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January 2012 Newsletter – What is the Placebo Effect?
The placebo effect is described as “the measurable, observable, or felt improvement in health or behavior that’s not attributable to a
medication or invasive treatment that has been administered.”
A 1955 study by H.K. Beecher evaluated 15 clinical trials covering different diseases, and found that fully 35% of the 1082 patients were
relieved by placebo alone. Other studies have since calculated that the placebo effect was even greater, effective in 50-60% of patients
with certain conditions such as pain, depression, some heart ailments, gastric ulcers and other stomach complaints. What’s going on
here?
Science has long known that placebos can work, but they’ve only recently started to figure out how and why. One explanation of the
placebo effect is called the “Subject-Expectancy Effect” and this involves a strong desire for recovery or relief on the part of the patient
as well as a belief that the treatment will be effective. In a 1998 study by Irving Kirsh, where 19 clinical trials of antidepressants were
analyzed, he concluded that expectation of improvement, and not adjustments in brain chemistry accounted for 75% of the drugs’
effectiveness and concluded that: “The critical factor is our beliefs about what’s going to happen to us.”
A person’s beliefs and hopes about a treatment, combined with their suggestibility, may have a significant biochemical effect. Sensory
experience and thoughts can affect neurochemistry. The body’s neurochemical system affects and is affected by other biochemical
systems, including the hormonal and immune systems. And so, it’s consistent with current knowledge that a person’s hopeful attitude
and beliefs may be very important to their physical well-being and recovery from illness or injury.
Many people are dismayed when they’re told that the effective drug they’re taking is a placebo. It makes them think that their problem
is “all in their mind” and there’s nothing really wrong with them, but there are too many studies that have found objective
improvements in health to support the notion that the placebo effect is entirely psychological.
Several recent studies have shown how the brain responds to a placebo to decrease pain. A 2004 study at the University of Michigan
demonstrated that the placebo effect is related to endorphins, which are the brain’s own natural pain reliever. In the study, healthy
subjects were given a painful but harmless injection in the jaw while their brains were scanned by a PET scanner. The subjects were
asked to rate their pain level and the researchers injected more or less saline to keep their pain level at a consistent rate during the
brain scan. The subjects were given what they thought was a pain reliever, and all of them experienced a decrease in their pain levels
after receiving the placebo. But the biggest finding was that they also showed a change in their brain activity, in the brain’s opioid
receptors (which receive endorphins) and its areas that were related to processing and responding to pain. The expectation of pain
relief caused the pain relief system of their body to activate.
Placebos have not only resulted in measurable effects in the brain, but they’ve also been shown to relax muscles and nerves to bring
pain and symptom relief to patients.
Doctors have been prescribing placebos for a long time. In a 2008 survey of nearly 700 internists and rheumatologists published in the
British Medical Journal, about half said they prescribe placebos on a regular basis. The most popular were over-the-counter painkillers
and vitamins. However, the American Medical Association says that a placebo cannot be given simply to soothe a difficult patient. A
doctor can use it only if the patient is informed of and agrees to its use.
It’s reasonable to say that there is no scientific consensus on how the placebo effect works, but since many scientific tests have
positively shown the placebo effect, it is one way we know for sure that the mind and the body are connected.
In general, though, most agree that the placebo effect operates in the borderland between mind and body. And while conventional
medical science still doesn’t have enough to offer us by way of explanation, our subjective experience of the placebo effect needn’t
baffle us. The placebo effect is part of the human potential to react positively to a healer, no matter what… or who the healer is.
Warm regards,
Laurie Baxter, CHt,
Owner - CG Wellness Center, LLC