Several years ago, I wrote a blog titled “The Placebo Effect.” In it, I wrote about how important this psychological phenomenon is to both medical investigators and practitioners who employ it daily in research and clinical practice. It is a very powerful tool that tests the ability of the human mind to understand suggestion from reality. To explain it on a rational basis is the same as divulging how the magician makes the rabbit disappear or how he saws the woman in half. Revealing that “trade secret” eliminates any sense of surprise or curiosity. The placebo effect convinces the mind that what your seeing, hearing, feeling, or ingesting is the real thing.
Placebos come in several forms, but in the medical realm they are a pill, capsule, syrup, or injection. The purpose of the placebo item is to convince the patient/participant that the item they have just been given is a drug that will accomplish its intended purpose. But instead of being active drug, the placebo item contains nothing that will have a beneficial effect. It is an inert substance that has no therapeutic effect on the recipient. The placebo effect, then, is the patient’s supposition that he is receiving something of substance, the real drug, when he is not. Any improvement the patient experiences after receiving a placebo is the placebo effect.
An example, for instance, would be in the evaluation of a new blood pressure drug. Say you have 1000 study participants, and they are divided into four groups. The first 250 are given 10 mg of the drug. The next 250 are given 25 mg of drug. The third group of 250 receive 50 mg of drug. The last 250 receive placebo, a pill of sugar, with no active drug. None of these folks know what they’re taking. For the next three months their BP’s are taken every day. Every 3 months for a year, the groups remain the same, but the dosages they are given are changed. At the end of every 3 months the data are analyzed to see which doses worked and which was best. Placebo patients’ blood pressures drop, but not nearly as much as the BP in the patients who took 10, 25, or 50 mg of active drug. Through this process, a new drug is tested and evidence of its efficacy is gained. In studies like this, the effect of active drug is always compared to placebo.
Another example of the placebo effect is when a patient is being treated for pain. Pain is a very subjective symptom. Each patient feels pain differently than every other. There is no quantitative measure of pain so when a patient says they’re in pain it’s their description that is a purely individual assessment of pain level. One subjective measure is the verbal pain scale: “On a scale of 1 to 10, what level is your pain?” If he says “8” you know it’s bad, but it’s bad to him only. “8” to your patient may be “6” to someone else. It’s an individual assessment. Placebos are used when the doctor feels the patient isn’t having as much pain as he lets on. If he just had morphine an hour ago and is still complaining loudly of pain, a placebo can be given to calm the patient. If he falls asleep after a shot of saline, you are seeing the placebo effect fully demonstrated.
Placebos can not only provide a semblance of pain relief, they can also cause side effects—nausea, diarrhea, headache, dizziness, weakness—when there is no rational reason why they should. The human mind is suggestible and patients can think themselves into all sorts of symptoms that aren’t directly caused by the substance given.
The human mind is a complex, amazing thing that I think is one of the reasons a higher being exists. We are able to think, reason, and decide for ourselves, and we have a conscience that determines right and wrong. The mind also has the ability to be influenced. The placebo effect is not imaginary, but is based on anticipation, expectation, and influence. If our expectations are strong our minds are motivated by that influence. We are suggestible, and when there is a strong desire for something, we can be convinced it is real. If we have a strong enough faith in something, such as our treating physician, any associated suggestion, treatment, or recommendation is believable. Anything given is effective. This is the placebo effect and medical science uses it effectively every day.
Dr. G’s Opinion: Pharmaceutical researchers use the placebo effect in clinical trials literally every day. It’s an integral part in the studies they conduct and without it, the true efficacy of a new drug would be hard to determine. Practicing physicians employ it much less often because situations where it can be used do not occur every day. I rarely saw the need to use in my office practice, but for hospitalized patients, especially those patients who had major operations, it came in very handy. The purpose is not to trick someone into thinking they’re getting active drug as much as it’s getting them through a situation that is psychologically difficult. The good thing is, the placebo effect works very well, and physicians should not hesitate to, or feel guilty for, using it.
Another placebo effect is the charming of warts
True.