Placebos, commonly thought of as fake treatments that people think are real, have been found to be helpful even when people know they’re fake.

A Placebo Can Work Even When You Know It’s A Placebo, Harvard Health, 7 July 2016

What if people were told, up-front, that they were getting a placebo and not an active medication? It stands to reason the placebo would have no effect. Right?

Wrong.

Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School, has been studying placebos for more than 20 years:

In one study, Kaptchuk looked at people with irritable bowel syndrome (IBS), a common condition that causes abdominal cramping and diarrhea or constipation that can be debilitating for many. Half of the study volunteers were told they were getting an “open-label” placebo and the others got nothing at all. He found that there was a dramatic and significant improvement in the placebo group’s IBS symptoms, even though they were explicitly told they were getting a “sugar pill” without any active medication.

Here’s that study:

Placebos Without Deception: A Randomized Controlled Trial In Irritable Bowel Syndrome, PLOS One, December 2010

Kaptchuk also found open label placebos were useful for back pain. This is from: Fake Pills Can Work, Even If Patients Know It, NPR, December 2010

And Kaptchuk and his colleagues found the same effect among people with garden-variety lower back pain.

All the participants were told that the placebo was an inactive substance containing no medication.

Then half the group was assigned to simply continue their usual treatment regimens, which included things like non-opioid painkillers, rest and alternative or complementary remedies. The other half were assigned to continue with their usual treatment, but to also take the placebo.

Participants rated their pain levels and their difficulty in performing daily activities, like getting dressed or climbing stairs, at the beginning and the end of the three-week study. And researchers found that people who received the placebo saw their scores for both usual and maximum pain levels drop by 30 percent, compared to 9 percent and 16 percent declines for the control group. The placebo group also reported a 29 percent reduction in their score for difficulty in performing daily activities, while the control group saw no change. (A higher score on that test indicated more difficulties.)

Here’s that study:
Open-Label Placebo Treatment In Chronic Low Back Pain: A Randomized Controlled Trial

So, in many cases, it’s definitely not the pill:

But there’s no question that people also benefit from the entire interaction with a physician. “It’s absolutely not the pill,” Kaptchuk says. “It’s what surrounds the pill,” he says. That includes a trusting relationship between the doctor and patient. In that situation, if you think the treatment might possibly work — even if you have been told the pill is inactive, as in the back pain study — the brain can fill in the picture and improve symptoms, he says.

Two things here:

• • How many drugs on the market (money-making drugs) do something more because of doctor-patient relationship than because of any effects of the pill?
  • If we suspect something might be helpful, even when another part of our brain says it can’t be, why not go with it?