The conclusion drawn from this study defies rationality; the patients may have suspected that they were being lied to and that they were, in fact, taking real medication.  Whether the patients were conscious of their suspicions is another matter.  Another suspicious aspect to the conclusion drawn is that the performance of the medical ritual of receiving placebos caused the effect; not so: more likely, the patients suspected that in spite of the possibility that they were not receiving real medicine, that they were still being looked after by real doctors, and that this attention from a doctor might have benefits in and of itself.  In my opinion, the conclusions did not take into consideration many other perhaps more viable explanations for the patient's subjective reporting.