The power of the placebo effect explained.  Placebo — Latin for “I shall please” is a substance or treatment with no active therapeutic effect. A placebo may be given to a person in order to deceive the recipient into thinking that it is an active treatment. For millennia, doctors, caregivers, and healers have known that sham treatments had therapeutic effects. Thomas Jefferson wrote in 1807 “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of coloured water, powders of hickory ashes than of all other medicines put together,” “It was certainly a pious fraud.” These days it is much more than a pious fraud. It has been widely understood that belief is the oldest medicine known to man because even some patients who know they are receiving a placebo still report improvement in their condition if they are told that the placebo can make them feel better. This psychological phenomenon, in which the recipient perceives an improvement in condition due to personal expectations, rather than the treatment itself, is known as the placebo effect or placebo response.

Appropriate use of a placebo in a clinical trial often requires or at least benefits from a double-blind study design, which means that neither the experimenters nor the subjects know which subjects are in the “test group” and which are in the “control group”. Additionally neither doctors nor patients know who is on the active drug and who is taking an inert pill.

Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials.

When researchers started looking closely at pain-drug clinical trials, they found that an average of 27 percent of patients in 1996 reported pain reduction from a new drug compared to placebo. In 2013, it was 9 percent.

Jeffrey Mogil, the McGill University pain researcher says that the placebo response is growing bigger over time,” And it’s not just growing stronger in pain medicine. Placebos are growing in strength in antidepressants and anti-psychotic studies as well.

Expectations about efficacy can influence results. “The placebo effect is more than positive thinking — believing a treatment or procedure will work. It’s about creating a stronger connection between the brain and body and how they work together,” says Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center, whose research focuses on the placebo effect. Scientists have been studying this complex connection between brain and body in detail over the past 15 years, and they’re learning the benefits of sugar pills. The new science of placebo is bringing new understanding to why alternative treatments — like acupuncture and reiki — help some people. “Placebos may make you feel better, but they will not cure you,” says Kaptchuk and can only help symptoms that can be modulated by the mind “They have been shown to be most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea.”

The least-understood component of placebo is that It’s not just about pills. It’s about the environment a pill is taken in, the person who gave it to you and the rituals and encounters associated with them as well as doctor-patient relationships.

Some findings that explain the rise in placebo response are:-

Regression to the mean

(In statistics, regression toward (or to) the mean is the phenomenon that if a variable is extreme on its first measurement, it will tend to be closer to the average on its second measurement—and if it is extreme on its second measurement, it will tend to have been closer to the average on its first).

When people first go to a doctor or start on a clinical trial, their symptoms might be particularly bad and in the natural course of an illness, symptoms may get better all on their own. In other words, time itself is a kind of placebo that heals.

Confirmation bias

Definition of confirmation bias – the tendency to interpret new evidence as confirmation of one’s existing beliefs or theories.

A patient may hope to get better when they’re in treatment, so they will change their focus. They’ll pay closer attention to signs that they’re getting better and ignore signs that they’re getting worse.

Expectations and learning

The placebo response is something we learn via cause and effect. When we take an active drug, we often feel better. That’s a memory we revisit and recreate when on placebo.

Studies show that post-operative patients whose painkillers are distributed by a hidden robot pump at an undisclosed time need twice as much drug to get the same pain-relieving effect as when the drug is injected by a nurse they could see. So awareness that you’re being given something that’s supposed to relieve pain seems to impact perception of it working.

The research also suggests that fake surgeries — where doctors make some incisions but don’t actually change anything — are an even stronger placebo than pills.

Pharmacological conditioning

Just like Pavlov’s dogs learned to associate the sound of a bell with food and would start to salivate in anticipation, our brains learn to associate taking a pill with relief, and start to produce the brain chemicals to kick-start that relief.
Some studies suggest that the placebo effect’s powers may possibly move beyond the brain.

Researchers have used flavoured drinks to condition an immune response to placebo.

In a 2012 study, participants were given a sweet drink along with a pill that contained an immune suppressant drug for a few days. Without notice, the drug was swapped with placebo on one of the trial days. And their bodies still showed a decreased immune response. Their bodies had learned to associate the sweet drink with decreased production of interleukin, a key protein in our immune systems, which is produced in many cells outside the brain.

Social learning

When study participants see another patient get relief from a placebo treatment they have a greater placebo response when they’re hooked up to the machine.

A human connection

In the early 2000s, Harvard’s Ted Kaptchuk and colleagues conducted an experiment to see if usually intangible traits like warmth and empathy help make patients feel better. In the experiment, 260 IBS sufferers were split into three groups:-

  • One group received sham acupuncture from a practitioner who took extra time asking the patient about their life and struggles.
  • A second group got sham acupuncture from a practitioner who did minimal talking.
  • A third group was just put on a waiting list for treatment.

The warm, friendly acupuncturist was able to produce better relief of symptoms. “These results indicate that such factors as warmth, empathy, duration of interaction, and the communication of positive expectation might indeed significantly affect clinical outcome,” the study concluded.

Learn more about Ted Kaptchuk’s research here

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