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Is the placebo effect real or just response bias? Ie, you give someone a sugar pill, tell them it will relieve their pain, and absolutely nothing physiological changes but when responding they're more likely to feel socially compelled to say there was some small reduction even if there wasn't, or they're more likely to pay attention and notice small improvements that happen randomly. Or is there an actual physiological change that happens (presumably downstream of their mental state expecting such a change and then the brain altering something to reduce pain response).
My understanding is that an awful lot of studies are hopelessly confounded by response bias and just kind of shrug because there's not much they can do about it. Are there any good papers that directly try to measure physiological effects of placebo and/or disentangle response bias from real improvements?
literalbanana from twitter has a more developed version of this argument against the way people interpret the placebo effect here: https://carcinisation.com/2024/11/13/a-case-against-the-placebo-effect/
I think that most measured 'placebo effect's in studies are of this type, but there's also a thing where people claim to feel medicine working in ways it actually isn't, or feel herbal remedies work, that was closer to the origin of the idea of the placebo effect and isn't just bad statistics or a simple trick
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