Placebo Pills: More Than Just Sugar

After more than four decades of testing in tandem with other drugs, placebo gained approval for prescription use from the Food and Drug Administration.

"For years, scientists have been aware of the effectiveness of placebo in treating a surprisingly wide range of conditions," said Dr. Jonathan Bergen of the FDA’s Center for Drug Evaluation and Research. "It was time to provide doctors with this often highly effective option."

Those two paragraphs are the opening of a satirical report fabricated by the staff of The Onion, a humorous "news" web site. The sly joke here, of course, is that placebos used in clinical trials are completely inert – just "sugar pills."

Most people would never think to question the contents of a placebo. After all, everyone knows that placebos have no active ingredients. But if a placebo could talk, it would respond just like any con man caught with his hand in your pocket: "Who ME? Would I lie to you?"

Sugar coating

There was a time when doctors sometimes prescribed phony medication to their patients who they regarded as hypochondriacs. They called the pills "placebo" (a Latin word meaning "I shall please"), and when the patients reported positive results the concept of the placebo effect was born.

These days, placebo pills are used in clinical trials to measure the true effect of a drug or supplement. They are thought to be made of inert substances designed to have no effect. But consider this: there’s no such thing really as an inert substance.

For instance, placebo pills are commonly called sugar pills. But is sugar inert? Far from it, of course. If you take a sugar pill, your body will have a reaction, especially if you happen to have an insulin disorder. But if you’re given that same pill as part of a drug research trial, your reaction becomes a factor in the research.

That may seem like nothing (what real difference could a tiny boost of sugar make?), but a little sugar is not the issue here. Far from it.

A little secret

When a pharmaceutical company tests a product in a placebo-controlled trial, where do you suppose they get placebo pills? Do they place an order with a placebo pill manufacturer? Or does Nestle’s candy company run a side business that supplies researchers with sugar pills?

The fact is, drug companies make their own placebo pills for research purposes, and for each individual study they create a unique placebo formula – sometimes including ingredients that match ingredients in the drugs being tested. But the contents of placebos are never revealed.

Does that sound "inert" or "inactive" to you? Suddenly the idea of a "sugar pill" doesn’t seem so innocent anymore.

Before conducting human trials for drugs, pharmaceutical companies are often fully aware of many of the side effects of the products they’re testing. So, for instance, if a drug is known to cause dizziness and nausea, the drug company running the test may want the placebo to have the same side effects. And they have an explanation for this. They say the placebo should mimic the drug being tested so that the control group of the experiment will have side effects similar to the placebo group. Without that, they claim, the results of a blind study would be compromised.

There are plenty of gray areas to debate in that logic, but for the moment let’s focus on the idea of what they call an "active placebo," designed to mimic the side effects of a tested drug. And with that in mind let’s look at an advertising campaign for a popular allergy medication. In the TV ads, when the moment arrives to list the side effects, the voice-over says, "The most common side effects – including headache, drowsiness, fatigue and dry mouth – occurred about as often as they did with a sugar pill."

A sugar pill? Really? Just what kind of "sugar pill" were the researchers using that caused headache, drowsiness, fatigue and dry mouth? Sounds to me like a sugar pill with a little something added. But they want us to believe that this medication will produce side effects no more serious than what you’d get with a TicTac.

Inertia standardized

Dr. Beatrice Golomb, MD, PhD, is an assistant professor of medicine at the University of California, San Diego, and has been actively fighting the research establishment’s claim that placebos are inactive substances. Dr. Golomb wants scientists to provide a list of placebo ingredients so trial results can be properly evaluated.

To level the playing field, Dr. Golomb suggests that drug companies start divulging all placebo ingredients. She also recommends that standardized placebos should be developed so that side effects will be uniform and predictable. This would go a long way toward eliminating the pharmaceutical industry’s cynical manipulation of test data.

As you might suspect, the drug companies are not very receptive to Dr. Golomb’s idea of letting go of this aspect of product testing that they have full control over.

Meanwhile, what about physicians and researchers who work independently from the pharmaceutical giants – do they know the truth about placebos supplied by drug companies? Right now it’s hard to tell just how widespread this knowledge is. According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH), the placebo effect is defined as "desirable physiological or psychological effects attributable to the use of inert medications." From that statement it would appear that the NIH either believes that placebos are genuinely inactive, or they’re not saying.

Or maybe they’re just feeling drowsy, dizzy, irritable and nauseous from a sugar pill someone gave them.

Chemistry and Industry, Vol. 21, Pg. 900


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Jenny Thompson

Jenny Thompson is the Director of the Health Sciences Institute and editor of the HSI e-Alert. Through HSI, she and her team uncover important health information and expose ridiculous health misinformation, most notably through the HSI e-Alert.

Visit to sign up for the free HSI e-Alert.

Please let us know what you think about this article. All comments will be moderated before being posted publicly.


  1. lindhous1 says

    Thanks Jenny!
    This is the first analysis of “placebo” use that I can remember seeing. It helps clear away the cobwebs of “med-speak”.
    I’ve been reading your e-alert for years now, and have forwarded it to many people.
    Since I am in the AWAI program, perhaps I can help you in producing copy?
    Blessings! Keep up the good work!
    Raylyn Terrell

  2. Anonymous says

    I was on a trial drug – as a blood test showed a level in my blood had dropped, therefore I was taking the active ingredient. I have now been issued new ‘tablets’, the taste is different, and I don’t feel at all well. Has anyone else had this?

  3. Anonymous says

    I was wondering, if i take birth control pills, and they have a whole week of placebo, what am i taking? I think I have the right to know what´s in that pill, and I can´t find it anywhere…

  4. says

    I am interested in the use of placebo pills as an aid to wellbing – even if the recipient knows they are placebo – how and where can a person buy totally inert ones cheaply ?

  5. Tony27920 says

    Where can I find a company that sells Placbo pills… My 70 year old Mother in Law, believe it or not, has this problem with pain pills. I have searched for a while with negitive results. Maybe I’m just not putting the right question in I don’t know. But can someone tell me where I can get my hands on something that looks as close to Percicets as possible so I can get her off these things before she gets to the point or no return???

  6. Anonymous says

    I have a situation very similar to Tony27920. My mother has had blood pressure problems for years and now she is experiencing dementia. Her face gets very hot most of the day and she thinks that her blood pressure must be up and fears that she’ll have a stoke if she doesn’t get her blood pressure pill. The problem is that 1. Her blood pressure is often not high while she feels hot and 2. she seems to have no short term memory and always forgets that she’s already taken the blood pressure pill and fights to have another one. We get her to record the fact that she took the pill and often she won’t believe her writing. She spends most of the day with her head wrapped with ice packs or goes for a walk outside to cool off, even if it’s 2 a.m. in the middle of the winter! Of course, having dementia, she can lose track of where she is and needs someone to go out with her at odd hours. I was hoping that having a Placebo pill would result in fewer panic attacks when she is determined to have a blood pressure pill that she thinks she has missed. All I’ve seen is small Smarties candy or Yogen Fruz smoothies candies that are small and pill-like. Any suggestions for Placebo-like pills would be very appreciated.

  7. Matt S says

    Ha. So you think the FDA allows active (“secret”) drugs to be in the placebo? You are crazy. You know how regulated this industry is? Stop spreading this ridiculous fear. Never ceases to amaze me, the conspiracy theories that exist out there.

  8. LAnderson says

    Ha..people like YOU Matt S crack ME up. You honestly think the industry is highly controlled and regulated? That the FDA is on top of things?

    Do you pay one iota of attention to the endless parade of not-even-shocking-anymore stories that come out each year about how the industry is virtually like the wild wild west with corruption, payoffs, mismanagement, and outright negligence running rampant?

    You don’t need a conpsiracy theory to see the system is incredibly broken. But go ahead and stick your head back in the sand Matt.

  9. says

    I have to add, I’ve never believed in plecebos past certain studies, however, I just recently experienced a situation where the doctor perscibed a plecebo and the pharnacy filled it. I know this truly happened because I’m not stupid. I have ADHD and with that sickness comes a few xtras like paying close attention to detail, extreme sensetivity both physically and mentally, and the ability to multitask. I’ve been on adderall for about 2 years now and it has worked wonders, I am doing great in school, I’m now in my fourth semester and loving the experience. I went to see my doctor as usual, he gave me a script I gave him a hug and never looked at it, because it had become routine. The pharmacist told me they were out of my kind, but they have the same milg tablets from a different company and of course I questioned it. We went back and fourth a few times about how they are the same pills and I wasn’t comfortable with that, I was willing to wait because I couldn’t return until 30 days by law. At home I took one and felt nothing all day, infact I noticed I was a bit tired and a little more relaxed than usual. Two days later I was having a hard time understanding the instructor and still felt a bit spacey in class. It wasn’t until I started popping more to overcome what I thought to be tollerance and that’s when I knew that it was a plecebo, because I began to feel a small headache, I wasn’t paying attention in class or sticking to my homework, I mean I cracked big time, I was wiggling my legs intensly. I was a person I hadn’t seen in a long while and boy was he annoying. I’m failing everything and just dropped a class to help with my GPA. I complained to the pharmacist and they were sticking to it, “it’s a different company, but it’s the same ingredients” In a case like mine where my ADHD is really intense, the change from being medicated to not being medicated is extremely noticable. I may have to just drop out, because I can’t sit still or even understand what’s going on. Do doctors calculate this in their little experiment?

  10. Jeff Sorrows says

    Placebo’s do work, I know the feeling. I wish I could find some kind of placebo for myself though. Currently I am on way too much prescribed anxiolytics, about 180 2mg tablets of Xanax to be exact a month. I get severe panic attacks, and we are treating my condition by stopping it before it starts. Though I do take an extra if I feel an extraordinarily large Panic Attack hit me. Though when I put the pill in my mouth, and it is before the pill can dissolve and hit the blood from within the tongue, I feel a little bit better.
    I know for a fact it will take at the very least 30 minutes, and about just over an hour to get the effect of the drug, but knowing the pill is coming down before the power of it hits, my panic attack begins to fade. I know all I need is something to just take. I’ve been on Ativan, Valium and all that good stuff, but I’m tired and would be ok with this somewhat not all “inert sugar pills” they have been talking about. I need help, of course having a few benzodiazepines around in case of something really bad would always be there. A
    placebo would help for my body just to do something, and focus on something else then feeling like my heart is going to explode and me die from the chest pains I already feel from it. I sometimes black out or pass out whatever you’d like to call it, from these panic attacks, and if any of you great people can post where I can just get a safe(ish) placebo, then I’m willing to purchase them. Also, if you are working for a drug company send some reps to the US to get some placebos in, I’ll buy them for the not so bad in between attacks I have. Thank you!

  11. Anonymous says

    I don’t believe most people anymore.
    physicians lie, politicians lie, presidents lie…
    There is excessive lying and even physicians can’t be trusted. I resent getting placebos. – People who smoke, don’t get fake cigarrettes, and they should because the stench affects all the people around a smoker. Cigarettes are more dangerous than many medicines. It is all too crazy.

  12. says

    Well of course the placebo’s gonna contain some other stuff, the control group still has constants…for example, let’s pretend you’re trying to test chemical A for its effects in the human body. You can’t, however, simply administer chemical A by itself to humans, you have to put it into a pill, which probably has to include some other ingredients (chemicals B, C, D) just to get the pill’s functionality working right.

    Well, now you have to have a control group to compare it to. This is where they generally administer a placebo. OF COURSE you’re gonna have to include chemicals B, C, and D with the placebo, because those aren’t what you’re testing; you’re testing chemical A. You don’t want to have the side effects of chemicals B, C, and D getting mixed up with those of A, so you put B, C, and D in both the pills.

  13. walt2go says

    I am involved in a double-blind study with a drug company called Purdue from Stamford Conn. and they are suppose to be testing a combination of Oxycodone HCI/Naloxone HCI controlled release pill. They were giving me the study drug but they changed it to double blind and because I really do have extreme pain I know they are not giing me Oxycodone anymore because it does nothing for my pain but I am getting a lot of side effects. This should be illegal to give some one drugs with out their knowledge of what they are taking. They told me I might get the real drug or a placebo but I took it that I would either get the drug or a pill that would not effect my health in any way as a sugar pill would do. I don’t know what drugs they are giving me but I will have it checked in case they are giving me something that will effect my health in a long term manner. They should not be allowed to give you drugs without your knowledge or they should have to state what is in their placebo cause I will tell you, this is no sugar pill.

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