The placebo effect

A placebo is anything that seems to be a “real” medical treatment, but isn’t.

What all placebos have in common is that they do not contain an active substance that is meant to affect health. The response to a placebo, also known as the placebo effect, can be positive if it implies an improvement or a perceived improvement in symptoms, or negative, also known as the nocebo effect, if it implies experiencing side effects from the treatment the person believes they are taking. Both placebo and nocebo effects have the same mechanisms which presumably are psychogenic.

Placebos have been in use since antiquity and may have been significant in improving health and quality of life when little was known about the cause of most illnesses.

The emergence of placebo-controlled clinical trials in the 1940s reintroduced the placebo effect to the modern day. It was considered a nuisance variable that interfered with a trial’s results; however, in light of some remarkable research demonstrating its potential to modulate treatment outcomes in recent decades, there has been a spiked interest in studying this phenomenon. For a long time, the placebo effect was held in low regard. The suggestion was that, if a patient experienced any changes after taking a placebo, they had been fooled in some way, and their response was inauthentic. In my humble opinion, rather than dismiss this, we should try to understand the placebo effect and harness it when we can.

Researchers use placebos during studies to help them understand what effect a new drug or some other treatment might have on a particular condition.

If patients on the new drug fare significantly better than those taking placebo, the study helps support the conclusion that the medicine is effective. In study after study, where both subjects and experimenters are “blind” to the experimental conditions—that is, no one, including the researchers, knows who is getting the placebo—measurable, clinically replicable improvements in disease conditions occur in a sizeable percentage of all cases, whether receiving placebo or a drug. Placebo effects are not limited to inert interventions. Proven effective treatments can also generate a placebo effect meaning that substances that actually treat one condition but are used as a placebo for another have a greater placebo effect than sugar pills.

It has been shown that placebos can have measurable physiological effects.

For instance when participants are told that they have taken a stimulant, placebos have been seen to speed up pulse rate, increase blood pressure, and improve reaction speeds. They can have the opposite physiological effects when participants are told they have taken a sleeping pill. Sometimes the placebo effect involves the person feeling an improvement to his/her symptoms even when objective measurements show no change. A Harvard study published in 2011 in The New England Journal of Medicine compared the response of 39 people with asthma to albuterol, an inhaled bronchodilator that’s commonly used to treat asthma, with two different inactive treatments, a placebo inhaler and sham acupuncture. Albuterol was much more effective than both the placebo inhaler and the sham acupuncture when an objective test of lung function, called FEV1, was used to measure the response of the asthmatic study volunteers. But when the study volunteers were asked about their symptoms and perceived improvement in their asthma, albuterol and the placebos performed equally well.

The placebo effect is not a single phenomenon, but the result of the complex interplay of anatomical, biochemical, and psychological factors.

The role of the placebo effect as a powerful determinant of health in certain disease conditions has been demonstrated in several research studies. Furthermore, the placebo effect is no insignificant statistical aberration: its effects are in the range of 15 to 72 percent. The longer the period of treatment and the larger the number of physician visits, the greater the placebo effect. Expectations appear to have a lot to do with the effect. If an intervention is believed to help a condition, a certain percentage of people who receive it will experience some benefit. How large a percentage varies tremendously and depends on the condition, the strength of belief, the subjectivity of the response, and many other factors. The placebo effect may also have an element of psychological conditioning: once someone benefits from an intervention, the person starts to associate that intervention with a benefit. The association, and therefore the benefit, may get stronger with additional exposures to the intervention.

Researchers have found, for example, that:

• Placebos follow the same dose-response curve as real medicines. Two pills give more relief than one, and a larger capsule is better than a smaller one.

• Placebo injections do more than placebo pills.

• The greater the pain, the greater the placebo effect. It’s as if the more relief we desire, the more we attain.

• You don’t have to be sick for a placebo to work. Placebo stimulants, placebo tranquilizers, even placebo alcohol produce predictable effects in healthy subjects.

Research on the placebo effect has focused on the relationship of mind and body.

One of the most common theories is that the placebo effect is due to a person’s expectations and how strong these expectations are. If a person expects a pill to do something, then it’s possible that the body’s own chemistry can cause effects similar to what a medication might have caused. The fact that the placebo effect is tied to expectations doesn’t make it imaginary or fake. Behind the subjective experience of feeling better (and worse) are objective changes in brain chemistry that we are just starting to understand. A number of studies have shown, for example, that the brain releases natural pain-relieving endorphins, when placebos are given to patients participating in pain studies. Measurable changes in brain chemistry may explain the large placebo effect seen in depression treatment. In Parkinson’s disease, placebos have increased the production of dopamine.

One problem with the placebo effect is that it can be difficult to distinguish from the actual effects of a real drug during a study. More studies may lead to a better understanding and new ways to use the power of the placebo effect in treating disease.

In some respects, the placebo effect offers the best of all possible alternatives: therapeutic effects without toxic side effects. And the effect does not even have to be unknown to the patient receiving the placebo: one small study of IBS patients found that an open-label placebo, meaning that volunteers receiving the treatment were told they were taking a placebo and explained that the placebo effect was powerful, was about 20% more effective than no treatment.

Researchers associated with Harvard’s placebo studies program published a study in 2008 in which the placebo treatment was sham acupuncture, which involves the use of needles that, unbeknownst to the patient, retract into their handles instead of penetrating the skin. The placebo effect of the sham acupuncture needles was impressive: 44% of those treated with just the sham needles reported relief from their IBS problems. When sham acupuncture was combined with attentive, empathetic interaction with the acupuncturist, the placebo effect got even larger, with 62% reporting relief from their IBS woes. This proves that the mind can indeed be a powerful healing tool when given the chance.

Dr Edward Bach based his whole Bach Flower system on the belief that the body can heal itself, as he explained in his famous book “Heal Thyself”.

The flower remedies only allow the healing power of the body to achieve balance, therefore, allowing the body to heal itself. I believe that homeopathy works on the same basis, as does acupuncture. In other words, I believe that the body can heal itself and the use of these therapies just helps the body to remember how to do it.

If you would like more information about the integrative therapies that I offer, please visit my web page drsauldiaz.co.uk, drop me an email on bookings@drsauldiaz.co.uk, call us on 07931679444, or make an appointment to see me.

Until then, stay well.

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