The Placebo Effect by Derek Howden
What is the origin and meaning of placebo ? Where does it fit in our lives and behaviour ? This article explores the following…
- History of Placebo
- Doctors use of Placebo through the times
- My trainers were placebos
- What doctors discovered
- Belief and Expectation play a vital role in patient recovery
- Implications and moral dilemmas of placebos
- Solution? Be honest
A Brief History
The word Placebo has been around since the 16th century when it was translated into Latin for the bible meaning “to please the Lord” and morphed into slang for a sycophant for a while back then. Doctors have known, since those barbaric medical days and “practised” with inert tablets that were to “please the patient” and so the name for these tablets was Placebo’s. They didn’t understand it but they knew how effective it was for appeasing patients in the middle of the night who would more often than not, not call the doctor the next day.
It was in the early nineteen hundreds that a Dr Frank Lanza that led a drug trial for treating ulcers. Only after each patient was examined with an endoscope and confirmed they had an ulcer were they admitted onto the trial. Patients were randomly given either Lansoprazole or Ranitidine and the idea was to test whether or not the new drug Lansoprazole would compare to Ranitidine. It was a double blind experiment so neither patient nor doctor knew who was being given which drug. Patients were asked to come back in two weeks and then four weeks to determine the effectiveness of the drug. And it showed that the new drug had 88% success rate over 30% for the old drug. Now interestingly, he gave a group of forty four patients an inert tablet and were tested after two weeks where it showed that 30% of patients had healed ulcers and after four weeks 49% of patients had healed ulcers. Unknown as to how it worked it became known as the Placebo Effect. For a fuller description of the Placebo Effect then please read this:
It’s a Mystery… But it works. In fact different colours have different results, an injection of saline works better than a tablet and a fake operation works even better. If you have high tech machinery that whirs away when in use amplify the Placebo Effect.
The mystery of the Placebo, which has been known by doctors for centuries, had to be factored into every medical trial due to the average thirty percent of people will show better or similar results. Even if you give both groups a placebo!.
It is generally understood that belief and expectation are the main ingredients for a Placebo tablet to work but it is not only in medication where belief and expectation come into play. After all what we believe and expect in a relationship can have a positive or negative influence on how “successful” that relationship is. What we believe and expect from our Governments can also affect what we do or don’t do and can make some people happy or it can make some people depressed. There are many holistic therapies and medical therapies that depend on faith and expectation and Neuro Linguistic Programming (NLP) requires us to change belief and expectations in order to bring about a change of “thinking” a change to the way we respond and behave to the events and influences of our lives.
Our beliefs and expectations work either way so if our belief and expectation in “real” medicine declines then we witness the delice of the effectiveness of a drug. For example when Prozac was first introduced it scored highly against Placebo’s but as faith and expectation in the drug has demised it has been shown that Prozac can not perform better than a Placebo in drug trials. Nothing has changed in the drug, it’s the same ingredients prescribed in the recommended doses yet it fails to beat a Placebo now.
Doctors are baffled until they accept the Placebo Effect and some factor it into their healing practices while some doctors in some countries still blatantly prescribe them when they feel they have nothing else to offer a patient. A lot of a GP’s work is often with the same people trying different drugs hoping to find the right one for the patient. The advances of smart medicines specifically targeted to genetic profiles does offer hopeful avenues in how a medicine can specifically tailored to a patient. But at the moment its hit and miss and nowadays Prozac can not beat a placebo, such is the belief and expectation of Prozac, when tested so doctors are still practising.
My Trainers were Placebos
To look at me now you wouldn’t believe it but I used to run five miles a day in under half an hour and my dad was right cos by the end of the week I was thirty five miles away and couldn’t remember my way back. One of the things I appreciate my dad for was the fact he liked to keep fit and encouraged me too. We used to go on runs together and I got into it and went to the local athletics club to do cross country. I’m not competitive so was happy to see other people win and often wondered why they were upset when they didn’t win. I suppose I didn’t understand it for a while but I now know that just as I am hard wired to be non competitive so they are to be competitive. I’m quite happy knowing I can hold my own in most things and didn’t worry about the people who beat me. In fact I admire them and the talent and determination that makes people be the best. But for me? Worrying about whether or not someone will beat me?
No thanks it’s really not worth sweating cos as the old adage goes there is always someone somewhere who will beat you no matter how good you are. When someone sets a world record a hundred people try to beat it so nothing will last. But you gotta lift your hat to competitiveness because without it we wouldn’t be able to run so fast.
What a luxury “we” I could never run that fast but when it comes to humans I like to think we went to the moon and we defeated smallpox and how great we are. We never associate ourselves with the bad and the failures like we are murderers and we abuse the weak. No that’s someone else.
Anyway getting back to my run I would pretty much run everyday and on my birthday or Christmas I would be hoping and expecting to get some new trainers. I was versed in heal shock absorption and insteps to adjust pronation and with all these little design features I believed I was going to run faster, I mean the technology made it very clear that it was so, and so it was because on the morning of celebration I would unwrap the box to find my new go faster trainers. The smell and the look just spoke of fastness and my anticipation was high. Putting them on was like putting on power packs that were gonna run me along those long lonely runs. They seems to mould my feet and clad them with super powers like Iron Mans suit and so I set off in my gentleness up pace. And as I warned up and the trainers took effect I would start running faster than my usual pace feeling able to push the hills harder and not be lazy on the downhill letting gravity do aplenty work. The other thing I would do with my trainers is clean them everyday for about two or three weeks and after that the lustre seemed to wear off and the magical running powers were gone and it was back to my determination to get to the end of the run as the trainers would lose their magical powers.
It was the same when I got a digital watch that was like Steve Austin’s the six million dollar man because owning such a watch made me feel like I had bionic eyes and limbs. The mere suggestion was imbibing me with bionic powers and such was my mind as a child which should change as an adult? Well lets look at that because even to this day I will only wear clothes that feel right and if my hair is bad, well like most folk I’m aware of it and again it brings its feelings. How many people wear perfume, clothes and jewelry to enhance their state of being? We all do to some level or another because the stuff that we wear has a perceived power to us and we wear them to feel better about ourselves.
Pretty much like my trainers that made me run faster, which I did until they got dirty and I stopped cleaning them. And although they stopped working by the time a few weeks were over I was running my old times easier and the extra bit of effort from the trainers helped me to raise my fitness a little so it could be argued that they really did work because the times were not in my head.
Mind and Body
The belief and expectation results do nothing if not prove that there is a physiological and real connection of mind to body and body to mind and each can affect the other in many bizarre and wonderful ways. From all religions and their testament there are a myriad of miracles, healers, potions, chants and prayers all apparently randomly working for some of the people some of the time and if you were to give it a percentage? From reiki and crystals and unlucky rabbit feet belief and expectation is intertwined into our lives positively or negatively. Which Introduces the Nocebo effect, the doctors despair, because they know that if a patient doesn’t hold out much hope for a proven and approved tablet they can sabotage their own recovery with negative belief and expectation, and the medication doesn’t work. It seems that the Placebo effect is needed for real medication too!
And doctors today do recognise this which is creating a new creative holistic well being centered approach to recovery and health care practises. Further reading:
What I am saying is common knowledge as we all have had some sort of mind over matter experience and we certainly attribute it to others when we surmise it was the Placebo Effect. However, rather than using Placebo to dismiss the effects but rather we should celebrate that Mind and Body have triumphed through belief and expectation and then imagine the possibilities.
What are the possibilities to mind over matter? If we take a humane look on humanity without God’s and external agencies we would all agree that all human experience including ‘supernatural’ are entirely produced by our minds and bodies which would mean that every miracle of healing that comes from “faith” was produced by ourselves. In this article scientists have discovered that you can controll your pupils dilation with our minds.
The reason this is fascinating is because the reaction of pupils reacting to light intensity has predominantly thought of autonomous and beyond our control. At one time we would have thought this about our hearts but it has been clearly shown we can control our heartbeats through relaxation and meditation. Our minds and bodies are closer linked than we imagine and it maybe that this is a first truth is an error. We are not mind, body and spirit the three realms of consciousness that define us into three entities but we are one entity, a body which is comprised of many components that produce awareness. An awareness that swills on the waves of belief and expectation which regulates our physiology, something again to be thought of as autonomous yet the truth that our minds can have an influence over our bodies is clearly demonstrated and scientifically measured in every drug trial that takes place today.
So, Placebo’s work but they only work if the patient and doctor believe they are the real thing. It’s against the doctors code of ethics to lie to a patient so prescribing Placebo’s is not something that has been pursued as a real therapy for patients. Or has it? In this study…
…patients were given Placebo’s for Irritable Bowel Syndrome knowing they were Placebo’s and still reported benefits from the inert medication. So knowing whether or not it is a Placebo is not a requirement for the tablets to work. In fact there are many people selling and taking Placebo’s knowing that belief and expectation are the important ingredients.
I have asked several GP’s and they all reckoned about eighty percent of their patients are psychosomatic in nature and struggle to cure them of illness. In the good old days the doctor would give a placebo and say come back tomorrow if you get worse. Nowadays they have to try different drugs until they find the right one that works for the patient and more often than not it is the same ingredients but with different packaging and branding. It’s like people who will not buy the cheap the cheap Ibuprofen and insist it has to be Nurofen with it’s strong brand and packaging yet exactly the same ingredients.
Solutions? Be Honest with Patients
It throws some questions into the arena of healthcare. An industry financially driven by the cost of drugs unlikely to investigate if 30% of their market could be given a placebo instead and the allotted twenty minute doctors appointment extending care into support groups that are positive fostering high expectation and belief in the care they provide. The Beth Israel Deaconess Medical Center / Harvard Medical School have realised this and pursue a more holistic approach to recovery and medical care.
This is from the front page of their website “For many years, the placebo effect was considered to be no more than a nuisance variable that needed to be controlled in clinical trials. Only recently have researchers redefined it as the key to understanding the healing that arises from medical ritual, the context of treatment, the patient-provider relationship and the power of imagination, trust and hope.”
So at last we are starting to recognise that the once belittled “Placebo Effect” has been realised to be the key to understanding how much our belief and expectations have on the outcome of recovery. As it has been shown that it is not vital for the patient to be deceived in order for it to work which means that anyone could harness the power of placebo if they were willing or wanted it so. And this is a key part of it, a psychiatrist can change a lightbulb but the light bulb has got to want to change and as hard as it sounds we are capable of being accustomed to illness and something we are accustomed to can be hard to shift.
Some more reading
- Nocebo http://www.aerzteblatt.de/pdf.asp?id=127210
- Placebo Pain Killers http://wagerlab.colorado.edu/files/papers/Wager_Fields_Textbookofpain_toshare.pdf
- Ted Kaptchuk http://tedkaptchuk.com/
- Irvin Kirsch http://programinplacebostudies.org/about/people/irving-kirsch/