Placebo effect

Renee Lehman

(9/2016) The word placebo, "I will please," has its origin in Latin. A placebo effect is considered the effects of an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance (as a drug). However, this description can be misleading.

In general, placebo effects are improvements in patients’ symptoms that are credited to their participation in a healing encounter, with everything that is connected with this encounter – all of the rituals and interactions. These can include medicine, medical equipment, healthcare environments, interaction with clinicians on a body/mind/spirit level, etc.

In the past, placebo effects were often considered worthless and illegitimate. They were thought to be unscientific and caused by bias and prejudice. However, these thoughts are changing. More research is being done on placebo effects. A leading scholar in this field is Ted Kaptchuk, a Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School and Director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Ted says that the placebo effect has a biology, and that it is not just something that is made up in the mind. "The pathways that we know the placebo effects use are the pathways many significant drugs use."

In recent articles (in The Wall Street Journal, Nature, and New Scientist), Ted mentioned placebo studies that have been done with patients who have Parkinson’s disease, irritable bowel syndrome (IBS), pain, and migraines.

The Parkinson’s disease research (done in 2001) showed that patients who were given a placebo pill, had a 200% increase in dopamine (the neurotransmitter that allows for smooth movement), which was equivalent to a prescribed dose of 250 mg of Levodopa. This means that when given the placebo pill, the brain released the very same chemicals that physician’s prescribe to patients who have Parkinson’s disease.

In 2010, Ted Kaptchuk did a placebo research study on patients with IBS. He was upfront with who was taking the placebo pill to help control pain and other symptoms. The results were startling: 59% of patients who knowingly took sugar pills reported adequate relief from their symptoms, compared with 35% in the no-treatment group — better than most IBS drugs. "I was very surprised by the results," said Kaptchuk, "even though I hoped it would work."

Finally, a recent study of episodic migraines in 2014, demonstrated that when patients took a medication that was labeled "placebo" (a treatment that theoretically had "pure pharmacologic effects"), the outcomes did not differ from those in patients given placebos deceptively labeled medication (pure expectation effect). However, when the medication was correctly labeled its analgesic effect increased by 50%.

In an article entitled, Placebo Effects in Medicine, in the New England Journal of Medicine in July of 2015, Ted Kaptchuk summarized that placebo effects rely on complicated neurobiologic mechanisms involving neurotransmitters such as endorphins, and the activation of specific areas of the brain that deal with pain, movement disorders, and emotional illnesses.

Evidence to date suggests that placebos primarily address subjective symptoms (such as pain, fatigue, nausea, etc.). Research also suggests that the effects of clinician interactions can markedly enhance the efficacy of medications.

So, in the past, placebo effects were considered worthless and unscientific. They were considered to be unscientific. Really? Medicine’s goal is to restore health, manage disease, provide symptom relief, or cure illness. Why then wouldn’t the placebo effect be considered a form of treatment? It can support an individual, provide relief, and give someone hope. Compassionate health care can help to support individuals as they gain more insight into their symptoms/illnesses.

The use of placebo effects are here to stay. They are not shams. More research on placebo effects will be able to show that for appropriate illnesses, placebos that are sincerely prescribed by clinicians could possibly become a routine part of medical care. "Placebos have always been negative for medicine," Ted Kaptchuk states, "but for many patients, trying open-label placebos could be a first line of treatment before any drugs are prescribed."

The real question, I believe, is WHY placebo effects work. This month’s article has only dealt with HOW they work. The research has been focused on the materialism of placebo effects, meaning that the research is looking only at the processes and phenomena through the physical realm. I believe that placebo effects work because of an individual’s faith and their beliefs. They work because of the non-physical realm – the spirit. And, how can this be measured by the scientific method?

"The doctor-patient relationship is critical to the placebo effect." - Irving Kirsch

"I'll take transformational change any way it comes. One way to look at meditation is as a kind of intrapsychic technology that's been developed over thousands of years by traditions that know a lot about the mind/body connection. To call what happens 'the placebo effect' is just to give a name to something we don't understand." - Jon Kabat-Zinn

Renee Lehman is a licensed acupuncturist and physical therapist with over 25 years of health care experience. Her office is located at 249B York Street in Gettysburg, PA. She can be reached at 717-752-5728.