Placebos are amazing things. All schoolchildren should be taught about them. Then we might not have so many people believing in the local charlatans with their lime bud tea and the like for gastro and “impotency.” A placebo is simply anything that seems to be “real” medical treatment, but isn’t. It could be a pill, a shot, or some other type of “fake” treatment, like a sham operation or the laying-on of hands or inhalation of special scents etc.
What all placebos have in common is that they do not contain an active substance meant to affect health. This differentiates them from substances like soursop tea, which contains chemicals that induce sleep. A placebo effect is the relief of symptoms just by believing you are receiving helpful care. About one in three people get better when they believe they are receiving care that is going to help them. So placebos work. This isn’t news. It’s been known scientifically for more than 50 years and for centuries before that. One-third of people respond to treatments without any active ingredient in them. It’s so well known that ethical researchers automatically take this into account when assessing the efficacy of a new drug.
A drug is only useful when it’s better than the placebo effect. You all would be amazed at how many new, expensive drugs are no better than placebos. Ah, but their advertising is a wonder! The other good thing about placebos is that they have no side effects, unless the side effects have been suggested. If people expect to have side effects such as headaches, nausea or drowsiness, there is a greater chance of those reactions happening. In one study, people were given a placebo and told it was a stimulant. After taking the pill, their pulse rate speeded up, their blood pressure increased, and their reaction speeds improved. When the same people were given the same pill and told it was to help them get to sleep, they experienced the opposite effects.
Placebos are extremely useful for those common yet frustrating afflictions that have a psychological component: back pain, sleep disorders, irritable bowels, depression, headaches and so on.
This strong psychological component to placebos helps explain the tremendous success some charlatans, whether medical or non-medical, have. In one study involving asthma, people using a placebo inhaler did no better on breathing tests.
But when researchers asked for people’s perception of how they felt, the placebo inhaler was reported as being as effective as medicine in providing relief. Scary stuff! There is a relationship between how strongly a person expects to have results and whether or not results occur. The stronger the feeling, the more likely it is that a person will experience positive effects. This may well be due to the interaction between a person and the health care provider, but other belief systems are involved. Expensive placebo pills are more effective than cheap ones. (This may be true of doctors also). Taking two placebo pills (eg sugar pills) relieves more pain or is more sedating or heals stomach ulcers more quickly than taking just one.
This good-feeling phenomenon is not imaginary or fake but due to a physical change that occurs with all placebo effects: an increase in the body’s production of endorphins, one of the body’s natural pain relievers. But it gets better: it’s not only about sugar pills. Sham acupuncture (or fake acupuncture), which doesn’t target traditional pressure points and doesn’t penetrate the skin, reduces migraines in 38 per cent of patients, making it as effective as real migraine drugs. Sham surgery (fake operations), in which you go into an operating theatre, go under anaesthesia, get cut and immediately stitched back up without anything else being done, helps 58 per cent of migraine patients who undergo the operation, potentially better than actual drugs for migraine.
The hypothesis that when we believe placebos will heal, they do, at least to some extent, is hard to reject. Perhaps for this reason, childhood is full of placebo effects. Parents do it all the time to their children, who, with their belief in magic, get better remarkably quickly. If a child falls, a bag of ice on the knee soothes even if the knee really isn’t injured. A Dora plaster over an injection ends tears immediately. Hugs and a kiss from Mummy can heal almost anything. The widespread use of antibiotics for conditions that don’t require them (flu, tonsillitis) is a form of placebo prescribing. Trinis real believe in this. The more the injection hurts, the better. Paracetamol for back pain appears to be a placebo as well. These may help patients feel better, but only because they believe they will do so. The active ingredient adds nothing. Most people don’t seem to mind, even if they suspect the doctor may be tricking them. Nevertheless, prescribing a treatment that may not have any direct physical effect is an ethical grey area, even if it harnesses the placebo effect.
The lesson of placebos is simple: the mind-body connection is strong. A lot of good can come from caring and feeling cared for. Many times we need additional help from surgery, medication and other therapies. But for a wide range of common problems, from earaches to sleep disorders to headaches, often we don’t. Words, touch, and hope can be therapeutic. Perhaps what we need to figure out is how we can put that power to good use. Is there an ideal combination of advice, empathy and touch that can release our body’s natural disease-fighting agents?