If you went to the doctor with some physical problem – IBS, say, or painful arthritis; maybe even something as serious as Parkinson’s disease – you’d probably be a bit annoyed if you were sent home with medication you later found out was little more than a sugar pill. Especially if you had been charged a few thousand dollars for the privilege.

But would your reaction be justified? True, the placebo effect is often thought of as being in opposition to “real medicine” – it is, pretty much by definition, a “medication” that contains no active ingredients. But research is increasingly showing a more nuanced picture: that placebos can not only be pretty effective treatments in their own right – but that charging more for them might actually make them work better.

Fancy placebos work better

Most of us don’t like to think of ourselves as shallow. Well, bad news: you are, and the placebo effect knows it.

“Depending on the condition being treated […] pills of certain colors and descriptions are more effective than others,” explained psychologist and author Christian Jarrett in a 2019 article for the British Psychological Society. For example, he wrote, “blue placebo pills [make] better sedatives than pink ones, and branded placebo pills [are] more effective than those without any labelling.”

Similarly, a placebo you believe cost more is more effective than one you’re told was cheap. Consider the results of one 2015 study, for example, which told Parkinson’s patients they were testing a new injectable treatment for the disease: the regimen involved two shots, one which patients were informed cost $100, and another they were told cost $1,500.

In fact, both were saline – but that wasn’t what was important. What the researchers were in fact measuring was whether there was any difference in how well the “expensive” drugs worked compared to the “cheap” ones. And the answer was quite a resounding “yes”: all the patients saw an improvement in motor function – Parkinson’s is unusually susceptible to the placebo effect, probably because of the specific neurological pathways it affects – but those who received the “expensive” dose first got better than those who didn’t. 

“People probably feel more effect from higher-priced homeopathic preparations, too, although they're the same distilled water as all the rest of them,” wrote medicinal chemist Derek Lowe in a Science comment piece on the experiment. In fact, so ingrained into us is this idea – that expensive things should work better than cheap or unbranded alternatives – that it can even show up outside of medicine. Being told you’re playing sports with Nike-brand equipment will make you perform objectively better than using the same product without the famous label; using ear plugs you think were made by a company like 3M will, somehow, improve your ability to block out distractions more than if you think they’re a generic brand.

Similarly, “if you tell people that they're drinking expensive wine, they report that it tastes better than the cheap stuff, even though they both came from the same bottle,” Lowe pointed out. “[It] raises some interesting philosophical points – when you're reporting a sensation like taste, there's no way to distinguish between what's ‘objectively’ in the substance being tasted versus what being ‘added’ by the mind. Some parts of medicine are closer to that than we like to think.”

Complicated placebos work better

It kind of goes without saying that surgery is not always going to be the best treatment for some illnesses. But as it turns out, the placebo response doesn’t know that – so if you’re trying to trick yourself into getting better without any real treatment, it may help to make your fake therapies more invasive.

“Not all placebos are pills. They also include minimally invasive surgery, acupuncture needles that don’t pierce acupuncture points, manipulations, and others,” wrote Jeremy Howick, Director of the Oxford Empathy Programme at the University of Oxford, in a 2019 article for The Conversation. 

“Some evidence suggests that injections are more effective than pills,” he explained, “and sham surgery is the most powerful placebo of all.”

There’s no obvious reason why a saline shot should be more effective than a sugar pill – but experts think it has to do with how effective we think a treatment ought to be. “The more powerful we imagine their effect will be, the larger the benefit,” Jarrett wrote. “This means that four placebo pills have a larger effect than two; and placebo injections […] are more powerful than pills.”

So powerful is this cognitive bias that in certain cases, fake injections can be more effective than real pills. And for the most powerful results of all, reach for the scalpel – just don’t actually do anything with it. In three-quarters of patients, simply thinking they had surgery will be enough to make their symptoms improve; for pain relief, meanwhile, there’s essentially no difference in the effectiveness of fake surgeries and real ones.

“One of the most astonishing demonstrations of the placebo effect that I’ve come across […] involved ‘placebo brain surgery’,” Jarrett recalled. “Specifically, the research showed that patients with Parkinson’s Disease who undertook a form of placebo brain surgery (supposedly, but not really, involving the injection of stem cells) showed greater symptom improvements than those patients who received the stem cell treatment, but didn’t think they had.”

And let’s face it: while it needn’t be anything dramatic that raises your expectations of a treatment – even just a doctor taking extra time to explain it, or seeming enthusiastic about it – it’s easy to see why fake brain surgery would elicit the biggest placebo response. After all, Jarrett pointed out, “what could elicit a greater hope for a treatment effect than the elaborate paraphernalia and protocols involved in experts operating on your brain?”

Placebos work, even when you know what they are

Of course, even despite all this evidence that placebos can work, you might still be annoyed if you received one in lieu of real medicine. It’s the principle of the thing, right? Sure, the sugar pill might work – but it was a lie.

Well, it doesn’t have to be. In fact, it’s long been known that placebos can reduce symptoms of both mental and physical ailments even when they’re labeled as placebos. “[It] turn[s] our understanding of the placebo effect on its head,” said Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. "The placebo effect is not necessarily elicited by patients' conscious expectation that they are getting an active medicine, as long thought.”

Theories are split on how this works, by the way. Some argue that there’s something to do with the ritual of taking a treatment – any treatment, even one you know to be useless – that prompts the brain to recalibrate the levels of disease in the body; others put the effect down to a greater self-awareness induced by cognitive dissonance at the treatment. As one study put it in 2022: “Facing the paradoxical conundrum of being offered inert pills to treat their symptoms made them seriously reflect and contemplate not only about placebo effects but also about their own symptoms, their habits and their personal influence on how they feel.”

But regardless of why it happens, it’s evidence that placebos are not necessarily the opposite of medicine, so much as they are an intrinsic part of it. 

“You're never going to shrink a tumor or unclog an artery with placebo intervention,” Kaptchuk said. “It's not a cure-all, but it makes people feel better, for sure.”

“[But] you can't throw the placebo into the trash can,” he added. “It has clinical meaning, it's statically significant, and it relieves patients. It's essential to what medicine means.”

All “explainer” articles are confirmed by fact checkers to be correct at time of publishing. Text, images, and links may be edited, removed, or added to at a later date to keep information current. 

The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.