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Dear Babby 29 January 2013 04:04 PM

How Superstitions Really Work

A belief in a force external to ourselves that can be invoked to help us may not be merely comforting, then. It may be a powerful psychological lever we can pull to access forces within ourselves that actually affect our ability to achieve what we want—even if our belief is incorrect.

Which raises a troubling question: what if our belief is incorrect? Should we care? Should we pursue the truth even if it may mean forfeiting not just a comforting notion but a notion that may help us succeed in life? What do readers think?

Esprise Me 29 January 2013 08:20 PM

I'm really troubled by the mindset that justifies self-deception on grounds that it seems to work, if only because it seems logically inconsistent that someone in denial could adequately judge whether something was working.

I've been reading a lot lately about antidepressants and the studies that seem to indicate they only work because of the placebo effect. Of course, there's a lot of evidence on both sides and I don't want to hijack the thread with a debate over which studies are more valid. What strikes me is the philosophical debate that follows if we postulate that they only work because patients believe they work. Should we stop prescribing the drugs or at least publicize this information, at the risk of destroying the positive effects they have on people who believe in them? I can understand why some would say no, but I just can't get on board with that.

damian 30 January 2013 10:07 AM

1. A placebo is not a real medicine, but it works in many instances, therefore, it is real. Telling people it's not real may stop it from working, but why do that? Same with superstitions and lucky charms etc. If someone thinks they run faster wearing their lucky socks, then why try to prove them wrong?

2. Do we have the right to force our views on others, even if our views are correct and theirs are demonstrably wrong?

Having the truth available is fine, but I don't know that we should be forcing others to believe it.

ganzfeld 30 January 2013 11:00 AM


Originally Posted by damian (Post 1708652)
1. A placebo is not a real medicine, but it works in many instances, therefore, it is real.

What is your evidence a placebo "works"? Also, "works" compared to what?

damian 30 January 2013 12:33 PM

Sorry. A placebo is a pretend medicine. Sometimes it is used in place of "real" medicine because of the "placebo effect" in which a person who believes they are being treated with real medicine may get better, even though they are taking sugar pills or similar.

Every clinical trial has to test a control group, a placebo group and the trial group to get clear evidence that the new medication actually works. It is thought that around 1 in 3 people will feel the effects of fake medicine.

ganzfeld 30 January 2013 12:39 PM

Yes, I know what a placebo is.

I was wondering why you think there is evidence that a placebo works. So I asked you: A placebo works compared to what? If you're comparing a medicine to a placebo are you claiming that the 1/3 of the people get better in that case because of the placebo? So, for example, a placebo is put on wounds in one group, a drug is put on wounds in another. Both groups get better and you're saying that the placebo "worked" in some way? Is that the kind of evidence you're talking about?

Originally Posted by damian (Post 1708664)
It is thought that around 1 in 3 people will feel the effects of fake medicine.

Is that what you think? (Sorry but I don't think the passive tense is going to allow you to make this claim without evidence.)

damian 30 January 2013 12:48 PM

If those in the placebo group show measurably better results than those in the control, then that would be evidence that the placebo has worked.

People have acupunture and it makes them feel better. People pray and it makes them feel better. People use magnets and power bands and they feel better. The evidence shows none of these things really work.......but they do.

ganzfeld 30 January 2013 12:53 PM

I was asking for your evidence, not more of your opinions. But let me just ask something that should be easier: Where did you learn this?

Steve 30 January 2013 02:33 PM

Yeah, apparently there's not as much evidence for the placebo effect as is usually believed.

crocoduck_hunter 30 January 2013 03:43 PM

Same goes for acupuncture and prayer. Merely wishing for something to be true isn't sufficient to make it work and many times it isn't just the person who has the belief who's affected. Parents who think prayer or homeopathic medicines are effective ways to treat disease try to cure their kids that way, with disastrous results.

Richard W 30 January 2013 06:35 PM


Originally Posted by Steve (Post 1708713)
Yeah, apparently there's not as much evidence for the placebo effect as is usually believed.

That's not what that article says - it says that around 2000 or so, some analysts cast doubt on a lot of previous studies that had shown a placebo effect because they thought that they weren't designed carefully enough (they quote a couple which didn't even have a control group) - the samples were small and they'd not ruled out some other possibilities. (Although it seems a bit misleading to me to concentrate on the ones without even a control group, because a lot of those difficulties are dealt with by the "many researchers" who did use a third control group).

Anyway, the analysis didn't say that there wasn't a placebo effect. It said that more careful studies were needed to demonstrate it. And then the article says that several more careful studies have since been carried out, and demonstrated that a placebo effect exists.

Esprise Me 30 January 2013 08:14 PM


Originally Posted by damian (Post 1708652)
Having the truth available is fine, but I don't know that we should be forcing others to believe it.

But if the truth is available, some people are going to find out about it, and that will presumably destroy the placebo effect. What constitutes forcing it on people? How do you even force someone to believe something? (I grew up in a heavily evangelical community; if it were possible to force me to believe in God, I'm sure they would have done it.) If I went to my doctor and asked for antidepressants and she told me she'd write me a prescription for Prozac if I really wanted it, but that in her studied opinion they don't work, is that forcing the truth on me or just being a responsible physician? (Again, assuming for the sake of argument that the placebo effect is the only reason Prozac works, which hasn't been established definitively.)

ETA: Personally, if my physician wrote me a script for a drug she knew was ineffective without telling me, I'd be furious.

erwins 30 January 2013 08:33 PM

Even more so with a drug that has very serious negative side effects, such as SSRIs. I mean, if it were OK to prescribe a medicine simply for a placebo effect, then responsible doctors would have to use something more like a true placebo and not a powerful drug that just doesn't work as claimed.

ganzfeld 30 January 2013 09:49 PM

Here is another opinion about the so-called placebo effect:

crescent 30 January 2013 10:22 PM

Of course a placebo effect exists - without it, homeopathy and a good bit of herbal medicine* would not be around.

Some things are subjective, to a degree. My wife thinks her homeopathic pills help with motion sickness. She thinks she gets less nauseous when she takes them. Nausea, like pain, if a hard thing to quantify. So, she thinks she is less nauseous, and can enjoy travelling more. Of course, it is all in her perception and the homeopathy does nothing physical. But - she feels better.

Granted, there is no placebo effect for actual physical effects, other than the fact that there is a connection between one's mental state and immune response, as mentioned in ganzfeld's link:


Stress hormones do suppress the immune system, and it is probably true that extreme stress leaves us physically susceptible to disease for this reason.
So, deal with the stress, the immune response might perk up a bit - it's not a huge response, but it exists. A placebo that makes a person feel less stressed can have that effect - even if the effect is minimal and due only to the person's idea that the "medicine" will work.

ETA: Obviously, placebos only work if the person believes and expects them to work. That's kind of the point, really. They don't work on everyone, and only work on things that are subjective (like pain levels), or that are tied to emotional/physiological connections. The are less "effective" on the latter.

Double ETA: I don't really get the logic of the article that Ganz lined to. He seems to be arguing that there is no biological placebo effect. Does anybody really argue otherwise? The impact is emotional - any biological effects are only a response to the emotional impact of the placebo.

ganzfeld 30 January 2013 11:01 PM

I don't think that one sentence is a fair representation of the post at all.

This is very frustrating for me because we have about 22 factors that would not by anyone be considered "working" in any sense of the word (reporting bias, etc.). So let's call them A, B, C... V. Then we have about four things that people would consider working (mind over body, hormone action, etc.): W to Z. So scientists first have to eliminate A to V before they can even say that any of W to Z are happening. In the very very few cases in which A to V are eliminated or carefully accounted for, there's still a tiny effect. But at the same time the people doing these studies have already eliminated W, X, and Y. Z is still equivocal. Now comes the frustrating part. In conversations like this we have so-called skeptics claiming that W, X, Y, and Z have something to do with the placebo effect. No! Most of them have been ruled out. Even more frustrating is that we get another round of experiments that don't account for A to V completely and still claim their results are in favor of the so-called placebo effect. It's so stupid. No evidence from any of these experiments has ever shown that there is any benefit at all to giving someone a fake treatment, exclamation mark! Except that you can probably charge them something for it and keep them coming to your acupuncture clinic based on the incorrect and disproven claim that it "works" through the placebo effect.

Dr Novella's post is just a brief introduction to some of the problems with the claim that "placebos work" (which is not at all the same as asking whether there such a thing as a "placebo effect" exists).

erwins 30 January 2013 11:04 PM

Is decreased subjective perception of pain not a benefit?

ganzfeld 30 January 2013 11:33 PM

Reporting less pain does not mean feeling less pain.

erwins 30 January 2013 11:40 PM

Ah. So you don't believe that the subjective experience is different, you think people are lying?

ganzfeld 30 January 2013 11:50 PM

Yes, that is what scientists believe. Whenever someone can't describe the reality of a complex phenomenon exactly as it exists in nature, they must be lying.

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