I think more technically it is nocebo effects which cause the (bad) immune response, whereas the placebo effect cancels or at least ameliorates it.
Paul Garner has described how worry about covid helped to maintain his long-covid / ME/CFS symptoms, and he was finally able to recover after addressing those fears:
I managed to fully recover from ME/CFS myself 20 years ago with a similar route (with no symptoms since). In my case I don't think there was any significant worry about the illness itself, it was more pre-existing life stressors that I had to deal with, with the viral infection being the final straw for my body.
I think that some people have post viral mental disorders. Or just general mental problems after going through anything out of the ordinary with their body. After going through Thyroid Cancer I generally don't give two thoughts about much of anything, while people at work are 25 years old and getting boosters for Covid. Some kind of mental thing going on here.
One thing I also found out during this pandemic is people generally don't get sick which was surprising to me since I have 2 kids and have generally been sick with a cold every 2 to 3 months for a decade. Maybe that's why Covid wasn't that bad for me? Although it did put me on my ass for 2 days.
Placebo is such an interesting phenomenon. I had a certain physical pain difficult to describe that I could’ve sworn to have felt, but after addressing my perspective I’ve no longer had any such symptoms. Not sure if related, but I still don’t understand it.
I find it a rather disturbing phenomenon, to be honest. Governments, scientists and media insist that we place enormous faith in the outputs of medical trials and studies. Anyone who expresses doubt about these is ostracised and forced to comply regardess. Yet every single one of them has to control for this entirely mysterious, inexplicable force that magically heals people with no actual medicine. This effect is so real, large and standard that it's mandated by law to take it into account yet we understand basically nothing about it (often even what the placebo was chosen to be is opaque), it's barely researched and the total lack of ability to explain it doesn't seem to bother anyone. Least of all regulators, who are meant to ensure the effect size of trials are correctly interpreted.
It feels like there's this enormous, sophisticated scientific edifice that can draw pictures of proteins and explain how they interact, and in the centre of it all is a giant rotating question mark that everyone by convention ignores and pretends isn't there.
It's not like they don't try to figure it out. But as you said:
>> "This effect is so real, large and standard that it's mandated by law to take it into account yet we understand basically nothing about it"
What would you prefer doctors do? Not use life-saving and life-improving treatments that are proven more effective than placebo after rigorous trials just because they don't understand it 100%?
The problem is we currently tend to ignore certain biases in our process which are known to introduce errors. Once it becomes a recommended medical practice that medical professionals use, medical opinion often trumps common sense and patients have trouble defending themselves even when they, personally, are certain this is harming them.
Doctors will outright suggest you are mentally ill and need to see a therapist if your life is on the line, you aren't satisfied with their course of treatment and you question what they are doing and/or express concerns that this could kill you. Once they more or less declare you crazy for questioning them, you lose even more control over your body, your health, your life and your right to actively make decisions for yourself.
There is definitely room for improvement in our current process.
That western medicine is often full of itself, deeply [insert -ism or -phobia] in practice, and frequently misguided is all very true and reasonable criticism. The person I replied to was essentially writing off the entire foundation of western medicine because doctors and medical science people don't always fully understand why things work.
It would be like someone writing off Newtonian physics before quantum mechanics was a thing because a lot more of the how wasn't yet understood. The practice of medicine has moved past the "if she floats, she's made of wood, and that means she's a witch" phase even if it still sees anyone other than cishet white dudes as witches.
I don't know. But how can we really claim things are "proven" or the trials are "rigorous" when they literally assume some sort of magic in their fundamental design? I mean we should at the very least dial down our certainty in medical claims until scientists can satisfactorily explain why they think new age woo/homeopathy/etc is beyond the pale neanderthal stupidity, up until the moment it's relabelled "placebo" when suddenly it can work.
I mean we're in an environment where the US President is forcing an entire nation to take an experimental medical treatment on the back of (failed!) trials, simply because politician's faith in "science" and the medical establishment is 100% unshakeable. Largely because scientists themselves hardly seem to admit to the true levels of uncertainty in their own work (replication crisis etc). There's a huge mismatch between people's perception of study rigor and "sometimes people think themselves better lol magic innit", which is basically the state of our understanding of the placebo effect.
(don't want to put words in GP's mouth, this is my interpretation of it, and my experience)
I do skateboarding and had multiple ankle sprains. What happens every single time is that the wound heals, physiotherapy proceeds and strengthens the whole joint system, and then I'm left with an ankle that is still in pain when it should not physically be anymore since it has fully recovered.
That is, until I literally "decide" the remaining pain is a construct of my mind, and then the pain vanishes overnight, and the ankle that I felt brittle and was scared to use to its full extend suddenly feels as strong and stable as ever, if not more.
In a nutshell, the idea that there's a straightforward causal link between something being physically broken in your body and you feeling pain is simply wrong. Sometimes people feel pain in various body parts without any detectable physical changes and sometimes classical training injuries, like herniated spinal disks, can be found by medical imaging without the person feeling any pain at all. Also the common advice to rest until the pain subsides is often - but no always - wrong; there are plenty of anecdotes of people with completely fucked up knees or ankles or back starting heavy powerlifting program and suddenly healing from their injuries or at least learning to use their body in such a way that the injuries don't bother them anymore.
I dont know about rapidly resuming the activity that caused the injury, but I totally agree that stopping all activity to exclusively rest and recover is terrible. You have to try to walk a bit at the very least.
I participated in a chronic pain study where I personally learned that there are times, much more often than not, that one should not second-guess their joint that is having a flare-up and continue to walk a similar amount each day. I can't overstate how empowering it is to not be in a thought loop on a case by case basis and trust the learned system.
Increased blood flow, released endorphins, usage of muscle, flexing of connective tissues and operation of joints often addresses the issue (if it is not an acute injury that really does need our body's regenerative abilities). We evolved to walk.
Physical activity -- muscle movement -- also increases the flow of interstitial fluid back to the circulatory system. This is how the body "takes out the trash" which is essential to the healing process.
I have a serious medical condition. I sometimes go for a short walk when I feel awful because I know from long experience that doing so frequently makes me feel better and I've gotten good at telling when I feel awful in a way that will likely be helped by taking a walk.
This connects the dots even further! I had a time where I went on a walk and thought it would be an extremely short one. After I thought I had been hitting the wall and I was sure I was making it worse, my joint started feeling much better. I extended the walk and returned feeling like the flare-up I had been experiencing before the walk had rapidly dissipated. That was a defining learning moment for me.
Placebos generally aren't sugar pills, unless there is sugar in the medication itself (which I don't think is generally the case). They are designed to be impossible to tell apart from the active medication.
The pain-killing effect has nothing to do with sugar.
Not to say Wikipedia is infallible. I'm sure it's not. Just checking how clueless I am and the internet suggests my understanding is "common knowledge."
Perhaps you can share more of your knowledge about what placebo pills typically contain and enlighten us? (Citations welcome should you choose to share.)
Actually, I did some searching and it seems that most RCTs don't actually list the contents of the placebo pill. I found this article which describes the problem:
Thank you. Very enlightening and happily agrees with both your statements (that they usually aren't sugar pills) and mine (that placebos themselves may have medical impact).
> For example, in the COVID-19 vaccine developed by the University of Oxford, the control group receives a meningitis and septicaemia vaccine as a placebo.
> The benefit of using an actual vaccine as the placebo control is that it will cause a similar reaction at the site of the injection as the COVID-19 vaccine, such as muscle pain and soreness. This prevents patients from knowing whether they are getting the placebo or the real treatment.
