The placebo effect is a beneficial reaction to a medically inert substance, such as a sugar pill. Its working can be explained as an interaction of psychological and biological forces.
As a kid, I loved going with my mother to the supermarket. The aisle of chocolates always made my eyes sparkle. On one of those beloved visits to the store, after my tantrums failed to earn me those chocolates, I proudly told my mother that I would buy them with my own money. Little did I know that Monopoly money couldn’t buy me anything!
As an adult, I obviously know that one cannot possibly buy real stuff with Monopoly money, just as one cannot cook real food with a toy microwave oven, and can’t make real calls over a Chatter telephone. These things are mere imitations—they look like certain things, but cannot actually perform their functions. Logically, it must also be true that fake medication cannot treat real illnesses, but…
Believe it or now, it has been observed that fake medicines can work, at least to a certain extent. For example, a sugar pill or an empty capsule given to people suffering from depression can cause the symptoms to subside just as a real antidepressant would. You might have experienced the sensation of feeling better right after popping a pain-killer, even though it takes a bit of time for its effect to actually kick in. This happens due to a strangely fascinating phenomenon called the placebo effect.
The placebo effect is a beneficial, psychobiological reaction to a medically inert substance, such as a sugar pill. This substance (called a placebo) is designed to give the exact feeling of the real medicine, but doesn’t actually have any medicinal properties of its own. Nonetheless, its effects mimic, to some extent, the effects of the actual medicine.
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How Does The Placebo Effect Work?
The working of the placebo effect is not magic. Instead, it is a result of the interaction of psychological and biological factors operating within our body.
Initially thought to be imagined, or purely psychological, the placebo effect has been recently found to have legitimate biological responses! Research has proven that the effects caused by placebos can cause tangible changes in brain mechanisms and neurobiological signaling pathways.
However, swallowing a sugar pill at home won’t cure your headaches! The biological response to placebos is triggered by our expectation to heal. We feel better after taking a placebo because we expect the medicine to work.
The anticipation of relief triggers our body’s natural ability to heal and activates the reward center of our brain, releasing endorphins. Endorphins, also called ‘natural painkillers’, are chemically similar to opioids (e.g., morphine) and cause pain relief in a similar manner. The anticipation of such a benefit also releases dopamine, a neurotransmitter associated with decreased pain sensitivity (Source).
Thus, a placebo, with no medical properties of its own, reduces pain without actually doing anything. It simply fools our mind into convincing our body that it was in fact a real drug, thus stimulating healing.
This means that the placebo effect will only manifest if we expect and completely believe that we are going to feel better. As a result, it won’t work if we take a sugar pill by ourselves. However, if we go to the hospital, explain our problem to a trusted doctor who then gives us that same sugar pill (without us knowing that it’s not a real drug), we would believe in the therapeutic capabilities of the pill and expect it to work.
This elevates the importance of the social context surrounding the treatment, e.g., our relationship with the doctor. The level of comfort we feel with a doctor and the amount of trust we place in them hugely affects the magnitude of the placebo effect. The doctor’s reassurance and his apparent faith in the effectiveness of the treatment also go a long way in deciding our body’s response to the placebo (Source).
However, placebos cannot cure illnesses; they can only help us soothe our pain and discomfort by working on symptoms regulated by our brain. In addition to alleviating pain, they can be useful in tackling conditions related to stress-related insomnia, anxiety, nausea, fatigue, etc.
However, the placebo effect also has an evil twin!
What Is the Nocebo Effect?
As a kid, I was always scared of injections. During one such scary visit to the doctor, my elder brother (unfortunately) accompanied me. While we were waiting for the doctor, he told me how badly the injections hurt and narrated a bunch of freaky injection stories. Petrified, I went inside when it was time for the dreaded shot, and I swear that it was the most painful thing I’d ever felt in my whole life!
What I experienced that day was a nocebo effect.
A nocebo effect is the opposite of the placebo effect. While positive expectations cause the placebo effect, which reduces pain and provides relief, negative expectations cause the nocebo effect, which actually makes us feel worse. For example, if we strongly believe that a treatment will have side effects, we would experience these side effects, even though the treatment was fake.
A nocebo effect can result from verbal suggestions, i.e., warning someone about pain can actually cause it. People who were warned that a mild electric current would be passed through their heads, leading to a headache, experienced a headache even though no current was actually passed.
Sometimes, our own conditioning and past experiences make us feel these ill effects. This explains why we feel queasy when we enter the dentist’s office if we have had a painful experience in the past while getting a tooth extracted.
The nocebo effect still cannot be adequately explained in terms of its biological mechanisms. However, it is suggested that, similar to how the expectation of relief releases endorphins, the anticipation of adverse effects may release stress hormones, resulting in the negative effects of the nocebo effect (Source).
It’s interesting to note that the same inert substance that served as a placebo turns into a nocebo in the presence of negative expectations and verbal suggestions.
Are Placebos Used In Clinical Trials?
Placebos have proven to be very useful in conducting clinical trials to test the effectiveness of treatments, especially for pain medications. In such trials, people are divided into two groups—one that gets the real drug and the other that gets the placebo. Reactions of both the groups are recorded and compared.
If the degree of improvement offered by the drug is not significantly higher than what is offered by the placebo, the drug is not approved, even if it shows an improvement in the patient’s condition. Think of it this way—the improvement seen upon taking the drug should be the sum of its biochemical effects and its placebo effects. Therefore, if the drug cannot outperform the medically inert placebo, it ought to be rejected!
A logical question is: if placebos are so powerful and effective, why don’t doctors prescribe them as a treatment?
Why Don’t Doctors Prescribe Placebos?
Using placebos as an actual treatment seems like a logical thing to do, given its astonishing uses. Moreover, this would cut the costs of the treatment, because a placebo is essentially just a sugar pill. So why don’t we see placebos being used to treat patients?
For placebos to work, doctors would have to ‘deceive’ their patients by hiding the fact that they are prescribing a placebo. This is considered to be unethical by many medical professionals, since the patient would be in no position to give informed consent to the treatment. In fact, the American Medical Association has prohibited the use of placebos without the consent of the patient, a fact that is explained in its revised ethical policy in 2006.
Giving placebos to patients would put the bond of trust between the doctor and the patient in jeopardy, if the patient were to find out that they had been deceived. Moreover, a world that allows placebos to be prescribed also runs the risk of having doctors who would be tempted to simply write a placebo prescription, leading to many cases of negligence and misdiagnosis (Source).
However, doctors can always create a placebo effect with their kindness, compassion and ability to build meaningful relationships with their patients.
When all is said and done, the placebo effect gives us a very important life lesson. It is a reminder that our mind is a powerful thing and it is in our hands to make good use of it. While facing whatever life throws at us, we should try to take on a positive mindset and give ourselves and others a bit of the placebo effect!