In the daily practice of medicine and in the myriad of medical research studies, one of the physician’s strongest and most influential weapons is the placebo effect. Defined as a substance having no pharmacological effect but given merely to satisfy a patient who supposes it to be a medicine, placebos are a psychological tool physicians occasionally use but researchers employ all the time.
Placebos can be a pill, liquid, of an injection whose purpose is to make the patient think they are taking a drug that will help them. I hate to use the term, but patients are duped into thinking they are receiving a real medicine. But they are not. Oftentimes, patients will actually have a response to a placebo which can be negative or positive. For example, an asthmatic who uses a “dummy” inhaler, has no measurable improvement, but when asked if they feel better say “yes.” Or the patient who has a headache, is given a placebo, and the headache goes away.
The human mind is an amazing and confounding thing. It has control over our bodies and our concepts of well-being, alarm, or discomfort. In other words, we want to feel good, be safe and be free of pain so our minds work constantly to stabilize our physical feelings. Anytime something interrupts that sense of normality we do whatever we can to restore it. People’s expectations are so strong that anything given to them with the intent of improving how they feel will be effective. The stronger those expectations are the more positive the response.
On the other hand, negative responses (adverse reactions) occur when patients expect to have problems with medication. Headaches, nausea, dizziness, or weakness are some symptoms that people experience.
Thus, the placebo effect is an expression of a patient’s mindset and expectations. If they desire improvement, a placebo may help. If the patient is prone to having side effects from drugs, a placebo may cause negative symptoms. The placebo response is not imaginary, but it is definitely subjective and rooted in patient expectations. Objective, measurable improvement is hard to find, however. The placebo effect plays an important role in the efficacy of medical treatment, and frequently doctors note its presence and effect.
In medical research studies, placebos are used to determine the effect of new drugs. Researchers will group study subjects into those who receive the active drug under investigation and those receiving placebo to compare the new drug’s ability to do what its proposed to do. Subjects in the placebo group are not expected to get a response while those in the active group are. Subjects don’t know which group they’re in. For example, studies for a new cholesterol lowering drug will have measurable results in the active drug group while those receiving placebo will not. To verify their results, after several months, investigators will reverse the groups, and those receiving placebo will receive active drug and vice versa. In this scenario the placebo effect plays almost no role because you can’t will your cholesterol to drop.
Dr. G’s Opinion: The human mind is amazing. No better example of its importance in day to day life is the placebo effect. Doctors see its presence every day. The response patients have to treatment depends a lot on their faith and trust in their physician and their mindset and expectations. It partially explains why some patients get better quickly and others take much longer. Physicians who know their patients, often use the placebo effect to bring about patient well-being.
