You’ve heard the old joke before. The medical doctor, upon hearing a patient’s complaint, says to the patient, “Take two aspirin and call me in the morning.” If that’s ever happened to you, you’ve been prescribed a placebo. Your doctor wasn’t necessarily being lazy — he may have been trying to tap into your mind’s power to heal your body via the placebo effect.
The word placebo may bring up visions of sugar pills, sham remedies, and being told your problem is “all in your head.” But learning to harness a placebo’s power may be one of the best things patients, healers, and doctors alike can do to maximize the effectiveness of any treatment.
What Is A Placebo?
A placebo is described as a harmless treatment that has a positive healing effect that cannot be attributed directly to the treatment itself. Most commonly it’s thought of as being given a “sugar pill” for an ailment instead of real medicine, but placebos can be injections, ointments, counseling, mind-body healing techniques, or even surgery.
Placebos comprise no known mechanism that can affect your health condition, yet you feel better from it. Even though placebos offer no known therapeutic value, they can have a variety of measurable physical and psychological effects. Being administered a placebo can alter your pain perception, blood pressure, heart rate, and brain activity.
Surprisingly, medical doctors prescribe placebos to their patients more than you might realize. A survey of over 600 doctors across the United States found that more than half admitted to prescribing placebos on a regular basis. These doctors prescribe placebos when they feel there is no effective medical treatment available that is appropriate for their patient.
Most commonly they’ll recommend vitamins or over-the-counter painkillers like aspirin. Infrequently, they’ll prescribe sedatives or antibiotics, and rarely they’ll actually use saline or sugar pills. Doctors sometimes prescribe antibiotics, often at a patient’s insistence, for a cold, which is caused by a virus, not a bacteria. Yet patients often feel better immediately. Of course, the ethics of prescribing antibiotics for colds, which can lead to antibiotic resistance, is debatable!
Sugar pills and other placebos are often used in clinical pharmaceutical trials. In fact, for a new prescription medication to receive FDA approval, it must perform better than a placebo in two clinical trials. The use of placebos for vetting drug effectiveness was sparked by desperation during World War II. With morphine supplies running low, a nurse tending to wounded soldiers injected them with saline solution while assuring them they were receiving the potent painkiller morphine. Amazingly, it worked! The sham injection relieved soldiers’ pain and prevented them from going into shock.
After the war, the attending anesthetist, Dr. Henry Beecher, wrote a paper titled “The Powerful Placebo” that was published in The Journal of the American Medical Association. In it, he described how placebos could be used to determine the effectiveness of medical treatments. At that time, there was no standard way to determine a medical intervention’s safety or effectiveness.
Examples Of The Placebo Effect
Medical literature teems with fascinating examples of the placebo effect at work. Placebo pills are nearly as effective as antidepressant medications, with upwards of 70 percent of patients reporting a reduction in symptoms whether they take an antidepressant or a placebo. With results like this, there’s considerable doubt that standby antidepressants like Prozac would pass FDA approval today.
Not all placebos are pills. A surprising number of placebos have been surgeries such as in the classic New England Journal of Medicine knee surgery study. Study participants suffering from osteoarthritis of the knee were randomly assigned to have either a real procedure or sham surgery.
How do you do fake surgery? Surgeons simply made incisions so that it looked like all of the patients had received an operation. (I can’t imagine anyone signing up for this, can you?) Amazingly, both groups reported that their knees felt better after surgery with equal frequency. The researchers concluded, “In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.”
Another placebo study involved heart surgery to relieve angina — chest pain caused by insufficient blood supply to the heart. Thousands of patients underwent a surgical procedure to increase cardiac blood supply. The surgery was a big success with as much as 90 percent of patients experiencing relief from their pain. But when a controlled trial was done, 76 percent of patients who had the actual surgery improved, but 100 percent of those who received the placebo surgery reported improvement!
One of the most unexpected examples of the placebo effect occurred when some balding men were given a placebo for Rogaine, a topical hair growth stimulator, and actually grew hair.
The Nocebo Effect
No discussion of the placebo effect would be complete without mentioning its opposite, the nocebo effect. This occurs when a patient believes an innocuous treatment will cause harm and so it does. Voodoo curses work on this principle. Subjects can literally be frightened to death.
Doctors inadvertently do this kind of medical hexing by telling patients that their condition is incurable, they will never walk again, or they have only a few months to live. These doctors don’t understand the power in their words and sadly their pronouncements often come to pass.
How The Placebo Effect Works
The positive benefits of a placebo are generally dismissed as being “all in your head,” but, in fact, changes initiated by the mind are noticeable and measurable throughout the body. No one understands exactly how or why the placebo effect works, but there are some promising theories.
One possible explanation is that a placebo triggers a release of endorphins, your body’s natural painkillers. Using PET scans, researchers have seen that areas of the brain containing opiate receptors become activated by both painkilling drugs and placebos. Another theory is that a patient’s expectations of being healed play a role. However, this does not explain why people who don’t believe in the placebo effect, or who know that they’ve been given a placebo, get better as well.
Another hypothesis is that patients receiving a placebo improve simply because they are receiving care and attention. Dr. Lissa Rankin, author of Mind Over Medicine, goes so far as to say that not only do health care providers facilitate the process, they actually become the placebo.
According to Rankin, a placebo works by triggering the relaxation response which should be our default state unless we are in danger. While in a relaxed state, our body’s natural repair mechanisms kick in, initiating a cascade of healing hormones and neurotransmitters. But negative thoughts and perceived threats keep most of us locked in the stress response, commonly called the “fight or flight” response. Most of us experience the stress response 50 times or more per day. During the stress response, our bodies gear up to survive the immediate threat and healing shuts down.
The more we learn about the placebo effect, the more questions there are to be answered. How can the placebo effect work in people who don’t believe it? How can it work in small children and animals? Why does the color of a placebo pill impact its effectiveness? These are the kinds of questions researchers will look to answer in the future.
How To Make A Placebo Work For You
In the meantime, Dr. Ted Kaptchuk, director of the Harvard Medical School placebo program, shares what you can do to reap the benefits of the placebo effect and get the maximum healing benefit from any treatment you receive:
- Make sure you’re getting the support you need from your doctor. Placebo effect research has shown how important a supportive doctor-patient relationship can be. If you’re not getting the support and attention you need, consider switching doctors.
- Recognize that it might be “in your head,” but that there’s nothing wrong with that. Behind the subjective experience of feeling better are objective changes in brain chemistry that we’re only starting to understand.
- Find treatments you can believe in. Expectations that an intervention will have some benefit increase the chances that it will.
- Keep your healthy skepticism. Quacks and charlatans can exploit the placebo effect to peddle treatments that are useless, and even harmful, and prevent people from receiving treatments they need.
Many medical doctors are dismissive of the placebo effect, but Dr. Lissa Rankin calls for the medical community to embrace it as one of the safest and most reliable tools in their healing arsenal. In interview with Dr. Frank Lipman, Rankin states:
“The placebo effect is a thorn in the side of modern medicine. It’s an inconvenient truth that gets in the way of proving that new treatments are more effective than letting nature take its course. But the placebo effect is nothing to be avoided. It’s something to embrace, because it provides concrete evidence that the body is equipped with innate self-repair mechanisms that have the power to cure.”
Learn more about how doctors and patients alike can tap into the mind’s ability to heal the body in Rankin’s inspiring TEDx Talk “Is There Scientific Proof We Can Heal Ourselves.”