Chris Kresser: Well, I’m probably going to make some people upset with my answer here! I tend to feel like homeopathy probably is no more effective than placebo, and the effects that it does have are placebo effects, but I think a more important question is, so what? If you can use a sugar pill to achieve significant reductions in pain or discomfort or digestive problems or headaches or improved mood or reductions in anxiety with no side effects, then isn’t that a very skillful approach? I interviewed Jo Marchant, who wrote Cure: A Journey into the Science of Mind Over Body, one of the best science books I’ve read in a long time, and we talk all about this. We talk about placebo effect and how it’s been denigrated in medicine and how really we should be studying how we can optimize placebo effect and use it wisely in practice because there are many medications, not just homeopathy, that have been found to be no more effective than placebo in clinical studies that are commonly prescribed.
How about antidepressants? SSRIs, in many cases, are no more effective than placebo for mild to moderate depression. Now, the caveat there is there’s a lot of individual variation. Some people respond really, really strongly to antidepressants. Other people don’t respond at all. But even when there’s a strong response, the point of those studies is that you can’t know that that strong response is due to a biological effect of the drug versus that person’s belief in the effect of that drug—and not just on a conscious level, on a subconscious level—because we now know that placebos work even when patients know they’re placebos. That sounds crazy, but there was a study done in IBS patients. It was an open-label placebo trials. They said, “We’re going to give you this placebo. It’s a placebo. It’s not an active medication, but placebos have been very helpful in these other trials,” and a lot of patients feel better. They get significantly better even when they know it’s a placebo.
What happens with the placebo effect is real and measurable. There’s a release of endogenously produced compounds, like endorphins or other things that can be measured, and when they are measured, you can see real changes on blood tests or in cases of Parkinson’s where they’ve done placebo trials, they can measure changes in the brain. There are placebo surgeries, which in most cases, the placebo surgery, where they’ll cut open the patient and not actually perform the surgery and then close the patient back up, that are just as effective as the actual surgery for things like osteoarthritis, knee pain, etc. People have asked the same thing about acupuncture and homeopathy, and one possible way of looking at this is that those kinds of approaches are just masterful ways of applying and harnessing the placebo effect. If that’s the case, then I don’t think that’s a reason not to use those therapies. If anything, it would be a reason to use them because they’re accomplishing these changes without any side effects or risks compared to the active medications.