The placebo adherence effect

Why doing a useless thing might actually help

There’s something beautiful and also kind of haunting about the idea that taking sugar pills religiously might keep you alive longer than not taking them at all. That’s not a metaphor. It’s a real phenomenon observed in large clinical trials like the Coronary Drug Project, where patients who consistently adhered to a placebo had significantly lower mortality rates than those who didn’t. Not because the pill did anything, but because they took it anyway.

A friend of mine who works in radiopharmaceuticals terms this the placebo adherence effect, a mostly overlooked corner of behavioral science where outcomes don’t track mechanism, but discipline. I looked and there were just 4 results in Google for this phrase, meaning it’s probably new to you, too. So let’s talk about it.

The sugar pill doesn’t fix your heart. But taking it on schedule, every day, might reflect something else: trust in the system, belief in care, maybe even a broader pattern of self-respect. The placebo doesn’t have a mechanism of action, but you do.

In philosophy we sometimes come at this sideways. Action that signals belief can, over time, become belief. Or at least become a proxy for all the inner architecture that belief requires (hope, commitment, identity). Much simpler said: if you act like someone who takes care of themselves you actually start becoming that person.

It's like making your bed every morning even if your life is a mess. Or praying when you don’t believe. Or attending therapy and talking in circles. Or pretending to meditate and understand meditative states even if you don’t yet. Nothing “happens” until it does. Until the small act of showing up reshapes you in ways your conscious mind can’t quite measure.

Here’s a more grounded example: two people are diagnosed with prediabetes. One follows the doctor’s lifestyle recommendations to the letter: tracks meals, walks every morning, drinks more water. The other maybe just cuts back on dessert, but is cavalier about everything else. Statistically, we might say the first person is just more motivated or genetically lucky. But what if the real “treatment” wasn’t just the walking or the salad, it was the act of following through, no matter what? The adherence itself, as a kind of low-key spiritual discipline.

This has implications far beyond medicine. Think of education. Two students get the same homework assignment. One does it meticulously, even when it feels redundant. The other skips it if it seems pointless and the parents are complicit. Ten years later, which one has better career outcomes? The homework didn’t teach them anything new, but the habit of doing it anyway might have shaped their trajectory more than we’d like to admit. Or if the kid’s personality isn’t interested in school, maybe it’s tinkering with computers or composing music. Something they follow through with. You get the idea.

In a world obsessed with outcomes and optimization, the placebo adherence effect is a kind of glitch in the matrix. It suggests that meaning might emerge not from doing the optimal thing, but from doing something, anything just with consistency and care. Even if it’s arbitrary. Even if it’s sugar.

Something else worth noting here is the difference in outcomes for those who adhere to placebo vs those who don't isn't too dissimilar from the improvements demonstrated by some FDA approved drugs. In short, these approved drugs actually do less than just taking a sugar pill in a disciplined fashion.

And that’s a little terrifying, isn’t it? That we’re not just the sum of our knowledge and choices, but also of our rituals, our habits, our quiet adherence to structure, especially when no one else is watching.

Maybe the line between “real” and “fake” progress is thinner than we thought. Maybe the act of pretending to believe in the medicine is itself a kind of medicine. This would also explain the self-directed supplement industry. But you’re probably still better off taking an empty placebo pill regularly than random things affiliate bros try to sell you that long-term tax your liver, even if short term they make you feel better. I personally would still adhere to a good diet and the ritual of exercise instead.