It had long been believed by researchers – and the general public – that for the placebo effect to work, patients must be deceived into taking placebos. If patients knew they were taking a placebo, traditional wisdom espoused, the placebo’s effect would lose its power. Then, in 2010, a groundbreaking study brought into question years of belief about how the placebo effect really works.
Placebos Without Deception
In the study, entitled Placebos Without Deception, 80 patients with irritable bowel syndrome were divided into two groups. One group was provided with placebo pills introduced as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes”. A second ground was provided with no treatment but the same compassionate interaction with a care provider as the first group.
According to classic beliefs about how the placebo effect works, “a placebo is… intended to deceive the patient“, as described, even today, on Wikipedia (we’ve got to get their editors up to speed!). Thus, the setup of this study seemed to ensure that the patients receiving placebo pills would experience no better results than those receiving nothing. After all, there was no deception at all. Patients knew they were taking placebos (i.e. this was an open-label placebo study).
But a very different result happened…
The patients receiving placebos experienced marked improvements in their symptoms. A full 59% of patients reported “adequate relief in the previous seven days” at the conclusion of the 21-day trial. This is compared to just 35% of patients in the no-treatment group who experienced adequate relief. This was also 8% higher than the 51% of patients who tend to experience adequate relief with Alosetron, an often-prescribed medication for irritable bowel syndrome.
But the Science Says Placebo Effect Requires… Deception?
Those old models need to change. This was outdated science.
We’ve learned from the results of the above study – and other open-label placebo studies – that placebos simply do not require deception to work. Placebos work because of a combination of expectation bias, classical conditioning, and ritual. Deception has only been associated with the placebo effect because most researchers use placebos specifically to deceive – as a control against pills and procedures in clinical trials. Deception isn’t a characteristic of the placebo effect; it’s just how placebos have been used!
Not only do we now know deception isn’t required to create a placebo effect, but we are also learning that when care providers are honest about placebos, they may actually increase their effectiveness – for without deception, people can then begin to cultivate placebo effects they wish to experience!
Conclusion: A New World of Placebo Research Opens
Now that we know placebos don’t require deception, researchers can begin to work with placebos in a more honest fashion. We can create new and innovative clinical studies that test the impact of placebos in open-label placebo studies, and we can begin to ask the biggest and most important question: How can we use placebos to support people in creating meaningful change in their lives?