A placebo for placebos

To shorten the introduction, there’s two things you need to know, and instead of making a pretty narrative out of it, I’ll just assert the two facts directly. (1) I asked my doctor to give me some Adderall, and he said no. (2) Placebos work even when you know they are a placebo. [1]

I understand my doctor’s position—his reluctance to prescribe me Adderall. But then I wondered if I could ask him to prescribe me a placebo for Adderall. He could literally write “Placebo for Adderall” on the prescription note, and the pharmacist could literally give me a bottle of sugar pills or Advil or whatever, with the label removed and “Placebo for Adderall” written on it instead, and I’d be happy. But my psychologist friend Stephanie told me that there are regulatory practices that would forbid them from doing this.

A fun little digression here; she says the reason why it’s illegal for pharmacist to give people placebos is because it would be too paternalistic; i.e. it’s not okay for the pharmacist to make a judgement about what’s in my best interest in opposition to my own desires. So in an attempt to fight paternalism, the government has established a law that disallows me to have the pharmacist and I engage in a consensual transaction, because it might not be safe for me.

Okay, so the pharmacist won’t give me a placebo. But no problem, I can just make my own placebo, and it should still work, because placebos still work, even if I know they are placebos, right? But how do I make my own placebos? Well, my first idea is I could just directly eat a spoonful of sugar or something, and tell myself that this is a placebo for Adderall. But I suspect it wouldn’t actually work, because deep down inside, I would not truly believe that this is a placebo; it’s just me eating sugar.

Stephanie suggested that I take one of my mom’s homeopathic pills for diabetes. After some thought, I think we both decided this wouldn’t work either, because although we both know the homeopathic pills are placebos, they are placebos for the wrong thing. I.e. I specifically need sugar pills which are placebos for Adderall; it won’t work if you give me sugar pills which are placebos for diabetes.

So it seems that although “placebos for X” work even if you know it’s a placebo, “placebos for placebos for X” do not work, unless you actually think you’re receiving a placebo for X.

[1]: This is apparently well documented, e.g. http://www.scientificamerican.com/podcast/episode.cfm?id=placebos-work-even-when-you-know-10-12-23 http://www.guardian.co.uk/science/2010/dec/22/placebo-effect-patients-sham-drug http://www.newscientist.com/article/dn19904-placebos-can-work-even-when-you-know-theyre-fakes.html

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