The Known Placebo

What do you believe? I don’t mean this specifically related to health and fitness.

Although for people nutrition can become a theology and they speak of it as though it were a religion.

I believe eating organic is the only way to go.

I believe that eating meat isn’t healthy.

These statements don’t reference science but instead our beliefs. And sometimes our beliefs can be at odds with science. Just ask Kyrie Irving.

So there are times in life where we believe so strongly in something that we make life decisions based on this belief.

Consider the placebo effect which basically says that a positive health change is due the placebo itself. The placebo has no active medical ingredients and therefore it is our belief that the placebo will work that accounts for the beneficial effect.

We are probably familiar with these types of research studies. One group takes a pill to treat a disease and the control group does not. The pill has no medical ingredients but the study participants don’t know this. They are made to believe the pill will deliver a positive health result. The experimental group, i.e. the ones taking the pills, experience the positive health outcome.

More recently there have been studies involving an open label placebo and a control group.

An open label placebo involves a group of research subjects that know they will be receiving a placebo. The other group of study subjects continue their regular treatment plans known as treatment as usual.

Now it’s important to be clear that the placebo group knew what a placebo was and that is what they would be receiving during the study. I’m imagining the information session for the study going something like this:

You’re not getting any medicine. Instead you’re going to eat Tic Tacs twice a day for 3 weeks. Before we get started we’re going to watch a video on what a placebo is so there’s no confusion as to the fact that you’re receiving a placebo. We’ll give you the pills in a prescription bottle labelled ‘Placebo’ and the pills themselves will also be labelled ‘Placebo’.

The researchers also explained to all the study participants the power of the placebo effect. They talked about how the placebo effect can induce certain behaviours similar to Pavlov’s response. The shared how a positive attitude is necessary for the placebo effect to work. And they stressed how it was essential that the experimental group continue taking the placebo pills for the full 21 days of the experiment.

All of the participants, n = 83, were adults of least 18 years of age and had chronic back pain for the past 3 months. If subjects were taking NSAIDs prior to the study for pain they were allowed to continuing doing so. 6 subjects refused to participate, 3 discontinued in the placebo group and 2 discontinued in the treatment as usual group.

At the beginning, half-way and end of the experiment subjects were assessed for level of low back pain and disability due to pain.

The table on the left shows the improvement in pain. A higher value indicates a more favourable reduction in pain. The table on the right shows disability improvement. A higher value indicates a more favourable improvement in ability. The white bars are the treatment as usual group and grey bars are the open label placebo.

The results showed that the open label placebo group had a 30% greater reduction in pain and disability.

So how do you explain this?

Well, part of it has to do with wanting to please the experimenter. Maybe they were swayed in their subjective responses when asked about their level of pain or disability in order to provide the experimenters with a favourable response.

There are also the potential psychological analgesic effects associated with opening a bottle of pills and swallowing a pill. It could be having the pills in a prescription bottle written out as though it was a true prescription, even though only placebo was written on the bottle. Could the simple act of getting the bottle out of the cupboard, twisting off the child-proof safety lid, pouring a glass a water and swallowing a couple of pills be enough to start the psychological cascade of events to induce pain relief? Maybe it was simply the act of trying something different that may give them some relief.

The last thing I found interesting about this study was at the completion 17 of the study participants wanted the prescription refilled! Crazy, right? I mean these are sane, competent adults eating pills with no medical ingredients asking for more of these pills as it is working for them.

Going forward, do your research on your nutrition, your training and your health. And whatever it is you decide know that believing it will work is just as important as whatever the solution is. Except if you’re Kyrie Irving. That dude’s just crazy.

Here’s the link for the study for any that are interested.

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