Mind Over Medicine: The Placebo Effect

Jul 2

Imagine you receive a sugar pill without your knowledge but still experience real relief from your symptoms. This isn't magic; it's the placebo effect in action. The placebo effect is a fascinating phenomenon where a patient's belief in the effectiveness of a “dummy” treatment leads to actual, improved health, even if the treatment itself is a hoax.

The placebo effect isn’t just an intriguing anomaly; it plays a vital role in clinical trials by helping researchers determine the true efficacy of new treatments. By comparing the outcomes of patients who receive the actual medication and those who receive a placebo, scientists can accurately determine the treatment’s true effectiveness.

But the power of the placebo effect goes beyond research. It can actually be harnessed to enhance patient care. In this, we will explore real-life examples of the placebo effect in action and discuss how it can be effectively intertwined into modern medical practices to benefit patients.

First off, we need to know how the placebo effect works.

As of now, how placebos work is not quite understood, but it involves a complex neurobiological reaction that includes the release of our body’s natural relievers– the feel-good transmitters– like endorphins and dopamine, to greater activity in certain brain regions linked to moods, emotional reactions, and self-awareness.

Psychology Explains Placebo Effect

There is also a psychological component. One is classical conditioning. It is basically learning type where you associate something with a specific response.

For example, let’s say there’s a patient with chronic pain. They are put into a clinical trial where they are given placebo pain medication pills. Initially, the placebo does not cause any specific pain relief. However, if the patient consistently experiences reduced pain after taking the placebo, they may start to associate the placebo pill with feeling less pain.

Over time, the patient begins to anticipate feeling pain relief whenever they take the placebo pill. Eventually, just taking the placebo pill can trigger a reduction in their perceived pain, even though the pill itself has no active ingredients.

Expectations are another big thing. If you have expectations from something before you experience it, they can influence perception. In Dr. Jill Seladi-Schulman’s article, What Is the Placebo Effect and Is It Real? she explains the three cues that can generate expectations for improvement:

Verbal - A doctor tells you the pill will be effective in treating your condition.
Actions - You may feel better when you’ve actively done something to address your condition, such as taking a pill or receiving an injection.
Social - Your doctor’s tone of voice, body language, and eye contact can be reassuring, making you feel more positive about the treatment.

Now that we know how the placebo works, we need to know the effects of it.

So, how can the placebo effect be used to improve patient care? Let's dive into some cases and insights to find out.

Placebo in Patient Care

Placebo is the Latin word for “I please,” and refers to a treatment that appears to be real but has no therapeutic benefits. Some of those treatments can include saline injections, sugar pills, and even sham surgeries.

Placebos are used in randomized clinical trials to test the effectiveness of medical treatments. It has been used in medicine since ancient times and was significant in improving health and quality of life when little was known about the causation of most illnesses.

Real Studies

Blood Pressure (stages 1 and 2 of hypertension):

The cardiovascular system is sensitive to placebo mechanisms. Experimental research suggests that placebo interventions can decrease systolic blood pressure.

The Department of Veterans Affairs Cooperative Study observed their randomized trial evaluating the blood pressure response and adverse effects of placebo vs. six active treatments administered in 15 Veterans Affairs hypertension centers. The 1292 subjects of the Veterans Affairs Cooperative Study receiving single-drug therapy for hypertension were randomly distributed to receive treatment with 1 of 6 active drugs (n=1105) or placebo (n=187). Treatment success was defined as maintaining a diastolic blood pressure of less than 95 mm Hg for at least 1 year.

Overall, the placebo significantly impacted lowering blood pressure in some patients, particularly older white patients. However, the placebo group had higher discontinuation rates due to inadequate blood pressure control than the active treatment group, highlighting the efficacy of the active treatment in maintaining lower blood pressure levels.

Migraines:

A study published in Science Translational Medicine found that a placebo was only half as effective as a migraine drug in reducing pain. The study involved 66 participants and aimed to investigate how the labeling of drugs affected migraine episodes.

During the study, the participants experienced six different migraine episodes and were given randomized pills, which included a placebo and the migraine medication Maxalt. The labels on the pills were also switched during the study to indicate either the placebo, Maxalt, or neutral labeling.

For each episode, participants were asked to rate their pain intensity 30 minutes into the migraine attack, take the assigned pill, and then rate their pain intensity again 2.5 hours later.

Probably as expected, Maxalt provided more relief than the placebo, however, the placebo pills were more effective than no medication even if they knew it was a placebo! Labeling was important too. For both Maxalt and placebo, the rating of relief was ordered based on labeling. In both groups, pills labeled as Maxalt were highest, neutral was in the middle, and placebo was lowest. The effect was so powerful that when Maxalt was labeled as a placebo, it was rated to provide nearly the same level of relief as when a placebo was labeled as Maxalt.

Now that we have some knowledge about real case scenarios, should they actually be used in healthcare?

Should Placebos be used in Healthcare?

Placebos have the potential to benefit certain aspects of healthcare, particularly in enhancing treatment outcomes through psychological mechanisms. However, their use must be carefully evaluated within an ethical framework that prioritizes patient consent and transparency. Open-label placebos, where patients are aware they are receiving a placebo, provide a promising method for leveraging the placebo effect without compromising ethical standards.

Ultimately, it would be best if the decision to use placebos should be made on a case-by-case basis, weighing the potential benefits against ethical and practical considerations, and always prioritizing patient welfare and informed consent.

As we continue to advance in medical science, it's essential to keep exploring and understanding the placebo effect's potential while adhering to ethical standards. By doing so, we can enhance the therapeutic experience and offer more holistic and compassionate care.