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Placebos can alleviate all sorts of symptoms, but there's debate about their usage from an ethical standpoint. Of course, a doctor can't tell a patient they're taking placebos or they won't work anymore... or will they?

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Despite not containing any actual medicine whatsoever, studies have found that placebos can help people. They've been shown to alleviate symptoms in a number of medical conditions, including depression, pain, and even Parkinson's Disease.

And that's supposedly thanks to the power of belief. Basically, if a person really believes that they're taking an effective drug, their brain is somehow tricked into making them feel better, whether it's by producing chemicals or activating key neural regions. But... it turns out that's not the whole story.

You see, scientists have discovered that even when patients know they're taking placebos, they still feel better. So somehow, they're experiencing the placebo effect even though they don't believe they're taking medicine. And figuring out why this happens will help us understand what things our brains can and can't fix all on their own.

Placebos were first used to test the effectiveness of treatments. The idea was simple: You give half of a test group medicine and the other half something inert, and if the group taking the medicine fares better, then the medicine works. But, in some cases, the placebo group got better, too.

So, instead of getting frustrated over a ruined study—though I'm sure that happened as well—clinicians took advantage of these happy accidents and started giving patients placebos as treatments. Anywhere from seventeen to ninety-seven percent of doctors say they've done this at least once, though there's a lot of debate about whether it's ok from an ethical standpoint. I mean, sure, if it works, you're helping the person.

But you're also lying to them about their medical care. Of course, you can't let them in on the ruse, because then the placebo won't work. Or… will it?

See, this whole practice of actually prescribing placebos made some medical professionals wonder if there was a way to use them without deception. And it turns out, there is. Open label placebos are ones where the patient is informed that they are taking an inert medication.

And like other placebos, they can be used in one of two ways: either as a dose extender after a round of medicine to prolong its effects, or just straight up as a treatment. Either way, clinical trials have demonstrated that they work. For example, in a series of small studies, one research team found that open label placebos were more effective than no treatment or the usual treatment for a variety of conditions, including cancer-related fatigue, migraines, and test anxiety.

They even worked for patients with irritable bowel syndrome in a 2010 study. The participants either received no treatment or a placebo that was carefully billed as such. They specifically told the patients it was “like a sugar pill”, and the pills came in a bottle labeled “placebo”.

Yet, after three weeks, fifty-nine percent of patients in the placebo group reported adequate symptom relief, while only thirty-five percent of the ones who received no treatment did. That's on par with the best pharmaceuticals for IBS, even though the participants knew they were taking a completely inactive pill. Weirdly enough, researchers think that these open label placebos still manage to work for many of the same reasons the usual, deceptive ones do.

Like, they can tap into prior conditioning—the automatic responses you associate with a specific, learned stimulus. I'm sure you've heard of Ivan Pavlov and his dogs. That's the most famous example of classical conditioning.

By pairing the click of a metronome with food, Pavlov was able to get his pups to salivate from the sound alone. And something similar seems to happen with medication. Say you take something to lower your blood pressure every day.

Your brain might learn to associate the ritual of taking that pill with a drop in blood pressure so much so that it actually stops mattering what pill you take. This is essentially the idea behind dose-extending placebos. A round of medicine first trains the brain, then the placebo maintains the response.

For example, in one study, patients were given an immune-suppressing drug along with green, strawberry-flavored milk. Afterwards, when they drank the weird milk with a placebo, their immune function became suppressed, just like it did with the active medication. And it only took four sessions over three days to condition their brains.

This kind of conditioning could also occur subconsciously all the time, which might be why you don't always need a training regimen with real medicine to see results. Simply taking effective medicines may condition your brain to associate pills, grossly-flavored liquids, or whatnot with the physiological responses that make you feel better. It's also possible the secret to open label placebos is in fact the power of belief or, what psychologists would call an expectancy effect.

Even if patients don't believe they're taking medicine, they could still believe that the treatment will work—and that might be why it does. You see, studies have found that open label placebos are more effective when a doctor explains the rationale behind them, especially when they explicitly say things like “It is well known that placebos are very effective”. Still, whether it's because of conditioning or expectancy or a bit of both, it's still pretty amazing that placebos work at all.

And researchers are still trying to figure out their limits. Since their effect comes from convincing your brain to help you out, they seem to work best when symptoms are directly controlled by brain activity—things like pain, nausea, and fatigue. So if larger studies continue to demonstrate their potential, open label placebos could eventually supplement or replace medicines like opioids that have nasty side effects.

But what's really wild is that, when you think about it, so much of what goes on in our bodies is ultimately controlled by our brains. So someday, open label placebos could replace all sorts of expensive drugs and reveal just how powerful the human mind can be. Aren't brains just the best?

I think so, anyway. And if you do, too, you'll probably love all the episodes we produce here on SciShow Psych. And to that end, I have some great news!

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