Side effects and placebo effect: interview with a Swiss Ig Nobel Prize winner

The 2024 Chemistry Prize went to the leaders of a Franco-Dutch study that used chromatography to separate drunken earthworms from sober earthworms. The Physiology Prize went to the American-Japanese study that discovered that many mammals are able to breathe through their anus. The Physics Prize went to an American research that demonstrated and explained the swimming abilities of a dead trout.

This is obviously not the Nobel Prize, but the Ig-Nobel, a prize that rewards every year the most “improbable” research carried out around the world, because even the serious world of scientific research knows how to have fun from time to time.

While the description of the awarded studies may, at first glance, make one think of fake research, this is not the case. The vast majority of Ig Nobel Prizes are won for respectable, peer-reviewed scientific work. However, they are characterized by the fact that they are laughable. Or better, as can be read on the Improbable Research websiteExternal link: they make you laugh… and think.

Lieven A. Schenk is Belgian and Swiss. He grew up in Reinach, a municipality near Basel. He has lived and worked in Germany for 10 years. “Nationality is a complicated thing for me. My children are Belgian, Swiss and German. I would say that I consider myself a European,” he says. He studied psychology and molecular neuroscience at the University of Basel, then systems neuroscience at the University Medical Center Hamburg-Eppendorf. “I consider myself first and foremost a neuroscientist,” he sums up.

Lieven A. Schenk

This is exactly the case with this year’s Ig Nobel Prize in Medicine, which was awarded for research that “demonstrated that fake drugs that cause painful side effects are more effective than fake drugs that do not cause painful side effects.”

This is what a research team from the University Medical Center Hamburg-Eppendorf in Germany wrote. A team that includes Dr. Lieven A. Schenk, originally from Switzerland, a country with many Ig Nobel Prize winners.

We spoke with him about this improbable consecration and the content of his study which, as you will understand by reading the interview, is not a trivial research work.

How did you and your colleagues react to the announcement of this award? Was it a surprise?

I was indeed very surprised. I had not thought about it and I did not expect it. But it is a prize that says nothing about the quality of the research, even if some of the work rewarded in the past was very good, even excellent. Influential research has been rewarded by the Ig-Nobel.

I think we received this award because we studied a topic that at first glance seems counterintuitive, but in the field of non-pharmacological effects, pain modulation and the study of the placebo effect, it is not.

Even my colleagues were surprised. I think in the past the Ig Nobel was more of a prize for “jokes,” but it has been reworded to celebrate research that makes you laugh first and then think. In our research group, reactions ranged from “I’m not convinced” to pure joy.

Anyway, getting an Ig-Nobel can give visibility to a research, right?

Yes, definitely. It will definitely give visibility to our research and I am happy about that, because I think this is a study that highlights an important aspect of clinical trials and clinical practice.

However, since it is a rather sarcastic award, there is always the fear that the scientific side will not be taken seriously because some people might think it is just a joke. But the visibility is there and I hope people will understand that the study is very relevant, even if the subject is counterintuitive.

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Can you briefly explain the content and results of this research?

We wanted to study how the side effects of a drug affect the patient’s expectations about the treatment, expectations that, in turn, can impact the perception of pain. In other words, we wanted to understand the influence of side effects on the placebo effect and identify the psychological and neural mechanisms on which it is based.

So we administered to patients [convaincus de recevoir un anesthésique par spray nasal] a placebo with no side effects, then another with a side effect [une légère sensation de brûlure]. When subjected to experimental painful stimuli, patients showed less pain when given the placebo with the side effect.

Using MRI, we also found that this effect is likely mediated by the so-called descending pain modulation system, which is activated during placebo analgesia.

What could be the implications of your research?

[Afin de s’assurer que les effets d’un traitement ne sont pas dus à l’effet placebo] In clinical trials, the drug to be tested is usually used on one group of patients, while the others receive a placebo that normally has no side effects. Our study highlights that this could have a negative effect on the test results.

Medical staff and patients do not know whether the drug is real or placebo. However, doctors know what the side effects may be and patients are also informed about them.

If these side effects occur, people suddenly realize that they are receiving or administering the real drug, which can lead to a greater placebo effect in the patient. Conversely, the placebo effect is reduced when side effects do not occur.

Our study shows that in these cases the placebo effect of the two groups can be so different that it is no longer possible to estimate the effectiveness of the treatment.

So the practice should change…

I think that when testing a treatment that has very specific and very noticeable side effects, it would be good to make sure that the placebo also causes them, in order to eliminate differences in perception between the two groups.

There are surely other ways to deal with this problem. For now, our study only highlights this.

Text translated from Italian using DeepL/op

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