The Pleasures of the Placebo

Along With Measurable Medical Effects

Near the end of the new Netflix series Apple Cider Vinegar, the main character says this vinegar (ACV) has cured her ringworm. According to one review, that moment serves “as a sort of placebo [that] points to the deeper meaning of the series.”

Observable medical effects of placebos have been making news since 2011, when Harvard’s Program in Placebo Studies and Therapeutic Encounters (PiPS) began studying “honest” or “open” placebos—pills clearly labeled “placebo” and dispensed along with clear explanations to patients about the brain’s role in their symptoms.

In Apple Cider Vinegar, the vinegar works “in the same way [the character] believed her fraudulent potions could help cure so many ills,” writes the Screenrant reviewer. When another character makes clear that ACV could not possibly cure this fungus, he adds, “Still, is that not magic… you’re all cleansed… how hopeful is that?”

“I want you to take this placebo. If your condition doesn’t improve, I’ll give you a stronger one,” says a cartoon doctor shown by Ted Kaptchuk, founder of PiPS, in his lectures on placebo research. PiPS medical personnel have employed MRI and PET scans to document actual body responses to placebo treatments—concluding, for example, that “placebo needles produce better pain relief than placebo pills but… placebo pills are better for insomnia.”

“Functional disorders appear to hijack the normal neurological mechanisms by which we experience our body,” according to a New York Times report on the so-called Havana Syndrome—a constellation of symptoms first reported in 2016 by U.S. diplomats in Cuba—that appeared to have no external cause. Placebo treatments work most effectively for symptoms modulated by the brain, such as pain, stress-related insomnia, fatigue, and nausea.

“Medicine is based on trust,” writes Kaptchuk. According to The New York Times, “Kaptchuk’s own pet theory… holds that the placebo effect is a result of the complex conscious and nonconscious processes embedded in the practitioner-patient relationship.” That patients often experience less pain when allowed to control the dosages of their medication is often-cited evidence of the placebo effect.

In a 2008 survey, 13% of doctors prescribed antibiotics for treating viral infections — although antibiotics having no effect on viruses — with the understanding that their patients’ belief in the drugs could help them feel better. And in a PiPS study on asthma, placebos that had no detectable effect on the pathophysiology performed just as well as powerful medications, based on patients’ self-appraisal of symptoms. In other research, fMRI scans documented improvement following sham treatment in patients with osteoarthritis of the knee or chronic low back pain.

Open placebos reduced chronic back pain for 97 patients who had not responded to previous therapies in a trial co-authored by Kaptchuk. The group receiving sugar pills clearly labeled “placebo”—along with explanations of research showing how and why these might work—reported “sometimes modest, sometimes dramatic improvements in pain and disability that had major impacts on people’s lives,” according to lead researcher and psychologist Claudia Carvalho at the Lisbon ISPA-University Institute.

PiPS has also cast a new light on studies that found antidepressant medications to be no more effective than placebos—results that were used to disparage the usefulness of these drugs. But proof that placebos have their own mechanisms for healing leads to a different conclusion—that antidepressants have an equally salutary effect.

Research on the converse of placebo, called nocebo—that is, when patients report negative effects of treatment despite lack of physical evidence—further supports the placebo’s power. According to Julia Haas, PiPS investigator who studies the nocebo effect, “Adverse events after placebo treatment are common in randomized controlled trials.”

In a PiPS meta-analysis of 12 Covid vaccine studies, close to 1/3 of participants who received a placebo had at least one complaint, described by Kaptchuk as “nonspecific symptoms like headache and fatigue—which we have shown to be particularly nocebo sensitive.” He believes “informing the public about the potential for nocebo responses could help reduce worries about Covid-19 vaccination.”

Back to apple cider vinegar: research has shown it can have some effect on lowering both blood sugar and cholesterol, according to medicalnewstoday.com. To be effective, the ACV must be raw, unfiltered, and contain the “mother”—which is composed of bacteria and yeast. ACV may also help with the inflammation responsible for the pain and swelling of arthritis, although a dearth of evidence has led the Arthritis Foundation to add it to a list of food myths about arthritis.

Hearing how well ACV recently helped combat a friend’s arthritis tempted me to try it, but the recommended dose—two tablespoons a day mixed with water—sounded too acidic for my digestion. Later I found out the friend had “gotten tired of drinking it” and stopped, leading me to suspect that its positive effects had not been sufficient to keep her on the regimen. On the other hand, antidepressant medication has worked well for me—which is pleasing, whether or not its benefits are simply a placebo effect.