What Are Placebos Made Of?

One of the reasons that people swear by homeopathy and herbal treatments that have been shown in studies to have no effect, is due to “regression to the mean.”

People take them at their sickest, when they are throwing everything against the wall to see what sticks-- when they are in the MOST pain from conditions that wax and wane, or when they have a cold, and the symptoms are at their peak. They feel better after taking the goose liver oil, or elderberry tincture, or whatever, and attribute feeling better to the “treatment”; but here’s the thing: do this enough times, and feeling better becomes a learned response to the non-medication.

In other words, your nasal congestion actually does get better when you take the fairy water, because you have taken it so many times when the congestion was going to get better anyway, that it’s a learned response for your nose to clear up.

I read an article regarding this in a print magazine that cited a number of studies, and Google-fu is failing me now, and I have to go teach Hebrew school in a few minutes, but I’ll try again to find the studies.

Anyway, it does show why there are people who swear by homeopathy, even though no one can ever show it to work in clinical trials.

Calcium pills are big because they include large quantities of calcium, which is the active ingredient. You need 600 mg of calcium carbonate (40 percent elemental calcium) to get 240 mg of calcium. 600 mg of a fine powder will require a large pill; there’s no way around this. The Vitamin D is infinitesimal, true, but the calcium is a bulk product.

When somebody is sick, takes some treatment, then gets better - trying to convince them that there may be no causal connection is virtually impossible.

Human brains are naturally very good at forming hypotheses, but very bad at rejecting them. Or to put it another way, we are calibrated to tolerate a very high false positive rate with a low false negative rate - the classic example being that every time the wind rustles the leaves in the night, we fear some predator stalking us in the darkness. The significance of the development of the scientific method was not that it yielded brilliant new creative ideas, but that it gave us a rigorous methodology to reject the ideas that were wrong.

There’s a good fictional example in Jeffrey Archer’s Not A Penny More, Not A Penny Less, in which it’s part of a con artist’s payback.

snicker I did a test for Omega in RI that was testing a guaifenesen/can’t remember combination, as I remember the options were guaifenesen with other ingredient, and placebo. I took the first dose in office like normal and told them immediately that I had the one with guaifenesen and they should have enteric coated it if they wanted an honest result with any medication with a strong taste. [It has an amazingly nasty strong taste, IMHO and one I recognize from taking it off and on for years]

Just like I recognized the diclofenac gel the instant I used it because my roomie did a test for arthritis in the knee using that vs a placebo - the scent hadn’t changed [I rather like it, it has a good clean chemically smell, not a floral mask]

Hey, they can pay decently for guinea pigging, and it can be interesting - I got my flu shots for a decade that way, free and paid typically $50. It generally was a crapshoot if I got the current one or not, except for the year they were testing using the air guns instead of needles =)

It especially POs me when it’s teachers who are convinced that kids don’t respond well to praise, but respond to criticism, because when they do a really good job on something, and get praised, their next effort is never even better, and usually worse, but when they do poorly, and are criticized, their performance improves.

Teachers don’t understand regression to the mean. Don’t they teach probability and stats to prospective teachers? I actually had to explain this concept to a junior high school math teacher.

Exactly, though there are a few treatments I do that work because I know what to do and when [my go to for a ‘cold’ that starts the usual way, a tickle on the left side of my throat that left untreated will progress to full on packed sinuses followed by raging sore throat and chest congestion is to immediately do a dose of guaifenesen, a shot of nasonex and a liter of liquid [hot tea or iced lemonade depending on season] and then to follow the exact dose and timing [12 on the guaifenesen, 24 on the nasones, hammer down lots of liquids whenever] because if I am off on the timing, the full effects of the cold show up, but if I follow the treatment for a week to 10 days, no full on cold, just a bit of fatigue and a bit of soreness behind my eyes.

“I’m addicted to placebos. I could quit, but it wouldn’t matter.” - Steven Wright

If they run a clinical experiment on the placebo effect, what does the control group take?

One group gets the red pill. The other gets the blue pill.

It is designed so even the dispenser of the placebo doesnt know which a subject got, so that the person isn’t affected by the dispenser’s unintentional subconscious communication, verbal or nonverbal.

One pill makes you larger and one pill makes you small?

The red one makes your head explode and the blue one makes you wise.

obligatory XKCD link

Gimme one of those.

They have run experiments with four groups, where one group gets a medication, one group gets an exact duplicate of the medication, down to special instructions about taking it with 8 ounces of water (or whatever), at the same time every day-- in other words, not a single deviation from the medication with the active ingredient, and they look exactly the same-- all it’s missing is the active ingredient. A third group gets a placebo that is obviously not the real thing, and a fourth group (this is the kicker) gets the medicine with the active ingredient, but is told they are getting a placebo– the medication may even be stamped “PLACEBO.”

No surprise-- the group getting the active medication with the bells and whistles has the best response, and the obvious placebo has no response.

However, in the other two groups, you gets mixed responses, with some people reacting very well to the disguised placebo, and many people having a poor reaction to the active medicine stamped “PLACEBO.”

I would imagine that in such a trial you would really have to monitor compliance, since otherwise people given the labeled placebo’s might not bother taking them.