The simple, clear definitions of placebos and placebo effects are seldom studied, seldom recognized. The words are often used inaccurately and inappropriately resulting in nonsense. What are the facts?
Placebo has two contradictory meanings. Many people assume a third meaning, which is documented, almost as a footnote in Webster's dictionary (see the bottom of this post for Webster's definitions).
Placebo - Historical Definition
Placebo, a real placebo, is created by a doctor, and cannot exist without a doctor. Anything, any real or fake treatment can be a placebo when:
- the doctor believes a patient has a medical condition.
- the doctor knows of no beneficial treatment for the condition.
- the doctor prescribes a treatment with the belief that it will not help the patient’s medical condition, but that it will help the patient feel better.
The treatment is then referred to as a placebo. Often it is an important treatment for other medical conditions.
Real placebos are defined by real doctors, with real intentions to help the patient. When it helps the patient, both doctor and patient benefit. When the patient is cured, both doctor and patient benefit.
A real placebo only exists as a result of the belief, diagnosis, judgement, and action of a medical professional. Real placebos are created by doctors, in the practice of medicine. They are often created using treatments that cannot, in theory, help the condition, but they are used because of a history of working. Sometimes, success trumps understanding.
Clinical Placebo
A clinical placebo is an intentionally fake medicine, specifically designed by researchers, to NOT help the patient. Clinical placebos are administered to patients in a clinical study, with an intention to NOT provide any benefit.
The intent of a clinical placebo is to provide a benchmark for a commercial product. Clinical placebos are sometimes even designed to trick the patient into believing they are receiving the medicine, by selection and design to produce side effects similar to the medicine being tested.
A clinical placebo only exists when created for a clinical study by a researcher or medical professional. Clinical placebos require the belief of a medical professional, that it provides no benefit, and the actions and intentions of a medical professional, to administer the placebo to NOT provide benefits to selected patients.
Clinical placebos are designed, created and administered by the doctor or medical researcher. Their existence requires a medical professional.
Clinical placebos, like all placebos, "work". If they don't provide any benefits to the patient's condition, they are not considered to be placebos. Clinical placebo treatment arms of clinical studies consistently provide real, positive improvements in the patient's condition. This is expected. Those benefits and their causes, are intentionally ignored by researchers.
When a clinical placebo helps the patient more than the medicine being tested, the research project fails. Benefits provided by a clinical placebo are deliberately ignored, seldom published, and rarely studied.
Placebo - Common Usage
In common usage a placebo is anything that makes the patient feel better, but does nothing to help their medical condition, and cannot cure any disease. However, this definition applies to most medicines. Most conventional medicines are symptomicines, which do not cure any disease and cannot claim to cure any disease. Most medicines are designed to address only the signs and symptoms of a disease.
The word placebo, in common usage, is generally applied to alternative medical treatments, as a term of dismissal. It is rarely applied to conventional medical treatments - even if they fit all the definitional requirements of a placebo.
Comparisons of conventional medicines to alternative medicines is a debate which can be summarized in the question:
"which medicine, conventional or alternative, DOES NOT CURE better?".
The Placebo Problem
Clinical placebos and real placebos are both called placebos, even though
- they are created by the intentions of the doctor
- the intentions of the doctor are dramatically different for real placebo vs clinical placebo
In addition, most people, even many doctors, use the word placebo without attention to either standard medical definition.
Common usage of the word placebo is often extended, without any scientific evidence, to cover any alternative to a conventional medical treatment. Anyone, with little knowledge or authority, can say "it's probably just a placebo" without any understanding much less proof, and never risk being challenged.
Placebo Effect
A Placebo effect exists when:1. the doctor believes a patient has a medical condition
2. the doctor believes the condition has been treated, by themselves, by another doctor, or perhaps self-treated by the patient.
3. the doctor observes or believes the treatment was followed by an improvement in the patient’s condition, possibly even a cure, although cures are rarely studied.
4. the doctor believes the improvement was NOT caused by said treatment.
the doctor dismisses the treatment, often dismissing the benefit as well, calling it a “placebo effect”.
5. The doctor cannot know the cause of the improvement. If the cause is known, it’s a real effect with a real cause, not a placebo effect.
Placebo effects are created entirely in the mind of the doctor. True placebo effects are caused by the beliefs of a doctor who does not understand the cause of the effect. Placebo effects are not caused by the beliefs of the patient.
Common Usage: Placebo Effect
In common usage, a placebo effect is caused by the beliefs of the patient, the benefit is imaginary and placebo effects are bad. This theory is simplistic and ignores many basic facts:
- A placebo effect is a real, positive effect on the patient's condition. By definition: placebo effects are good.
- Every effect has a cause. Every cause has a cause. Every placebo effect is a real effect, with a real cause, a real chain of causes. The patient's mind cannot bend spoons. The patient can bend spoons, once they set their mind to bend a spoon, but bending a spoon requires additional actions, additional causes.
- Pain and many other symptoms are increased or decreased by deliberate or even unintentional actions of the patient. These actions are real, not imaginary causes of the benefit. The benefit is real, not imaginary.
- Drug manufacturers make intentional manipulation patient's beliefs in creating and packaging medicines to increase their effectiveness against signs and symptoms of the disease. This is a real effect, intentionally created, not a placebo effect.
Placebo Effect Claims
Most claims of "placebo effect" are made by non-doctors, or by doctors making claims outside of their area of expertise. In addition, most claims of placebo effect are equivocations, like "It's probably just... placebo effect." A true claim of "placebo effect" requires that the speaker, or the doctor NOT understand the cause.
Why do so many people make false claims about placebo effects? Because claims of "it's only placebo effect" create status, make the speaker seem important, like a doctor. Such claims are seldom challenged, giving status.
Can placebos cure? Do placebo effects include cures?
Cures are not studied by conventional medicine - except for a few diseases caused by pathogens and parasites. Cured is not medically nor scientifically defined for any non-communicable disease, and cured cannot be tested, cannot be proven for most diseases. The word cure does not appear in many medical dictionaries and is not defined in any medical treatment reference or text.
We don't know if placebos or placebo effects result in cures, because of our lack of understanding of cure.
Clinical placebos are generally used in clinical studies on diseases that cannot be cured. However, because cured is not defined medically, if a clinical placebo, or the medicine being tested results in a cure, the cure cannot be noticed, cannot be documented. It is outside the parameters of the study. Cured is seldom defined for any clinical study.
"Placebos are medicines or treatments that provide no medical benefit." Truth: A placebo is not a thing. A placebo only exists when a doctor uses something - any treatment - as a real or clinical placebo. Placebos, by definition, provide benefits, real improvements in the condition of the patient.
"Placebo effects are a result of the beliefs of the patient." Truth: placebo effects require specific beliefs of the doctor, and require that the doctor does not know the cause of the effect, and believes it was not caused by the treatment. The patient is not required to believe and might even have negative beliefs about the placebo treatment and still receive positive results.
"Placebos effects are imaginary." and "Placebo effects are bad." Truth: placebo effects are real, positive, measurable improvements in the condition of the patient. Placebo effects are good. Placebo effects are a threat to conventional medical practitioners and researchers, because they are - by definition - unexplained. When they are explained, they become real effects.
"Benefits provided by alternative medicines are generally placebo effects, created by the beliefs of the patient, not true benefits." Truth: The distinction between conventional and alternative medical treatments is an artificial marketing distinction with no scientific basis. Inaccurate or inappropriate use of the phrase placebo effects, without evidence, only extends this lack of understanding.
Placebo Cures
Can placebos cure? Do placebo effects include cures?
Cures are not studied by conventional medicine - except for a few diseases caused by pathogens and parasites. Cured is not medically nor scientifically defined for any non-communicable disease, and cured cannot be tested, cannot be proven for most diseases. The word cure does not appear in many medical dictionaries and is not defined in any medical treatment reference or text.
We don't know if placebos or placebo effects result in cures, because of our lack of understanding of cure.
Clinical placebos are generally used in clinical studies on diseases that cannot be cured. However, because cured is not defined medically, if a clinical placebo, or the medicine being tested results in a cure, the cure cannot be noticed, cannot be documented. It is outside the parameters of the study. Cured is seldom defined for any clinical study.
Placebo Myths
Because of the conflicting definitions of real placebos vs clinical placebos, and the conflicts between conventional medical practitioners and alternative medical practitioners - there are many nonsense myths about placebos and placebo effects."Placebos are medicines or treatments that provide no medical benefit." Truth: A placebo is not a thing. A placebo only exists when a doctor uses something - any treatment - as a real or clinical placebo. Placebos, by definition, provide benefits, real improvements in the condition of the patient.
"Placebo effects are a result of the beliefs of the patient." Truth: placebo effects require specific beliefs of the doctor, and require that the doctor does not know the cause of the effect, and believes it was not caused by the treatment. The patient is not required to believe and might even have negative beliefs about the placebo treatment and still receive positive results.
"Placebos effects are imaginary." and "Placebo effects are bad." Truth: placebo effects are real, positive, measurable improvements in the condition of the patient. Placebo effects are good. Placebo effects are a threat to conventional medical practitioners and researchers, because they are - by definition - unexplained. When they are explained, they become real effects.
"Benefits provided by alternative medicines are generally placebo effects, created by the beliefs of the patient, not true benefits." Truth: The distinction between conventional and alternative medical treatments is an artificial marketing distinction with no scientific basis. Inaccurate or inappropriate use of the phrase placebo effects, without evidence, only extends this lack of understanding.
to your health, tracy
Author: A Calculus of Curing
A Calculus of Curing provides a clear, powerful definition of cure, cures, curing, and cured by separating illnesses and diseases into illness elements - each of which can be cured.
If clearly defines cure, compound cure, partial cure, temporary cure, and other variations of cure.
Dictionary References
Webster's: Placebo:
1. a: a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder
b : an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance (such as a drug)
2 : something tending to soothe
Webster's: Placebo Effect:
improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used
