Placebo?

I hope we can look at the placebo effect with wisdom and common sense.
Recent research1 supports the effectiveness and importance of placebos for palliative treatment, to help people access their own ability to feel better. Placebos work subjectively, and by very many people’s testimony can help people feel better and are generally best regarded as palliative not curative.

First, placebos are no substitute for vaccines, necessary surgery, necessary pharmaceutical treatments. They can of course be used in addition to these things. Conversely, there are strong objections to surgery as a placebo. This, even though in cases where a placebo is appropriate, surgery can be damned effective2. Antibiotics should only be given where they are needed. Pharmaceuticals with nasty side effects are shitty placebos.

I have wondered whether pharmaceuticals with very noticeable side effects are favoured in blind testing over gentler substances. The side effects might strengthen placebo effect by tipping off test subjects that they got the real thing and not a sugar pill. In a previous century,  I was a subject for the Salk polio vaccine trials on school children.  I guessed, correctly as it turns out, from the soreness deep in my arm where the needle had gone in, that I had gotten the real thing. (My experience is not proof, only grounds for speculation..) (I am not supposing that a tip-off effect skewed the results in this case- I would guess that polio diagnoses would be largely objective and unswayed by the subjective stuff.)

There may be circumstances in which palliative agents, including placebo, do have a real positive influence on healing and restoring health. For instance, an expectation of pain might lead to muscle spasms that could aggravate an injury. Or, relieving nausea might help someone keep food down. Or, helping someone to return to an appropriate level of activity ..

A placebo should be at least relatively harmless in appropriate use. Good-for-you is even better. Were somebody to eat Brussels sprouts to prevent growing-an-extra-head syndrome, well, in reasonable moderation Brussels sprouts are good for you.

Personally, I strongly dislike the use of deception, even though it may be a way of facilitating the placebo effect.
So.. how to use placebos honestly and effectively? I have speculated around the subjective experiences3.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601706/

2. https://www.scientificamerican.com/article/how-fake-surgery-exposes-useless-treatments/

3. http://chasens.ca/blog/2018/09/14/in-another-sense/

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