The Placebo Effect
The mind is a powerful tool.
It can convince your body that an empty tablet can cure your problems, causing what is commonly known as the placebo effect.
So what exactly is the placebo effect? A placebo is anything that looks like a medical treatment but isn’t. It can be a fake pill, a fake shot, or even a fake surgery that produces a positive effect on the body, which is comparable to that of the real treatment. This is called the placebo effect.
Is the Placebo Effect Real?
Generally, placebos are used in drug studies to measure the effectiveness of a real medicine. Earlier, these studies were conducted with two groups - one took the medication and the other didn’t. The third group or the placebo group has been introduced upon discovering that a placebo can cause a measurable health outcome. A drug is only approved when it creates an effect greater than the placebo.
Surprisingly, the effectiveness of placebos has been found to depend on factors like method of administration, number and size of pills, and even color. For example, a shot is more effective than a pill. Two pills are better than one. Red pills are better than white. The larger the pill, the stronger the effect.
There are several unbelievable examples of the placebo effect out of which the long lasting effect on those with Parkinson’s Disease (PD) is one. Separate studies were conducted to assess the effects of placebo medication and surgery on PD patients. After treatment, the placebo medication group exhibited an increase in motor scores by 20-30% and continued to maintain the elevated score for as long as six months. On the other hand, discontinuation of the placebo medication caused significant deterioration in their condition.
Placebo surgeries have been found to be even more effective than medication in PD treatment. A clinical trial of human fetal transplantation was conducted wherein embryonic porcine mesencephalic cells were transplanted into the brain of PD patients. The placebo group received an imitation surgical procedure. Neither researchers nor the patients knew which group got the placebo surgery and which group got the actual surgery - this is also known as a double blind study. Strikingly, a 30% improvement in motor score was observed in the placebo group that lasted for at least 18 months, which is triple the time period as seen in medication.
Such astonishing physiological changes associated with a placebo goes on to show that it takes more than positive thinking to believe that a fake treatment is the real deal. The plausible answer for this is that participants don’t know what they are getting. This creates an illusion that they are getting the real drug.
How Does the Placebo Effect Work?
A large part of how and why the placebo effect works is rooted in expectation. If you have a migraine and you take a pill for it, you expect it to work. These expectations are formed on the basis of certain cues like your doctor prescribing them, your doctor’s reassuring body language, the fact that you have done something to help with the pain, etc. This influences your perception of the medication and you start feeling positive effects regardless of whether it’s a real medicine or a placebo.
The placebo effect is not just about the medication. It is also about the ritual of treatment. For example, you go to the clinic, get examined by medical professionals, you are asked to take certain pills, and then undergo more tests and procedures. All of these factors condition the brain to associate the treatment with healing.
Even with all these explanations, what goes on behind the scenes when you take a placebo is still highly speculated. A common explanation is the triggering of a series of neurobiological reactions like increase in the secretion of feel-good hormones like dopamine and endorphin, higher activity level in the regions of the brain that are linked to mood, etc.
What Happens If You Know You are Taking a Placebo?
Ted Kaptchuk, doctor of oriental medicine and Harvard Medical School professor, along with colleagues conducted an experiment on 80 people with Irritable Bowel Syndrome (IBS). They divided the participants into two groups, gave the placebo group pills with “Placebo” labelled on the bottle and the other group was given no medication. The research team was upfront about the placebo to the participants. After three weeks of treatment, 59% of the people in the placebo group claimed to have experienced relief from IBS, especially the pain.
The experiment refutes the fact that the effects associated with placebo medication require intentional ignorance. Ted Kaptchuk explains that even if it’s not real medicine, the act of taking a pill regularly stimulates the brain to believe that the body has healed.
Is it All Just the Power of the Mind?
Yes and no. While the expectation of healing is the mind’s work, there’s actually more to it. It was found that an enzyme called COMT comes into play during pain and while taking painkillers. Turns out, this enzyme was correlated to Parkinson’s disease, schizophrenia, depression, and other clinical trials where the placebo effect was the strongest. While testing for COMT levels in the above IBS experiment, it was found that participants with low COMT levels exhibited strongest placebo effects and vice-versa.
Further analysis of the experiment was conducted to identify where the power of the mind came into play here. It was found that patients having low COMT level with exposure to interaction with the doctors showed the best outcomes of the placebo effect whereas those with low COMT levels and no interaction fared worse. This means that interaction activates a chemical pathway in the brain where the brain translates the attention and the caring into actual healing, thus triggering the biological processes that need to happen for the outcome.
There are still a lot of unanswered questions about how the placebo effect works. But the fact that you can hand an IBS patient a sugar pill, tell them it’s a sugar pill, put them through a regular doctor-patient interaction, and see positive outcomes is nothing short of extraordinary.