combinations to tell us about our diagnoses anyway. But from a psychological standpoint, what helps tremendously is the reduction of uncertainty- a sure-shot identification of what we’re suffering from and acknowledgment by a doctor probably calms the mind and inclines it towards the path of recovery!
Doctor expectations: As if all this mysterious mental magic wasn’t enough, one clever experiment showed that even a doctor’s expectations regarding the meds she’s giving can affect the way people heal! Here’s what the study did- it made 2 groups of doctors who’d administer medicines to their patients. Group 1 was given a mix of medicines that could either be A) The actual medicine or B) A placebo/an anti-medicine that’d make the situation worse. Group 2 was told they’d only get type B pills (i.e. anti-medicines or placebos) but without their knowledge, they were also given the same mix of pills that Group A got. Essentially both had the same mix but both had different expectations because of what they were told. Group A doctors felt that some patients would definitely get the right pills and were relatively more confident while administering their pills. Group B docs, however, were low on confidence (because they were misled into thinking that they’d only be administering placebos or anti-meds). Shockingly, patients in Group A showed better results than Group B even though they were given exactly the same pills! The explanation that seems more likely is that patients were observing the doctors’ expressions and body language- and since Group A may have seemed more optimistic and confident, their treatment was more effective!
As you can see by now, our minds work in fascinating ways, and there is a deep psychological element to the way we’re treated. It’s not just about the cold, calculated administering of a medicine. The way the doctor talks to you, identifies your condition, smiles while giving you the injection, and the color of the pill she suggests- all of these make a difference!
This doesn't give us the license to feed fake-as-hell products to unsuspecting people when they’re down with jaundice or deadly diarrhea that struck them after eating Chinese bhel at that deadly stall outside Dadar station.
There’s a place for the ethical use of placebo in the world of medicine- but it has to be done with care and by experts who understand it properly. It can even be used in treating maladies where there is no known remedy as long as doesn’t worsen the patient’s issues.
But let’s leave that to the doctors and policymakers. For our purposes, what matters is the knowledge that our body is not just a machine that works in specific ways when it ingests an input.
There’s a deep mind-body connection (we’ve spoken about it earlier) that shows up in all the fascinating findings we’ve explored.
We have a lot to learn about how the mind works. The fake but effective sugar pills are just helping us glimpse the tip of the iceberg.
Thanks for reading! If you want to dive deeper into the way medical trials work and how the pharma and nutrition industries keep scamming us, I’d recommend the book Bad Science by Ben Goldacre.
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Super interesting & informative. It's a lot like advertising itself - one stupid product isn't going to make you glow and change your face colour but you think it will because your mind is so used to buying the narrative that this will change everything. You might be applying water for all anyone knows.
Excellent article, Sahil! And thanks for also mentioning the book, I've gotta read it.
Appreciate you for choosing some very interesting topics to read about every week!