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Are Subliminal MP3s placebos?

The strange world of the placebo

Self-help products are marketed so well. So slick, is the marketing that it wouldn't be far off to suggest that the marketing is part and parcel of the service. In fact, one would be spot on.

In some sense, the debate of whether a subliminal programme works or not, must be won before the programme is followed. As the treatment by its very nature is hidden from the listener, marketing has a lot do to with how effective it is.

The question is often asked:
“It’s all just placebo isn’t it? If so, it works anyway, as long as I think it does.”

This question is also asked of religion, homeopathy and most notably Western medicine.

A simple explanation of the Placebo Effect

While it would seem that religion and homeopathy have been given a pass on this one, pharmaceutical companies must conduct clinical trials to acquire permission to sell their drugs. To do this, they need to be confident that their treatment is safe and probably effective. In this, researchers are required to demonstrate that the medicine performs better than a placebo. A placebo is something which appears to be a medicine but which has no real active treatment in it. Within the drug trial, a group of randomly chosen subjects are injected with saline solution or given a sugar pill. Some of the test subjects receive the actual drug and half receive the placebo. This is called randomised controlled double blind testing and is the standard in medical research (Leber, 2000).

This form of group testing is undertaken at great expense and effort to control for the placebo effect. Note: This placebo phenomenon manifests itself in both the test and the placebo group. It is the extent to which some form of healing takes place in absence of the treatment. In the wards of subliminal research, a placebo can be another suggestion concealed within the stimulus or no suggestions at all.

In laymen terms, the placebo effect is thought of as the healing power of imagination and expectation.

The power of placebo is thought to arise through the assurance or illusion of benefit. In other words, if it is suggested that you will benefit and you believe you will then well, you will.

The idea of the placebo effect has been ragged around. It has been represented to be something which is understood, finite, measurable, powerful and part and parcel of modern day medical science. Only the latter is true. Not only is the placebo effect found to be far weaker than believed, it is also among the least understood concepts within medical science (Brooks, 2009a).

There are a number of oversimplified theories which may account for the placebo effect.

  • The simplest explanation is that illnesses commonly go into remission anyway, regardless of whether a treatment or placebo is administered or not. This is unlikely, given the volume of evidence that there is a real force at play. It is possible to test this by including a so called third wing control to the study consisting of subjects who are ill, but whom receive no treatment. It's clearly not this.
  • The second explanation is the mainstream explanation. Here, the placebo has much ado with the level and quality of care one receives. More to the point, it is the level of personal attention received. The very best Homeopath and the very worst clergy in the world believe this to be the case.
  • The third explanation, is similar to the second, but placed squarely at the feet of subjective delusion. That is, there is a one to one link between the psychological and physiological conditions. They are one in the same. This would mean that convincing the mind is the same as convincing chemicals within the body (Vogelson, 2002). Sounds pretty farfetched, right? Given the enormity of the question this is, this is still one of the better explanations. The more one thinks on this, the more it feels right and it is the most widely accepted explanation amongst Psychiatrists and Psychologists alike.

However, upon review of the research, none of these explanations adequately explain the strangeness behind the placebo effect. There is still something missing.

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The ethics of subliminal placebos

What researchers can agree on is that the Placebo Effect has something to do with the belief you have in the treatment. There is certainly something to do with the faith you have in your doctor, the pharmaceutical industry, injections, framed degrees on walls, white lab coats, a religious figure or this very website for that matter. It would seem that positive expectation accounts for much healing or improvement. There are no credible self-help providers who may deny this. There is no pharmaceutical company who could.

When sugar pills are administered with a positive message they will induce less fear, less anxiety, and less pain (Goldacre, 2009.) What's going on?

When your family doctor says, "I'm going to give you this medicine to help with… they are said to be using the Doctors' incantation. It is the belief that the medicine will work that seems to help make it work. Offering a subliminal download within a flashy website, with the suggestion the programme is very beneficial for the given purpose, evokes the same mix of trust, expectations and affirmation. The same process is at play here.

When a Pharmacist receives a prescription from a doctor for what appears to be a placebo, they are obliged to play along! (This is according an article in the 2001 Journal of the American Pharmaceutical Association). They’re asked to conform to a script which goes exactly like this:
Generally a larger a dose is used for most patients, but your Doctor believes you will benefit from this dose... It’s easy to believe your doctor, and so hard to believe that this happens in every day practice. Moreover, this fantastical ruse is considered to be ethical by most practitioners. In 1985, the Oregon Health Sciences University estimated that 35%-45% of drug prescriptions administered were placebos (Helm, 1985). A survey of Israeli doctors has revealed that 2 out of 3 had prescribed placebo treatments and over half do so once a month or more. 94% of these doctors who prescribed placebo treatments reported them to be effective (Nitzan & Lichtenberg, 2004).

The medical fraternity believe that this is ethical because they are using their knowledge to heal you… even if this knowledge is how to evoke the placebo effect.

Measuring the Placebo Effect

Following a review of 19 clinical trials of anti-depressants at the University of Connecticut, it was reported that 75% of the effect of anti-depressants can be ascribed to the placebo effect. You might need to read that again! The remaining 25% of improvement can well be put down to side effects and other factors (Kirsch & Sapirstein, 1998). When the Boston Globe's now famous investigation of the seemingly magical anti-depressant Prozac, they found its efficacy could not be distinguished from the placebo in 6 out of 10 clinical trials (Moore, 1999). More recent analysis of 96 anti-depressant trials between 1979 and 1999 found that in 52% of the trials, the effect of the drug could not be distinguished from the placebo (Burne, 2002).

As both test and control subjects can improve, remain the same, or get worse in their condition, a comparison of the two groups is not straight forward. This means that:
The placebo effect is a statistic. It is not possible to statistically piece apart the influence the placebo has from that of the actual drug.

Although much of the improvement of the real treatment can be ascribed to placebo, an effective or worthwhile treatment it is not just placebo. The self-help industry are complicit with medical science in underestimating the degree to which the placebo influences our results.

The confounding reality of the Placebo Effect

So while good bedside manner, attention and flashy websites seem to be a part of what contributes to the placebo effect, it certainly is not a complete explanation, and still by no means a good one. The aforementioned explanations not only fail to explain how the placebo effect works, but do not venture to explain some of the lesser known properties.

Studies have demonstrated that perceived assignment is just as important as actual assignment (which is why researchers cannot know which group is which, otherwise they’ll let on unconsciously – hence why we require a “double blind” test.) It has been shown in repeated studies that anti-depressants don’t work unless you know you’re taking them. In these studies, the control group are effectively those who are on the drug and know it – the test group are those who are on the drug but do not know it (Collins and Pinch, 2005; Brody, 2002). When one swaps Morphine with a saline solution, the unaware patients report that the Morphine is still alleviating pain. However when Naloxone is secretly administered, a chemical which prevents Morphine working, the pain soon returns. Naloxone prevents the placebo effect from working.

This either means that the salt water was working as well as Morphine (for no chemical reason whatsoever) or that the expectation and imagination has a bio-chemical basis. Expectations of pain relief stimulate natural pain relief – perhaps it could be that Naloxone blocks these (at the moment) invisible or hidden endorphins (Brooks, 2009a). Perhaps it’s neither.

This process can also be reversed. Introducing the “nocebo” effect. Here we have harmless medicine, with a suggestion that it will make people feel worse. Benedetti (2009) had to use paid volunteers (as no ethics committee was going to sign it off otherwise). The study found that neurotransmitters can turn anxiety into pain. By Administering Proglumide (a CCK blocker) and while taking repeated blood samples, Proglumide was shown to stop the nocebo effect, just as the Naloxone shut off the placebo effect.

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The placebo effect however is not universally accepted, and its very existence is controversial. Hróbjartsson and Gøtzsche (2001) conducted a series of meta-analyses on hundreds and hundreds of clinical trials. Here many studies were looked at under the same conditions, and evaluated on a common yardstick. While these studies are controversial and dispute a host of other studies, the authors have revisited their analyses a number of times, and gained much credibility and respect. They concluded that the placebo effect was only found in studies which relied on the patients’ subjective evaluation. That is to say, in pain studies, where reporting bias could be in play. Patients are typically polite to their doctors.

This finding was later countered by a 2005 study at the University of Michigan. The experiment using brain imaging PET scans severed the link between placebo and patients subject reporting. The PET scans measured the level of endorphin in hypothalamus following a saline injection into the jaw. Endorphins increased in the brain although the test subjects themselves had no reason to report less pain (Benedetti, Mayberg, Wager, Stohler & Zubieta, 2005).

In some situations it is also possible to show the treatment working separately from the placebo effect. Again, using PET scans, a significant overlap between placebo and test subjects was found (however the placebo effect cannot be statistically parsed from the actual treatment.) Nonetheless, those receiving the antidepressant showed additional changes in subcortical regions compared with those in the placebo group (Mayberg, Silva, Brannan, Tekell, Mahurin, McGinnis & Jerabek, 2002). This study went a long way to vindicate the use of antidepressants, however brought the field no closer to understanding the placebo effect.

All that glitters is not gold

It’s fair to say that Homeopaths have an uneasy relationship with the placebo effect. That said, homeopathy has been shown to be just as effective at counteracting IBS as traditional medicine (Brooks, 2009b; Kaptchuk, 2008). One is reminded about the questions of ethics discussed above. Placebos cannot not cure cancer, HIV or stop organ disease. If the condition is not placebo responsive but the symptoms are, then there’s trouble!

There are limits, to what the placebo can achieve which is why it’s problematic to use the legitimacy of the placebo effect to defend Homeopaths and for that matter, Televangelists who trade on these “molecules of hope.”

For the time being it may not be possible to find a higher level of proof. It is clear that the methodology of clinical trials needs an overhaul, but this is so unlikely given the money behind the pharmaceutical industry. That said, for drugs to enter the market they must outperform the placebo. However, as successful treatment rates rise, so too do placebo rates! The pharmaceutical industry is a victim of its own success and is as Michael Brooks (2009a) so aptly put it, we all running to stand still.

At the moment, we do not know what happens on a chemical or electrical level because all measures are tainted the moment one approaches with a pill or needle (Brooks, 2009a). This is very similar to what we see in physics, the observation influences the phenomenon. It is not possible to separate out placebo from the chemical effects of the drugs. Furthermore, the research as a body of knowledge continues to suggest that the placebo effect is not just one, but many reactions, and we can only surmise that these may be chemical reactions.

Are subliminal messaging fakery?

There is no doubt that the placebo plays an equal or greater role in the success of subliminal self-help than the actual subliminal influence. In the defence of subliminal messaging, this is comparable to the actions of anti-depressants and pain relief. If subliminal messaging is a placebo - so is everything else.

Good bedside manner, blue pills, saline injections and white coats are akin to a great flashy website, cool sales speak, lots of scientific evidence with some liberally scattered quotes from people like you, who say it works too.

The placebo effect in all self-help websites is extremely strong, as it precedes openness for change, the strong desire for improvement and commitment. As with any treatment, improvement will be seen even if there were subliminal messages encoded, or subliminal messages had no effect on the brain. Subliminal research has grown tremendously, despite James Vicary’s manipulation of the original research. The field is still recovering from the stigma. Just as with the pain relief medication and antidepressant research, there is the odd study which finds weak to no improvement as a result of subliminal messaging (Greenwald, Spangenberg, Pratkanis, Eskenazi, 1991). Since the mid-1980s there has been a growing tide of evidence, within placebo controlled tests, that the treatment effect is real. In order to be taken seriously once again, subliminal researchers had to go beyond demonstrating that they were, but due to the hidden nature of subliminals, also show how they worked. This was achieved with access to MRI.

Just as with chemical treatment, subliminal influence is also vulnerable to the lack of belief. That is, if you don’t think subliminal mp3s will work for you, then they probably won’t, or their effect will be so slight that you don’t experience the change. An important part of getting the most out of a subliminal mp3 is to work with the subliminal priming effect.

Subliminal messages however diverge slightly in the classic placebo phenomenon – in that if you are not aware of them, they will still work. To date there are no studies which explore the relationship between subliminal stimuli and the belief in subliminal influence. Ironically, the strongest evidence we have for subliminals working without the placebo are those which show improvement in areas in which the test subjects are not informed about.

Presented with all the above evidence, the criticism of placebo can be levelled at all forms of treatments, the chemical, psychological and the... ahem... illogical. Where does this leave you now? Well, this much we do know, all forms of treatment work best when you get behind them with everything you've got, get emotionally charged up, remain committed and follow through with the changes they inspire. If placebo is a necessary part of the deal, make the most of it.

References: Greenwald, A.G., Spangenberg, E. R., Pratkanis, A. R., &,. Eskenazi, J. (1991). Double-Blind Tests of Subliminal Self-Help Audio Tapes. American Psychological Society, 2(2), 119-122.

Leber, P. (2000). The use of placebo control groups in the assessment of psychiatric drugs: An historical context. Biological Psychiatry, 47, 699-706. Kirsch, I., & Sapirstein, G. (1998). Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention & Treatment, 1. Helm A. (1985). Truth telling, placebos, and deception: ethical and legal issues in practice. Aviation Space Environ Med, 56(1), 69-72.

Nitzan, U. &, Lichtenberg, P. (2004). Questionnaire Survey on the Use of Placebo. British Medical Journal, 329, 944-946

Goldacre, B. (2009). Bad Science. Harper Collins Publishers.

Hróbjartsson & Gøtzsche (2001). Is the Placebo Powerless? — An Analysis of Clinical Trials Comparing Placebo with No Treatment. New England Journal of Medicine, 1594-1160.

Benedetti, B., Mayberg, H.S., Wager, T.D, Stohler, C.S., & Zubieta, J. (2005). Neurobiological Mechanisms of the Placebo Effect. The Journal of Neuroscience, 9 November 2005, 25(45), 10390-10402.

Benedetti, F. (2009). Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford University Press.

Kaptchuk et al. (2008). Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. British Medical Journal, 336-999

Brooks, M. (2009). 13 Things That Don’t Make Sense: The Most Intriguing Scientific Mysteries of Our Time. New York: Random House. Mayberg, H. S., Silva, J. A., Brannan, S. K., Tekell, J. L., Mahurin, R. K., McGinnis, S., & Jerabek, P. A. (2002). The Functional Neuroanatomy of the Placebo Effect. American Journal of Psychiatry, 159, 728-737.

Brooks, M (2009b ,6th February). Homeopathy: Sometimes a dose of nothing can do you a power of good. Guardian.

Brody, H. (2002). The Placebo Effect: Implications for the Study and Practice of Complementary and Alternative Medicine, The Role of Complementary & Alternative Medicine: Accommodating Pluralism, ed. Callahan, D., Georgetown University Press.

Collins, H., &., Pinch, T (2005). Dr Golem: How to Think About Medicine. University of Chicago Press.br/>
Moore, T. J. (1999, October 17). No prescription for happiness. Boston Globe, E01.

Burne, J. (2002, June 20). Make-believe medicine. The Guardian.

Volgenson, C.T. (2002, July.). Searching for the Placebo Effect. Modern Drug Discovery

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