You Know It’s a Placebo. So Why Does It Still Work? (Tom Vanderbilt, 12/19/23, Wired)

You might think that having a positive attitude about the nothing-pill is what transforms it into a something-pill. Perhaps OLPs are a sort of meta-placebo, a testament to how much we believe in our power of belief. But the real driving impulse for many patients who enroll in clinical trials isn’t positive expectation. It seems to be a more uncertain emotion: hope. As the 2017 study puts it, “Hope is a paradoxical combination of opposites, balancing despair and the counterfactual notion that things can improve—a kind of ‘tragic optimism.’” A patient who has suffered for years from some condition, taken drugs, undergone procedures, and gotten no relief may think: A sugar pill probably won’t help, but what the heck, let’s see what happens. As a 2016 paper in the journal Pain puts it, “Engendering hope when participants feel hopeless about their condition can be therapeutic.”