The placebo effect is often viewed as only minimally useful; it is considered too unethical or ineffective to be used to help actual patients. It is viewed as a basic idea, the concept of the “improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used”. There are many circumstances in which this complex phenomenon applies, but a common example is that of a person in pain who is given a sugar pill with no intrinsic healing properties, but starts to feel better after they have taken the pill.
The placebo effect is a complex and rapidly developing medical theory.
The traditional view of the placebo effect is fairly simplistic. It attributes the effects of the placebo effect solely to a belief that a treatment will happen. In reality, the placebo effect is infinitely more complex, and still not fully understood.
History of the Placebo Effect
The original use of the placebo effect was in 18th century medicine. Doctors would prescribe drugs they thought ineffective to patients who demanded medicine for their pain. Originally, the placebos used were impure, or effective medicines, just not for the condition treated. Later, pure, or totally ineffective, placebo medicines were developed, such as a sugar pill. Later, placebos were utilized in clinical drug trials. It was used as the baseline for effective medicines, but was not considered independently effective. If a drug could aleve pain or achieve results more effectively than the placebo counterpart, it made it through that step of new drug authorization.
The Placebo Effect Mechanism
There are many factors that contribute to what we consider the placebo effect. Some of them are biological, some merely psychological. Some major factors include regression to the mean, confirmation bias, expectations and learning, pharmacological conditioning, social learning, and a human connection. These separate yet interconnected factors create an extraordinary result: the somewhat miraculous placebo effect.
Regression to the mean is the gradual improvement of particularly sick patients, regardless of treatment.
Confirmation bias is the tendency of people to focus on information that suits their beliefs and ignore information that contradicts, so if someone thought they were improving, they could focus on the lessening of some symptoms instead of the increased or constant intensity of other symptoms.
In addition, expectations and learning means that if people associate some action with a certain reaction, then when that action is performed, people will react a certain way. For instance, people expect that when they are injected with a painkiller, they will feel relief, so they consequently feel relief, even if the painkiller wasn’t causing that relief. One experiment tested this by covertly injecting morphine in some patients, and telling others that they were injecting morphine, which led to larger decreases in immediate pain for the patient who were told they were getting painkiller, as seen in the graph.
Pharmacological conditioning is a similar effect. It takes place when someone with a disease takes a medicine to relieve their symptoms and they are covertly switched to a placebo medication, which ends up working just as well, because the patient’s brain has been conditioned to do certain actions after taking the medication.
Social learning is another variation of expectations and learning. In effect, when patients see another patient get relief from a certain treatment, they expect relief from that treatment.
The last factor is perhaps the most perplexing of all. A human connection with patients can make treatment more effective. The environment and rituals of treatment, especially feeling cared about, can make treatment more effective.
However, recent research has revealed that patients who have been told they are being a placebo, and have no expectation of the placebo working, have felt its effects, bringing into question some long held beliefs about the cause of the placebo effect. As we discover more, the placebo effect only seems to become more fascinating than ever.
The Catch
And yet, the placebo effect does have a limitation. It can help stop pain, nausea, phobias, and asthma, but it cannot knit bones together or stop a heart attack. In other words, it has a purely chemical, not physical, effect. This means that in practice, the placebo effect will relieve symptoms, but not cure the root cause. In one experiment asthma patients were given either legitimate asthma medicine, a placebo, or fake acupuncture. Patients reported feeling a similar decrease in symptoms for all three, but lung function only increased when patients were given legitimate asthma medicine.
The Conclusion
While it has limitations, the placebo effect has a variety of uses in alleviating pain. It is a complex mechanism that is still not fully understood but fascinating in its intricacy. As we discover more about the human brain and medicine, there’s a chance placebos become more widely used as a medicine.
References
Photo by Christine Sandu on Unsplash
“Placebo Effect.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/placebo effect.
Marchant1, Jo. “Placebos: Honest Fakery | Nature.” Nature, Springer Nature, 13AD, https://www.nature.com/articles/535S14a.
Resnick, Brian. “The Weird Power of the Placebo Effect, Explained - Vox.” Vox, Vox, 7 July 2017, https://www.vox.com/science-and-health/2017/7/7/15792188/placebo-effect-explained.
“The Early History of the Placebo - PubMed.” PubMed, https://pubmed.ncbi.nlm.nih.gov/23497809/. Accessed 14 Dec. 2020.
This was written by Aviva Weiser