Do placebos do nothing?

This depends on what you mean by nothing. When you think of a placebo, you probably think of a sugar pill or an injection of water: something that a doctor might prescribe when they don’t want to prescribe anything. The scope for such pure placebos is virtually nil in the modern world of patient rights and informed consent. But while sugar pills may be dead as a therapy — at least in conventional medicine — that doesn’t mean the placebo effect is dead. Far from it.

Before we go further we should make a technical but useful distinction between disease and illness. Disease is the name for what ails you physically, the internal struggle against invading germs or whatever it may be. Illness is the name for what you feel when you’re unwell. Disease is chemical, but illness is psychological, and that’s where the placebo effect comes in.

The placebo effect goes far beyond sugar pills. Placebos proper may do nothing to the body, but they do a lot to the mind purely because we expect them to help us. And so with any drug — even if it has a physical effect on disease it also has a placebo effect on illness.

It’s not just drugs either. The demeanour of your doctor, your belief in them — their belief in themselves — as well as the ritual of the consultation and all the other cultural trappings of medicine contribute to the placebo effect. Symbolism, experience, knowledge and expectation — on the part of doctor as well as the patient — all play a part.

And so we find that definite diagnoses are better than hazy ones. Pills can make us feel better, but their effectiveness depends on their colour. Injections make us feel better than pills. Placebo surgery can improve angina. Morphine relieves pain more effectively if you know you’re on it.

We go to the doctor for them to treat disease, but we judge their success by how well they treat illness, for which they rely heavily on the placebo effect. And that’s not nothing: it’s really something.

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