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Have you ever taken phenylephrine for a stuffed-up nose and then felt better? If so, you might have been perplexed when Food and Drug Administration experts recently said that that the drug — which is in some versions of DayQuil, Sudafed, and other medicines — is no more effective than a placebo.

But to Michael H. Bernstein, an assistant professor of diagnostic imaging at the Warren Alpert Medical School of Brown University, it all makes sense. Bernstein says that “no better than a placebo” still means that it works, sort of. “If we expect to feel better, then we probably will,” he told me. And that complicates the idea of what medical treatment “works.”

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On this episode of the “First Opinion Podcast,” we discuss the placebo effect and its counterpart, the “nocebo effect” — if you tell patients something will make them feel worse, it generally comes true. “You’re better off hearing from a doctor something to the effect of 3 out of 4 patients who take this drug have no side effects at all versus 25% of people who take this drug do get side effects,” he said.

Bernstein also shared the delightful story of how he got into the “medical expectations” field, which started with an experiment in which he had to convince underage students that they were drinking alcohol when they weren’t.

Our conversation was based on a First Opinion Bernstein recently wrote with Grayson L. Baird, “Phenylephrine is no better than a placebo. What if that’s still better than nothing?”

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