In all likelihood, you’ve heard of the Placebo Effect before. Not Placebo, the whiney, androgynous, English alternative rock group. I’m talking about the Placebo Effect. I find that the best and most scientifically accurate explanation of this fascinating phenomenon is provided by the 1970’s rock band, Journey:
“Don’t stop, belieeeeeving!! Hold on to that feeeeeeeling!!”
A Definition
The Placebo Effect is the actual or at least perceived improvement noted when a patient is given a totally useless “medicine” or “treatment” for a condition or disease. Only, the patient doesn’t know that the pills he or she is taking are actually completely inert, such as sugar pills, which are about as useful in treating disease as 10 Hail Mary’s. Sugar pills can’t cure anything other than boring tea, but, interestingly enough, you can overdose on them. When you do, the results are a hammering heart rate, Type 2 diabetes and hyperactivity.
Why on EARTH would any doctor want to treat a patient with sugar pills? If the treatment is ineffective, aren’t they wasting the patient’s time: why would they risk that?
Well, placebos, which come in the form of medicines AND procedures, including surgery, are most importantly used in medical research and in the development of new pharmaceuticals. In other words, they’re not actually prescribed by doctors to ailing patients.
Placebos are used in clinical trials to measure the physical response of patients to a useless drug (which they believe to be the real thing), versus those on an active drug. This helps the lab-coat clad nerds developing the medicine understand what improvement is a result of actual curing versus psychological “wishful thinking”.
Playing with Placebos: How to Perform Clinical Trials on Human Lab Rats
First and foremost, you recruit a group of people who all have a certain disease or fulfill a certain physical profile and pay them money to be your guinea pigs. You treat half of your lab rats with the medicine you’re developing – the medicine that’s actually supposed to cure them. Then, you take the other half and you feed them sugar pills, or perform mock surgery on them. LAWD knows how you pull that off… you may get away with anesthetizing a patient, but cutting up their body with a scalpel for no darn reason is sure to piss someone off.
You tell BOTH groups that they’re receiving a treatment designed to cure their condition and its symptoms OR you don’t tell either group anything. There are, in actual fact, many different kinds of placebo procedures: some involve telling your study group that they’re receiving proper treatment (as the above example pointed out) and others involve discretion and so neither group – the test group nor the placebo group – knows whether they’re taking a real pill or a sugar pill.
You then get your guinea pigs to keep a detailed record of the way they feel and the intensity of any symptoms over the course of the next however long is necessary. This is complemented by regularly scheduled physical examinations, so that you can keep your doctorly eye over their progress, or regress in the case of Temafloxacin. Oops.
Mind Over Matter
The awesome thing about the Placebo Effect, which is a pervasive phenomenon that has been documented in countless medical study groups and controlled clinical trials, is that many of the patients who believe they’re being treated do get better! Or at least they feel better! What doctors have found is that the Placebo Effect plays a role in just about every medical intervention we use on a daily basis, such as when you take an aspirin for a headache.
Unless you prefer headaches to sex.
Of course the medication works on a pharmaceutical level, but a small component of the treatment is you believing that it will work. The power of this positive thinking actually makes you feel better, if not physically, then at least about life in general. Hope is the heroine of the emotional spectrum (not the kind that wears a cape).
What the Placebo Effect illustrates is the incredible power of the mind in controlling our physical wellness. A fake treatment will, in all likelihood, not go so far as curing a disease (this is a science blog… let’s not get ahead of ourselves), but it certainly can distract us from the symptoms. If you believe you’re being treated for pain or fatigue, for example, the Placebo Effect can see you feeling better, more comfortable and perhaps more energetics simply because you believe you’re being treated. Your mind fuels your body’s convalescence.
The same can be said for the opposite: just think how you feel after heartbreak. Physically, there is nothing wrong with you and medically, there’s no such thing as a “broken heart”. Yet, you are burdened with the most incredible fatigue, overwhelming lethargy and even slight nausea. Depression and sadness are powerful things and their physical manifestations can leave even the most stoic of individuals crippled. It therefore goes to reason that the opposite – optimism, hope, relief – can bring about the opposite physical manifestations, such as a relief of pain and more energy.
This is not fantasy, it is a phenomena that has been documented innumerable times in the medical literature. So why not use placebos to treat non-threatening conditions? It would save us a staggering amount of money on medicine while negating the need for us to pollute our bodies with expensive chemicals… wouldn’t it?
The problem is the Placebo Effect, while widely documented, is not predictable and reliable. Since it is largely the result of “mind over matter” and, let’s face it, some people’s minds are a beer short of a six-pack, this effect cannot be used as the basis for an official medical treatment. It might work for some, but it might not work for others. And when you have irritable bowel syndrome, the last thing you want is a medicine that might work or might not work.
Something Smacks of Deception…
Yes, there are a number of ethical issues concerned with using placebos. In the context of medical testing and clinical trials, the use of fake pills or procedures may be well and dandy, but many people have issues with the fact that the entire premise of a placebo is to be deceptive. A patient believes they’re being treated or at least that the doctor is trying to treat them. Imagine how you’d feel if, after 6 years of a clinical trial, you find out you’ve been taking sugar pills the whole time. And here you were thinking you had a genetic predisposition to tooth decay!
The important distinction to be made here is the use of placebos in laboratory research as opposed to clinical trials. When you’re testing a “fake” medicine on patients who need actual treatment, you’re kind of wasting their time. Also, if the condition is serious enough, you could be allowing it to progress to a point of permanent and irreversible damage. These are all issues raised by people who, interestingly enough, will take medicine when sick. The very same medicine that went through these clinical testing processes involving placebos and human lab rats.
Class Dismissed: Your Take-Home Message
Even though placebo pills or procedures aren’t designed to actually change anything, they have been documented to work, which is pretty awesome because it highlights just how powerful our minds are. If you’ve ever felt stoned just from hanging out with a bunch of hippies (who’s stereotyping?) or drunk after a cocktail you were TOLD had tequila in it, but didn’t… then you’ve experienced the Placebo Effect, which is completely hang-over free!
The ethical debate raging around the use of placebos in clinical trials is interesting and one in which I would be torn asunder if I had to partake. While I’m all for the advancement of medical science and technology, I wouldn’t like to think that I’m being messed about by my treating physician. On the other hand, if your doctor tells you “would you like to take part in an experimental treatment, yadda yadda,” I’d be damn sure to read the fine print.
And finally… a fantastic bit of trivia: Placebo means (in Latin), “I shall please”. That doesn’t mean you can start feeding your girlfriend sugar pills in the hope that it lives up to its literal translation, but if it does work in getting her fired up in bed, be sure to let me know…
You may have stumbled across on of the biggest medical discoveries of our time.
Wander Woman Thea 
There’s also Siouxie and the Banshees’ ‘Placebo Effect’ which is about the stupidity of bogus faith healing (it wasn’t subtle, musically or lyrically…). I did once have the idea of testing the placebo phenomenon myself, with beer. However, such experiments always stalled at the first step which involved drinking 48 pints of Steinlager in one sitting to obtain a benchmark, so I never did get on to the double-blind test part…
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Darnit, Matthew… do it for science, man!!
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The placebo effect can be dangerous. I have a friend who started rock climbing, overdid it in her enthusiasm, and injured her shoulder. She gave acupuncture a try. She felt better, so she started climbing again. Now she’s hurt worse than ever and has trouble using that arm for even everyday things, let alone climbing.
I think there’s a perception that it only works on people who are gullible or don’t know about the placebo effect, but she was well aware of it.
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I’m not surprised… acupuncture will make you feel better and actually, it’s no placebo. The World Health Organization has officially recognised acupuncture as a legitimate treatment for pain and a whole suite of other maladies. But that’s the thing (problem) – it addresses the symptom, but not the cause, which was obviously still present. Your friend probably tore/strained/pulled a muscle or tendon and because the pain was addressed she believed the problem had been addressed, too. So she overdid it again and made the problem worse instead of allowing it a chance to heal. I hope she’s sought the attention of a doctor. Proper rest or at worst surgery might be the only solution.
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The ethics part is actually quite confounding. A fair part of drug testing is not to change the standard of care and merely analyze if a new drug helps. If the fine print is being clearly written and read, most likely the patient is already in some stress wondering whether the whole thing is bogus. If we really want the patient to improve one way or the other, we may WANT the placebo to show an effect but if the patient is too well informed, it may not happen. The basis of any treatment is patient first, so once a worsened prognosis is out of the way…do we really want the patient too well informed? Considering s/he has better chances of ‘unknowingly’ benefitting, while definitely not being harmed…hmmm. I don’t know. Enough badly managed trials and exploitation around so until then, all ethical considerations say inform and inform again…and so it shall be.
Enjoyed reading your post 🙂
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Precisely! You can’t tell a patient exactly what’s going on because otherwise the entire thing won’t work. And there have been some sickening stories of placebo trials going terribly wrong. Joetwo has it right, though… I don’t believe they perform these kinds of trials on life or death cases. Or at least they don’t anymore. Hopefully 😉
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Reblogged this on Kerberos616.
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There is also the opposite, the nocebo effect that shows when you’re convinced that you have something bad for you you’ll feel bad (think twinkies!).
On the ethical point it is my understanding that in cancer trials and other ‘life or death’ scenarios the controls are not given sugar pills any more but rather already approved drugs. So the new drug is compared with the leader in the field. Not strictly kosher from a scientific point of view but much better ethically.
Good post.
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Haha! Love the idea behind the “nocebo effect” although I can’t say I relate. Twinkies make me feel good 🙂
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