This is part of FJN’s Topic Briefs for Journalists series.
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“It is more important to know what sort of person has a disease than to know what sort of disease a person has.” –Hippocrates
Most people would agree that with minor ailments, our state tends to improve if we are met with compassion; for instance, if we are consoled, if we think positively or if we distract ourselves. Most would also acknowledge that blood pressure, pulse and sweating increase when we are anxious or nervous. But few would associate such obvious physical changes with inherent mental abilities to self-heal or self-harm.
According to the definition by philosopher and medical researcher Jeremy Howick, placebos are treatments whose core components such as a pill, injection or surgical procedure are inert relative to the disorder but, when administered in a meaningful context, can have a beneficial effect.
Placebos have been used throughout human history. In modern times, the placebo effect was long considered an annoyance in medicine and a sign of failure in medical trials, or, at best, irrelevant.
Yet the effect exists at the core of all medical treatment. It indicates that humans have an innate ability to affect the state of their bodies through the use of the mind.
The placebo effect can be powerful. An increasing body of research suggests that our mindset is instrumental for healing.
In some clinical trials, the effect is almost as large as the effect of the drug being tested. This is particularly true for pain treatments, in which the difference between placebo and drug can be as narrow as 9 percent. It is also sizable in trials on depression.
Placebo responses appear to be increasing overall, whereas drug responses have remained stable. The increase has been particularly marked in the U.S. in the last few decades. One possible explanation is that U.S. trials are bigger and longer than elsewhere.
Since the 1990s, myriad studies have been performed, and the use of placebos is ubiquitous today. As many as 97 percent of all doctors prescribe placebos at some point in their career.
How placebos work
The placebo effect used to be seen as a nuisance because it challenges the notion that bodily health is a purely physical affair that has nothing to do with the mind. However, modern science is becoming aware that this “nuisance” will not go away but rather should be paid more attention.
Here are some conclusions:
- Research involving placebo “provides critical information for how the mind, body, and culture heal”, and these effects are important “for developing a science of healing”.
- Research on the placebo effect “has the potential to revitalize the art of medicine”.
- “The neuropsychological processes behind the placebo effect are crucial for a wide array of therapies”.
In the context of placebo, it has been proposed that the notion of mind over matter, often associated with alternative medicine, should be taken seriously, since it “rings true even at the biochemical level”, as one scientific thesis puts it.
In this sense, the placebo effect can be regarded as one of the most widespread psi phenomena.
The question of how the mind affects matter leads to some aspects of quantum physics, notably the “measurement problem”, which entails that consciousness seems to influence how matter behaves at the quantum level.
One study concludes that human intention changes physical properties and that placebo becomes “information entangled with other subsystems”.
Per another study, the placebo effect could be a “quantum-like interference”. The study suggests alternative medical treatments, notably homeopathy, saliently show a quantum-like correlation to the placebo effect.
Nocebo
The evil sibling of the placebo effect is the nocebo effect (nocebo = “I will harm” in Latin). It works in exactly the same way, but it is to the detriment of health because of negative expectations of treatment or prognosis.
The nocebo effect seems to be even more powerful than the placebo effect.
Both effects are now widely acknowledged in Western medicine. ”Medical research has shown that state of mind plays an important role in the development of disease”, reads an official Australian health guide. It adds: “For example, stress is known to increase blood pressure, which in turn is a risk factor for heart disease. Just as the mind can contribute to a physical disorder, it can also contribute to its cure.”
Open placebo
Many doctors feel that being deceptive about which treatment they give isn’t ethically ideal. The latest approach is to use open placebos. It turns out that this, too, works well. The effect is basically as strong as when the placebo is hidden.
In one study that employed both open-label and hidden placebo, either approach accounted for more than 50 percent of the drug effect.
History
Placebo is a Latin word with Biblical roots. It entered the English language in the 13th century, translated as “I will please”, alternatively “be approved, be agreeable, satisfy”.
Seen through the lens of Western medicine, any beneficial effects from treatments before modern medicine should have been due to solely the placebo effect.
This lens, of course, filters out the possibility that the ancient Egyptians, Babylonians, Chinese, Indians and indigenous peoples had any knowledge about the actual healing properties of natural substances and traditional therapies – or, for that matter, that Hippocrates, the “father of medicine”, did. The healing power of nature was in fact a tenet in Hippocratic medicine.
The idea of intentionally administered inert substances was introduced into medicine in the late 18th century, and the term “placebo” became part of medical jargon.
In most cases, these 18th century physicians did not administer “pure” placebos but medicine they thought simple, feeble, or altogether powerless.
An increased recognition of the power of placebo came in the 1930s.
Anaesthesiologist Henry Beecher noted during World War II that soldiers experienced less pain than civilians with injuries of equal severity. He realised the psychological context was key: To a soldier, a wound meant survival and returning home, whereas to a civilian it meant hampered abilities and loss of income.
Beecher began administering placebos to the soldiers, due to lack of analgesics on the battlefield. An injection of saline solution had 90 percent of the effectiveness of morphine in relieving acute pain after injury.
During the 1950s, research on the placebo effect increased. Several papers were published. The notion of a pharmacology of placebo was approached.
Methods to evaluate studies of medical treatments were developed. What was to become the gold-standard of trials, the double-blind, randomized controlled trial (RCT), was introduced. The goal was to control the placebo effect of treatment.*
Not until the late 1970s, a neuroscience of the placebo effect emerged. It was analysed biologically. The effect on pain was quantified as equivalent to administering a hidden injection of 6-8 mg of morphine.
Written by Anders Bolling for FJN
*Prominent placebo researcher Ted Kaptchuk has problematized RCT as the gold standard of medical science. He points out that this purportedly unbiased method itself generates biases:
“The double-blind RCT may not be objective in the realist sense, but rather is objective in a ‘softer’ disciplinary sense. Some ‘facts’ may not exist independent of the apparatus of their production.”
The very act of setting up controls can alter the phenomenon sufficiently to yield quite different results, according to Kaptchuk.
Ventegodt et. al also finds fundamental problems with RCTs, for instance that the blinding is illusory when biologically active drugs are tested, because these leave a clue in the patient.
