Placebos and the

Meaning Effect

Dr Lisa Wynn
ANTH106, Drugs Across Cultures
• When can you perform
random experiments on
people?

• What ethical considerations

have to be taken into
account before you can
experiment on people?
– Harm from receiving drug
being tested
– Harm from not receiving
drug being tested
 How drug trials work
1. Open trial: both the researcher and the patient know full details
of treatment.
Problems: bias and placebo effect.

2. Blind, placebo-controlled trials

a. Single-blind trial
Researcher knows details of treatment but patient does not.
b. Double-blind trial
Both patient and researcher
are “blinded.” Most accurate
research results: no bias,
controls for placebo effect.

When can’t trials be blinded?

 Placebo effect as meaning effect
Moerman and Jonas, “Deconstructing the Placebo Effect and Finding the
Meaning Response.” Annals of Internal Medicine 2002;136:471-476.
http://www-personal.umd.umich.edu/~dmoerman/aim_plac.pdf

Their argument: placebos do not cause placebo

effects. Placebos are inert and don’t cause
anything.
Placebo effect is not about
placebos – placebo effect
is about meaning
 Placebos as “meaning effect”
• Example 1: medical students given either 1 or 2 red or
blue pills; told it was a study of a tranquilizer and a
stimulant

• Result:
– red tablets acted as stimulants
– blue tablets acted as depressants
– 2 tablets had a stronger effect than 1

• But every pill was a placebo!

 Placebos as “meaning effect”
• Example 2: 835 women with headaches given:
– aspirin in brand name packaging
– aspirin in plain packaging
– placebo in a bottle of brand name aspirin
– a placebo in plain packaging
• Result:
– All pills were effective, both aspirin and placebo
– 435 headaches reported by branded placebo users; 64%
improved 1 hr after pill
– 410 headaches reported by unbranded placebo users; 45%
improved 1 hr after pill.
 Placebo response as meaning response
• Moerman and Jonas argue that we should think of the
placebo response as a ‘meaning response.’ Placebos
clearly cannot do anything themselves, but their meaning
can.
• Definition of meaning response: ‘the physiologic or
psychological effects of meaning in the origins or
treatment of illness; meaning responses elicited after the
use of inert or sham treatment may be called the
“placebo effect” when they are desirable and the
“nocebo effect” when they are undesirable.’
 Steven Levitt on wine and sensory
perception
• “Do More Expensive Wines Taste
Better?” Journal of Wine Economics,
Vol. 3, No. 1.
Conclusion: fancy people with lots of
training can tell cheap wine from
expensive wine, but regular people
cannot.
• Champagne: Domaine Ste. Michelle
Cuvee Brut ($12, from Washington
state) vs Dom Perignon ($150 ) (Robin
Goldstein, The Wine Trials)
• Vinegar in your beer (Dan Ariely,
Predictably Irrational)
 The placebo effect (or meaning response):
what’s happening in the brain?
• Hilke Plassmann, John O'Doherty, Baba Shiv, and Antonio Rangel,
“Marketing actions can modulate neural representations of
experienced pleasantness.” Proceedings of the National Academy
of Sciences. http://www.pnas.org/content/105/3/1050.abstract
• Subjects told: cheap wine vs expensive wine
(actually, both wines the same)
• Hypothesis: "changes in the price of a product can
influence neural computations associated with
experienced pleasantness"
• Findings: increasing the price of a wine increases:
– subjective reports of flavour pleasantness
– blood-oxygen-level-dependent activity in
medial orbitofrontal cortex (area of brain
associated with pleasure)
– Bottom line: if you think a wine is more
expensive, you really do enjoy it more
 Pâté vs Dog Food
John Bohannon, Robin Goldstein and Alexis Herschkowitsch, April 2009 issue of
Wine Economics, http://www.wine-economics.org/workingpapers/AAWE_WP36.pdf

Abstract:
“Considering the similarity of its ingredients, canned dog food could be a
suitable and inexpensive substitute for pâté or processed blended meat
products such as Spam or liverwurst. However, the social stigma associated
with the human consumption of pet food makes an unbiased comparison
challenging. To prevent bias, Newman's Own dog food was prepared with a
food processor to have the texture and appearance of a liver mousse. In a
double-blind test, subjects were presented with
five unlabeled blended meat products, one of
which was the prepared dog food. After ranking
the samples on the basis of taste, subjects were
challenged to identify which of the five was dog
food. Although 72% of subjects ranked the dog
food as the worst of the five samples in terms of
taste…subjects were not better than random at
correctly identifying the dog food.”

© http://dinnerdiary.org/
 Key points to remember:
1. Placebo effect is really a meaning effect.
2. Meaning has physiological action in our brain (but
this can be lost over time through loss of
conditioning)
3. and… It’s possible to enjoy cheap wine (and
maybe dog food), as long as (a) you don’t think that
you’re drinking cheap wine, and (b) you aren’t a
wine expert.
How to get drunk without drinking:
http://www.youtube.com/watch?v=zryGzTbU49I