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The strongest argument for herbal medicine is also the one most often mistaken for evidence that the plant works.
guidePlacebo is not a synonym for nothing. A sugar pill given with expectation and ritual produces measurable relief in pain, nausea, and irritable bowel syndrome, and brain imaging shows real opioid and dopamine release behind it. That is why "people feel better" can never be the evidence that a preparation works: they feel better on the ritual too, and the size of the ritual effect is large in exactly the complaints herbal medicine is used for.
Taste, smell, being handed something by a person who is confident, and spending money on it, all increase the effect. A bitter tea that is unmistakably a medicine will out-perform a tasteless capsule at relieving nausea. This is a real mechanism and it is worth having.
The failure mode is the conclusion drawn from it. A preparation whose trials beat placebo has a drug effect; a preparation whose trials do not beat placebo, but whose users feel better, has a ritual effect and possibly nothing else. Both feel the same from the inside, which is why only the trials settle it.
The mirror image is nocebo: expectation of harm reliably produces harm. Telling someone a harmless preparation causes nausea produces nausea in a measurable share of them, and harvesting that as "a side effect of the herb" is a way to invent an adverse event.
The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD.PubMed 26599576 ↗
These clinical effects were independent of expectations, and accompanied by an attenuation of hyperalgesia in the targeted segment and a modulation of pain catastrophizing.PubMed 38369221 ↗
Government of the Netherlands Topsector Agri & Food Top Consortium for Knowledge and Innovation, AB Mauri Global Bakery Ingredients, Baking Industry Research Trust, Borgesius-Albert Heijn, CSM Innovation Centre, the International Maize and Wheat Improvement Center (CIMMYT), DSM Food Specialties, Fazer, Healthgrain Forum, the International Association for Cereal Science and Technology, the International Wheat Gluten Association, Lantmännen, Mondelez International, Nederlands Bakkerij Centrum, Nutrition & Santé, Puratos, Rademaker, Sonneveld Group, and Zeelandia HJ Doeleman.PubMed 38040019 ↗
This study provides first proof-of-concept evidence for the efficacy of a brief information session in preventing adverse events of chemotherapy.PubMed 36138381 ↗