The powers of the placebo effect
Ever been prescribed antibiotics for the flu? Given vitamins when you don't have a vitamin deficiency? Then you, my friend, have been prescribed a placebo.
What is the placebo effect?
The medical field has long been aware that when people are given a treatment with no medical value, often people will get better. This phenomenon is called the placebo effect. The number of people who respond to placebos tends to vary depending on what study or medical condition you're looking at, but the most recent estimates are that between 30 to 40 percent of people respond to placebos, an effect that is equivalent to many drugs.
Placebo effects have been demonstrated for a wide range of conditions. In the literature, you can find placebo effects with warts, stomach ulcers, depression, binge eating, post-operative pain, bipolar mania, skin rashes, arthritis, food allergies, Parkinson's Disease, migraine, asthma-the list goes on. Pretty impressive, huh?
Is the placebo effect all in people's heads?
Historically, doctors assumed that their neurotic patients were more prone to placebo effects, but the search for the "placebo personality" has been a bit of a dead-end. The one psychological factor that seems to consistently explain the placebo effect is if you believe that a certain type of treatment will work, you're more likely to show a placebo response. So if you believe deep down in your heart that a multivitamin will make you feel less tired, you're much more likely to feel energised than your average multivitamin naysayer.
How does the placebo effect work?
Some of the placebo effect can be traced to real biological changes in your body-studies looking at pain medications and placebos have found that when people believe they are receiving a pain medication, their body releases natural pain-relievers that act on the same receptors as the medications.
Together with biological changes, being treated for something makes you more likely to pay more attention to symptoms that indicate you're getting better. In one of the landmark studies looking at this, sneaky psychologists found that when people were told that they had tested positive for a completely fictional illness, they reported symptoms in line with the illness, whereas the group who had been told they tested negative continued to be symptom-free.
How does treatment affect people's placebo response?
Features of your treatment can impact on your placebo response-for instance, you're much more likely to calm down after a blue sugar pull than a red one, and to feel less pain if your meds look pricey. And when it comes to the kind of placebo treatment given, the more complex and invasive, the better. You're much more likely to improve after sham surgery than a sham injection.
Having a good relationship with your doctor is also a crucial aspect of the placebo effect, and can sometimes account for nearly all of the placebo response. If your doctor is more empathetic, you're more likely to respond to a placebo treatment. The bad news is that if you don't feel that doctor understands your health concerns, you're less likely to improve after placebo treatment.
Can you get a placebo effect when you're getting a proper medical treatment?
You don't normally see placebos used in healthcare-but they're the bread and butter of drug trials. For a drug to be introduced by the market, drug companies have to prove that patients will improve more with the active drug than they would with a placebo pill. The placebo effect is the reason your headache is more likely to go away when you have fancy branded medication rather than generic medication. The only difference between the two pills is the marketing; the active ingredients in the pills are exactly the same.
What is the modern health care system doing to the placebo effect?
Worryingly, the cost-saving measures of the modern health care system might be taking the placebo out of treatment. If you've had the misfortune of being a hospital inpatient, you'll know that you're often given injections and pills by busy hospital staff, who don't have the time to explain what the drugs they're giving you are supposed to do. And if you've filled a prescription lately, a quick glance at the pamphlets for your medication will tell you an awful lot about the potential side-effects of a drug, but very little about what the drug actually does, and what improvements you can expect.
While there are often legal reasons for talking about side-effects, drug companies may be shooting themselves in the foot by providing medication information that makes people expect that they are more likely to expect side-effects than to improve.
And you know how I said that the doctor-patient relationship is really important for enhancing the placebo response? Cutbacks in health budgets mean doctors are getting less and less time to spend with each patient. By the time your doctor has asked why you're there, checked your medical history and decided on treatment, they often don't have time to build any placebo-fueling rapport with you, let alone explain your treatment.
Is it ethical to treat people with placebos?
Doctors are discouraged from prescribing placebos due to the ethical quandary of prescribing a patient something that their medical training tells them won't work. Trust is crucial for good doctor-patient relationships, and the medical establishment is concerned that it could undermine patients' trust in their health care providers if people find out they have been prescribed a placebo. Interestingly though, studies have found that people still respond even when they are told that they are receiving a placebo.
It's vital that doctors treat patients' symptoms when treatments are available. But while medical treatments abound for things like cancer, heart disease the like, the truth is that the vast majority of symptoms get better with no treatment at all.
If you make a trip to the doctor with flu-like symptoms, you'll most likely be told that you just need to take it easy for a few days, or given a prescription for antibiotics-which have absolutely no effect on the flu virus, and will be contributing to the proliferation of scary antibiotic-resistant superbugs. Having a placebo treatment available during the annual flu season could actually be in all of our best interests.
The Hippocratic oath requires all doctors to vow that they will "do no harm." If someone is experiencing life-threatening side-effects of chemo, is it unethical to include some placebo treatments in their regimen to give them some reprieve from the constant nausea? Could medical practitioners' concerns about making use of the placebo effect actually be doing some patients harm by not giving patients the best possible care?
It's time we started taking the placebo effect seriously as a treatment option, and opened its use in health care up for public debate. We know that the placebo effect can lead to real improvements in people's lives, that people's health improves even when they have been told they're being given a placebo, and that it will likely lead to a reduction in unwanted side-effects. Haven't we got an evidence base that shows us that it might actually be more ethical to prescribe placebos in some cases?
- First published on Literally, Darling