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- Alex Hutchinson (@sweatscience)
One of my greatest regrets about writing this blog is that the more I dig into the evidence behind most of the supposed “performance-boosting” supplements out there, the less I believe most of them have any legitimate effect. If I never looked at the actual research, I could be popping all sorts of pills in blissful ignorance — and because I’d believe in them, they’d give me a nice robust placebo effect. In fact, I’ve toyed (mostly in jest) with the idea of suggesting that elite athletes should avoid finding out too much about the science of ergogenics, so that they can maintain the fantasy that these things work and thus get an edge from them.
But a recent study from Harvard suggests that one of my key assumptions may be false. The study (which is freely available here and described by a press release here) set out to determine whether you have to believe in a placebo in order for it to work. To that end, they recruited 80 patients with irritable bowel syndrome (IBS). Half of them received no treatment, while the other half received placebo pills to take twice daily — but they knew that the pills were nothing but sugar:
“Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had ‘placebo’ printed on the bottle,” says Kaptchuk. “We told the patients that they didn’t have to even believe in the placebo effect. Just take the pills.”
To everyone’s surprise, nearly twice as many placebo patients reported relief from their symptoms (59% vs. 35%), and “patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications.”
So what on earth is going on here? The researchers speculate that “there may be significant benefit to the very performance of medical ritual.” This isn’t a new idea — I read a very interesting book on the placebo effect a few years ago that argued, in effect, that the doctor-patient relationship is the most powerful placebo mechanism available to us. Of course, “feeling better” is not the same kind of outcome as “running faster” or “growing bigger muscles.” I’d love to see a study that investigated whether undisguised sugar pills could enhance athletic performance. What would WADA do if the results came back positive? 🙂