Have you ever heard of a saying Mind over body? It is funny, I would not use the word mind there but go for the brain instead and since the brain is a part of our body too, the saying becomes redundant. The brain controls all our functions including those related to hormone production and we must ask ourselves is the placebo effect only a delusion with no real health benefits or is something really there? Science says the placebo effect is real and there is no doubt about it. Your brain can be tricked to heal your body but when it comes to understanding why and how is that possible, we have theories but none of them has been confirmed and proclaimed as accurate.
Placebo and placebo effect are two different things and while placebo effect can be a subject of various contradictions, placebo is extremely useful in medicine, especially in the double-blind studies. One group of participants are given the actual medicine while another is given the placebo. Results are observed and measured but compared at the very end because nor the participants nor the researches know which person got what pill, ergo the title double-blind. For a certain drug to be considered beneficial, it has to have results higher than placebo had.
In medical research, a part of the patients in a study are administered a placebo while other participants receive the actual treatment. This is done to determine whether or not the treatment has a real effect. If participants who were taking the actual drug demonstrate a significant improvement over those that were taking the placebo, the study can claim the drug's effectiveness.
Advantages are numerous
Every medicine needs to be tested before it is released to the public. It is important that we learn if the medicine is actually treating an illness and what are its potential risks. The level of effectiveness is what researchers are interested in and the comparison with treatments that are already available. To eliminate or minimize the effect that expectations can have on the outcome, they use placebos.
Researcers are humans too
Every researcher expects to find a certain result and he or she may unknowingly convey clues, known as demand characteristics. Those clues might lead participants to guess what the researcher hopes to find and sometimes change their behavior. To prevent that, double-blind studies, where the researchers do not know what kind of pill they are giving, are a must and placebos are used.
A placebo is not a "real" medical treatment but it seems like it is. It could be a pill, a shot, or some other treatment. When it comes to pills, they usually contain sugar and hence the name sugar pills. Placebos do not contain an active substance meant to affect the health.
The placebo effect is a response that person has to placebo. It can be positive or negative and not all people have it. Some people can have side effects from the treatment and others can get improved symptoms.
"The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together"
Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center
Placebo works on symptoms
modulated by the brain
Placebos will make you feel better but they will not cure all illnesses. They work on symptoms modulated by the brain and are most effective for conditions like pain management, stress-related insomnia, depression, anxiety, irritable bowel syndrome (IBS), chronic pain, and cancer treatment side effects. There are estimates that approximately 30 to 60 percent of people will feel a decrease in their pain after taking a placebo pill which is considered a controversial and revolutionary way of thinking how the brain-body relationship may be stronger than we think.
One of the most common theories about the placebo effect tells us that the placebo effect takes place because of a person's expectations. When a person expects a pill to do something, it's possible that the body's own chemistry can cause effects similar to what a real pill would have caused. A release of endorphins is triggered and we all know that they have a structure similar to morphine and act like the brain's own natural painkillers. Brain scans revealed that many opiate receptors were activated in both the placebo and treatment groups.
The strength of the placebo effect
depends on many factors
Factors involved in placebo effect range from white suits we are exposed in hospitals to the color of the pill we take. An injection will cause a stronger placebo effect than a tablet, and capsules are stronger than tablets. Also, larger pills produce greater reactions. There has been a review of multiple studies that found how the color of pills made a difference to the placebo results. You can read the entire review here:
Effect of colour of drugs: systematic review of perceived effect of drugs and of their effectiveness by de Craen AJ, Roos PJ, de Vries AL, Kleijnen J. from the Department of Clinical Epidemiology, Academic Medical Centre, University of Amsterdam, Netherlands.
Personally, the most interesting findings about the placebo effect are that it varies between cultures. In treating gastric ulcers, the placebo effect is low in Brazil, higher in northern Europe and very high in Germany. Germans are also the ones that have the lowest effect of the placebo effect on hypertension.
The placebo effect changes from one individual to another and its strength varies so the reasons for the influence of it are not fully understood but it is highly likely that there is more than one mechanism at work. 4 factors that are often taken into consideration are:
- Expectation and conditioning
- Psychoneuroimmunology
- Evolved health regulation
- Neurological changes
The expectation and conditioning with white coats and expecting the pill to work we already covered. We also covered the neurological changes with increases in dopamine and opioid receptor activity. I have to add here that given how the same areas of the brain are targeted by antidepressant drugs, it is not that surprising that the placebo response rate in antidepressant trials is 50% to 75%. You can read the research about that here:
Changes in Brain Function of Depressed Subjects During Treatment With Placebo by Andrew F. Leuchter , M.D., Ian A. Cook , M.D., Elise A. Witte , Ph.D., Melinda Morgan , Ph.D., and Michelle Abrams , R.N.
A positive outlook can help with illness
The power of positive thinking was long considered to be a part of pseudo-science but guess what, it is not anymore. A dog can be conditioned to salivate at the sound of a bell, mice be conditioned to restrain their immune system when presented with a specific stimulus, and people can impact the efficacy of their immune system with expecting improvements which confirms that pathways by which the brain is impacting our immune system are fairly complex. This does not, in any way, suggest that you should stop all medicine and treat yourself without the doctor. You should not because you are not ready for that yet, you are not that evolved yet.
Evolutionary biology comes to save the day,
once again...
Everything that we are today is there because it was evolutionarily needed for our survival and for making us efficient at that same survival with the progression of our abilities. The placebo effect just might be the evolution of a human brain's ability to moderate healing. Let's look at fever as one of the examples. It helps remove bacteria and viruses by raising the internal temperature but the brain decides when it will carry out a certain response. There is no fever in response to infection in late pregnancy or during states of malnutrition because it could harm a baby or use up more energy than a starving individual can spare. The brain "decides" that it does not need to mount the appropriate response, such as fever or pain so it does not. One could argue that it can work the other way around and create self-healing techniques as a way of self-maintenance and self-preservation.
There is still more research needed.
There is no doubt that there is room for more work on this subject and that far more research is needed. Our brain is still a mystery when it comes to certain things but some are beginning to get demystified. Until more work is done, check out the researches that have been conducted so far and be amazed at what our brains can actually do:
The persistence of the placebo response in antidepressant clinical trials. by Khan A, Redding N, Brown WA. from Northwest Clinical Research Center, Bellevue, WA 98004, USA. akhan@nwcrc.net
The powerful placebo in cough studies? by Eccles R, from Common Cold Centre, Cardiff School of Biosciences, Cardiff University, Cardiff, CF10 3US, UK. eccles@cardiff.ac.uk
The management of erectile dysfunction with placebo only: does it work? by de Araujo AC, da Silva FG, Salvi F, Awad MC, da Silva EA, Damião R. from
Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Service of Urology, Rio de Janeiro, Brazil
The placebo effect in irritable bowel syndrome trials: a meta-analysis by Patel SM, Stason WB, Legedza A, Ock SM, Kaptchuk TJ, Conboy L, Canenguez K, Park JK, Kelly E, Jacobson E, Kerr CE, Lembo AJ. from Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
and many more...
To read even more about this, check out these references:
Is the Placebo Effect Real? from livescience.com
Placebo Effect Experiments, Studies, and Causes from verywellmind
The power of the placebo effect from harvard.edu
What Is the Placebo Effect? from webmd.com
Placebos: The power of the placebo effect from medicalnewstoday.com
