"Trust me bro" – harness the potential in placebo

“When we can rely on it, and when we shouldn’t”

Placebo is a complex topic to cover in health - we’ve all heard of it, but it’s hard to fully grasp its scope. The idea that your brain can convince your body a fake treatment is the real thing is both empowering and troublesome. 

In the past, placebo in research has always been linked with failure. Often used in clinical trials for medicine or treatments, placebo is something we implement to distinguish between correlation or causation between an action and its result.

In fact, most research revolves around mitigating placebo - that is, to eliminate mindset biases across the board to find out whether the dependent variable (response) actually results from the independent variable (treatment).

But why does placebo exist in the first place?

Because we humans are strange creatures deeply affected by our thoughts. Just the thought of being prescribed a drug could make our condition better or worse depending on what it was described to do, even if it was just a simple sugar pill. And that has to do with our brain and the complex neurobiological reactions that take place.

Pretty cool right? 

You could essentially show signs of recovery through a ritual of treatment and sugar pills provided by medical professionals wearing white lab coats, because you simply believed you were getting treated. Because your brain has been convinced that treatment has been administered.

It’s: 

1. how things have been presented to you, and 

2. whether or not they’re trustworthy. 

For example, an experiment published on Health Psychology in 2017 found that the same exact hand cream could either irritate or improve an administered rash shortly after application based on what the doctor told subjects. Patients who were told that the cream could potentially irritate and worsen an allergic reaction had their rash grow larger in just 10 minutes. And patients who were given the same inert cream showed signs of improvement when told that the cream would reduce irritation. 

In that case, can we take advantage of placebo?

We might ask: “what does that have to do with me?”

Maybe we’ve been looking for a treatment to alleviate back pain, or medicine to make us feel better. There’s a problem to solve and we should explore all our options – including the option of just…not solving the problem. (That is, use placebo.)

Is it blind trust?

Science is quick to dismiss methods to be useless when there’s a lack of evidence that could soundly prove causation. Fair enough – they’re dealing with issues of certainty, and particular findings (or lack thereof) could alter the perceptions of many. 

But on a personal level, I think we should value the role of placebo a little more. A positive mindset of simply believing could go a long way.

As a consumer, if simply believing in a treatment is all it takes to trigger some improvement, why not take advantage of it? You’re probably not going to be too concerned about the extent of the treatment’s efficacy. You’re mainly concerned about getting better. So the least we can do is believe. It won’t cost much.

We can’t just go around believing everything, can we? How do we not get taken advantage of?

Although trust is integral for placebo to take place, we can’t just go around trusting everyone. Critical thinking and evaluating are still necessary when deciding on the treatment plan.

Here’s another chance for me to talk about opportunity cost. (Look ma, my degree in economics can be applied everywhere!) My rule of thumb when it comes to my options is:

1. If it costs more resources than your other options, it better be significantly better than all of them

2. If it doesn’t cost you much, and there’s a chance you might benefit from it (either directly or indirectly), why not give it a go?

3. If you do enjoy it and it feels good, there’s nothing stopping you from going back even if it doesn’t deliver what it promised

An example I can think of is foam rolling. From healing and recovery to lasting flexibility adaptations, there are quite a lot of exaggerated claims out there about the benefits of foam rolling. But to date, the research has yet to demonstrate anything spectacular, with no consensus on the benefits of foam rolling being any more than a convenient warm-up tool that resembles manual therapy (massage). 

That is the perspective of science which I agree wholeheartedly with. Yet I still occasionally foam roll. And that’s because it just feels good. It hits the right spots and I feel less pain afterwards. It doesn’t make foam rolling a magic bullet - I just think of it as giving myself a massage on days that I feel like I need one. A placebo.

According to my rule, it has: 1. little to no cost, 2. uncertain effectiveness, 3. the added benefits of a massage (feels good).

Placebo’s great, but don’t let others take advantage of your trust

Alternatively, let’s talk about glucosamine.

Glucosamine and chondroitin were a large part of my highschool and university diet. After sustaining injuries and undergoing surgeries, my doctor prescribed a large amount of glucosamine pills and powder for me to take long term. I didn’t really know what it was for at the time. I was just told it would help my knee heal after surgery and promote long term joint health. That was all I needed to know to happily comply. I finished bottle after bottle of supplement pills, and continued to do so thinking it was going to strengthen my knees. (I was also told to stay away from exercises that would stress the knee. More on how that would’ve been more helpful than my supplements later.)

At some point, I decided to do some research. Did you know that glucosamine and chondroitin has yet to be proven to provide any of its claimed benefits of treating knee and hip arthritis, protecting joint health, improving joint mobility and reducing pain? 

A meta-analysis of 8 studies conducted in 2022 involving close to 4000 patients found some evidence that glucosamine and chondroitin could be beneficial, but not enough to show a significant difference between placebo. It was recommended as a treatment to a certain extent due to tolerability (lack of side-effects), which basically meant “hey, there’s a chance it could work, and it doesn’t harm ya – so go for it!” 

But the supplement isn’t in the clear. A study conducted in 2016 involving 164 patients with knee pain was cut short because the group of patients who were prescribed glucosamine and chondroitin actually reported worse symptoms than those taking the identical placebo pill.

And the nail in the coffin - glucosamine and chondroitin are marketed for knee joint health because they are both components that make up our cartilage. However, as cartilage in the knee is avascular (meaning there is no direct blood flow to the cartilage), the supplements we take won’t reach the desired area to be useful. We can take them, but our knee cartilage won’t be able to absorb them. Instead, cartilage can only be partially nourished through diffusion with moderate levels of compression or stress (exercise).

Yikes.

Being some of the most researched supplements in the market, glucosamine and chondroitin have time and time again failed to prove their inflated claims. At this point, the supplement stands as a placebo pill with some benefits (experienced perhaps because of the placebo effect), but not enough to be approved as a real science-backed treatment. But that hasn’t stopped the drug from raking in close to $3.5 billion dollars by 2025. 

How it scores in my books: 1. Higher cost for the supplement, 2. uncertain treatment, 3. no further benefits (and I dislike pills).

I’m not here to denounce glucosamine and other supplements; studies have shown that there’s some merit to their claims, and I’m sure some people have found benefits from them in their personal lives through the benefits of placebo.

However, I just want everyone to make decisions with the right information in hand. Do your own research! Since we’re paying for the supplements, we deserve to at least know the efficacy of the drug, and why we should pick it over an alternative. It’s not like the supplement has never shown positive results - it’s just that the evidence isn’t conclusive, and the results dramatically fall short of its marketed benefits. 

With that knowledge, we can then evaluate whether a simpler, cheaper, or more accessible alternative exists. And whether or not these alternatives can help us reach our goals too. 

And at the end, if we still choose to go with glucosamine and chondroitin, we would at least know that it would likely just be placebo, not the magical joint pill it was marketed to be. Or what I thought it would be when my doctor prescribed it.

Armed with hindsight, I would have chosen to spend my time and money on a gym membership rather than glucosamine pills to help my knees. Just wish my doctor would have prescribed moderate exercise as a treatment instead.

After all, exercise has: 1. Little to no cost, 2. Proven effectiveness, 3. TONS of added benefits! If only I had known!

TLDR:

Scientific studies are fundamental to our understanding of health, but don’t underestimate the power of placebo. Sometimes, just believing that you’ll get better may work wonders. As long as that belief doesn’t involve being leveraged or taken advantage of. Be critical and evaluate your options, and trust yourself once you’ve made up your mind! Be a cynical optimist to harness the power of placebo without getting conned! 

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