Nicholas B. Tiller

The blog that unifies scientific skepticism, critical-thinking, health & fitness, and the exercise sciences

  • Nicholas B. Tiller Ph.D.

#49 When it comes to placebos, urgency necessitates reality

Everyone is familiar with the concept of “placebo” as it relates to clinical trials. That is, an inert substance with no active ingredient that’s administered to study participants in place of the drug that’s being tested. This allows the researchers to distinguish between the effects of the drug and the anticipated effects of the drug.

In “double-blind” trials, neither the participants nor the researchers are aware of who has received the drug; in this way, the results are less likely to be biased. In the same way, placebos also have an important role in sports nutrition research when assessing the physiological effects of a new supplement. The presence of a “placebo control” is one of the hallmarks of a high-quality study.

Due to the ability for a placebo to evoke powerful psychosomatic effects by influencing perceptions (even in the absence of any active ingredient or real physical effect), its broader use is in the commercial health and fitness industry. Many products and practices – especially naturopathic remedies – are sold alongside extravagant claims but work only because of their anticipated effects. Some examples are a potent diet pill, most supplements, kinesiology tape, chiropractic, cupping; even some of the effects of altitude interventions are thought to be due to placebo. The list goes on.

These types of products are hugely successful because of their very powerful psychobiological effects; in other words, they influence people’s perceptions (e.g., how they feel). Based on pre-existing experiences, conditioning, and expectation, an individual using a placebo can convince themselves of uniquely positive experiences. Placebos have been used widely in treating pain (e.g., lower-back pain, arthritis), depression, and extensively to augment sports performance as a psychological ergogenic aid.

This is unequivocally positive, particularly for individuals experiencing chronic pain or poor mental health. Many practitioners and scientists are advocates of placebo-mediated treatments under such conditions.

However, the inherent problem with condoning widespread use of placebos is that they are thoroughly ineffective at treating serious problems. This is why placebo use must be considered more carefully.

If we condone placebos for minor ailments on the basis that the treatment “works”, we have little precedent for condemning it for more serious ones. There is no coherent way to distinguish policy in this way. It may be particularly problematic when advocating for the use of so-called “energy medicine” or other magical interventions, because wouldn’t magic be able to resolve any ailment?

What I find quite fascinating is how most people’s steadfast beliefs in placebo treatments and placebo medicine dramatically change when there is an imperative for results. When someone breaks a limb, sustains a head injury, or falls to the ground clutching at their chest, rarely do they call out for an acupuncturist or a chiropractor or a reiki practitioner (healing hands). When the shit hits the fan, most people get very serious, very quickly. When the need is sufficiently urgent, even the most ardent homeopath will usually invest in strategies most likely to work! In this sense urgency necessitates reality.

Even so, there are sadly instances when a minority of people will grip tightly to their misinformed beliefs for longer than they should. Reports in the media and published literature show tragic scenarios where individuals have succumbed to thoroughly treatable conditions because they preferred unproven, ineffective “remedies” over those approved by science. This is the damage wrought from widespread use of unproven “treatments”.

This is the price of placebo.