Your citation of SGU as an authority suggested that you had some appreciation of expertise.
Since you want point-by-point, though:
You don’t need to be “primed” to believe in the placebo effect; it’s an innate feature of psychology.
Even in animal studies, we control for placebo. When I’m giving my treatment rats a drug injection, the control rats get an equal-volume saline injection at the same time. Otherwise, there is no way to know if any neurological, physiological or behavioural differences are the result of the drug or the result of the distress and discomfort of the injection.
The psychological impact of that distress and discomfort is a part of the placebo effect. That is what I am trying to get across to you: the placebo effect is not just an excuse for quackery, it is the entirety of psychology’s influence on the body.
The primary focus of placebo research is on enhancing otherwise effective treatments and exposing ineffective therapies. Nobody with serious influence within the evidence-based medicine community is proposing abandoning effective therapies in favour of purely placebo treatments. What they are advocating is using every tool available in order to make the most of what we have. The Goldacre video I linked upthread addresses this point.
That isn’t a very plausible hypothesis.
The reality of the placebo effect is supported by a century’s worth of medical research. It’s about as well-established as the existence of gravity.
Yes, pain is subjective: it is a psychological phenomena. When people are psychologically influenced to “trick themselves” into feeling less pain, they actually are feeling less pain. We have a fuckton of neuroscience research to back that up these days.
It is very well established that placebo effects influence physiological measures.
Pacemakers improve heart function after they’ve been implanted but before they’re switched on. Two sugar pills a day heal gastric ulcers (a physical, observable symptom) faster than one sugar pill a day. Altering the verbal instructions given to subjects in a drug trial can measurably influence the rate at which drug molecules are eliminated from their bloodstream.
Part of the control arm.
More typically, you’ll have at least three groups. For something with no effective treatment, that’s likely to be “no treatment”, “placebo control” and “active drug” groups. If there’s an existing effective treatment, you’d normally replace the no treatment group with a standard-of-care group.
For even better control, you want an active placebo group: something that doesn’t directly address the health issue in question, but has enough of a physiological effect to convince the subject that they’re getting an active treatment.
In animal research, we often also use a negative control: something where you already know what result you’re going to get, conducted just to prove that your experimental technique is competent. For example, you might have a group of rats that are dosed with a well-researched drug and run through the same behavioural tests as your experimental critters. If the negative control responds unexpectedly, you know you’ve fucked up somewhere.
If a placebo treatment group shows significant improvement over the no-treatment group, this is evidence that the placebo was therapeutically effective. That doesn’t mean that you abandon all effort at finding physiologically effective treatments; it just means that the influence of placebo is a factor to be accounted for.
From a medical point of view, we don’t care if the patient’s healing is “falsely” psychologically driven. A healthier patient is a healthier patient, however they got there.
The placebo effect is neither a mysterious force nor a novel explanation. It is an extremely well-established medical phenomena which is the subject of active and productive research.
It is not impossible to disentangle placebo from other confounding factors; that’s the whole reason why we have placebo control groups, in order to disentangle that factor. No treatment vs placebo control: the difference between those two groups is the placebo effect, with all other confounds equally affecting both groups. This is basic experimental design.
Again, see the Goldacre vid upthread. Nobody with any influence is seriously advocating substituting sugar pills for modern pharmacology. Concern about that is getting into conspiracy territory.
There is no bizarre pathology involved. The placebo effect is a well-documented medical phenomenon, and current research is focused upon exploring its subtleties rather than questioning its thoroughly-established existence.
There are some real issues surrounding the use of placebos in research, but they aren’t what you appear to think they are. Some are hinted at upthread, in my discussion of nocebo: what to do when patient health and patient autonomy are in direct conflict? There’s a good introduction to some others in this video:
Start at the five minute mark if you don’t want to watch the whole thing.
