PLACEBOS: THE POWER OF PLACEBO

EFFECTS
A placebo is a medical treatment or procedure designed to deceive the participant of a clinical
experiment. It does not contain any active ingredients but often still produces a physical effect on the
individual.

Placebos are essential to the design of reliable clinical trials. Their once-surprising
effect on participants has become the focus of many studies.

The placebo effect refers to the impact of a placebo on an individual. Even inactive
treatment has repeatedly demonstrated a measurable, positive health response. The
power of the placebo effect is considered to be a psychological phenomenon.

Fast facts on placebos

 The placebo effect has been measured in thousands of medical experiments, and
many doctors admit to regularly prescribing placebos.

 Drug companies must show that their new drugs work better than a placebo
before the drugs are approved.

 Placebos have been shown to affect a range of health conditions.

 The color of a tablet can alter the strength of its placebo effect, and larger pills
induce a stronger effect than smaller pills.

 Some believe the self-healing properties of the placebo effect can be explained
by evolutionary biology.
What is the placebo effect?

The placebo effect describes any psychological or physical effect that a placebo
treatment has on an individual.

The placebo has become an essential part of all good clinical trials.

In early clinical trials, the capabilities of a new drug were measured against a
group of people who took no medication. However, since discovering that the
simple act of taking an empty tablet can produce the placebo effect, it is now
considered essential to have a third group of participants.

This additional group takes a tablet containing no active ingredient to measure the
response against them. Participants in this group will take a sugar pill, for example.

A drug is only approved when it produces a greater effect than a placebo.

Placebos have been shown to produce measurable, physiological changes, such as

an increase in heart rate or blood pressure. However, illnesses that rely on the self-
reporting of symptoms for measurement are most strongly influenced by placebos,
such as depression, anxiety, irritable bowel syndrome (IBS), and chronic pain.

Placebo interventions vary in strength depending on many factors. For instance, an

injection causes a stronger placebo effect than a tablet. Two tablets work better
than one, capsules are stronger than tablets, and larger pills produce greater
reactions.
How does it work?
The placebo effect changes from individual to individual, and its strength varies
from one disease to the next. The reasons for the influence of a placebo are not
fully understood. Given the variation in response, it is likely that there is more than
one mechanism at work.

1. Expectation and conditioning

Part of the power of the placebo lies in the expectations of the individual taking
them. These expectations can relate to the treatment, the substance, or the
prescribing doctor.

This expectation may cause a drop in stress hormones or cause them to

recategorize their symptoms. For instance, a "sharp pain" might instead be
perceived as an "uncomfortable tingling."

On the other hand, if the individual does not expect the drug to work, or expects
there to be side effects, the placebo can generate negative outcomes. In these cases,
the placebo is instead referred to as a nocebo.

One study gave placebo opioids to participants who had recently taken genuine
opioids. A well-documented side effect of opioids is respiratory depression. The
researchers found that the placebo drug elicited respiratory depression, despite
having no active ingredients.

Some believe that classical conditioning might play a part in the placebo effect.
People are used to taking medication and feeling better. The act of taking a drug
elicits a positive response.
2. The placebo effect and the brain

Brain imaging studies have found measurable changes in the neural activity of
people experiencing placebo analgesia. Areas that have been implicated include
parts of the brain stem, spinal cord, nucleus accumbens, and amygdala.

Strong placebo responses have also been linked to increases in dopamine and
opioid receptor activity. Both of these chemicals are involved in reward and
motivation pathways in the brain. Conversely, nocebos have been found to reduce
dopamine and opioid receptor activity.

Some of these neurological changes occur in areas of the brain that are often
targeted by antidepressant drugs. This might account for the 50 to 75
percent placebo response rate in antidepressant trials.

3. Psychoneuroimmunology

Psychoneuroimmunology is a relatively new area of scientific study. It studies the

direct effect of brain activity on the immune system. Just as a dog can be
conditioned to salivate at the sound of a bell, so can mice be conditioned to restrain
their immune system when presented with a specific stimulus.

It has long been known that a positive outlook can help stave off illness. In recent
years, this pseudo-science has become science fact. Expecting improvements in
health can impact the efficacy of an individual's immune system.

The pathways by which the brain impacts the immune system are complex. An
explanation has only recently started to form. There is a possibility that this type of
interaction plays a role in the placebo effect.
4. Evolved health regulation

The body of a mammal has developed helpful physiological responses to

pathogens.

For instance, fever helps remove bacteria and viruses by raising the internal
temperature. However, as these responses come at a cost, the brain decides when it
will carry out a certain response.

For instance, in late pregnancy or during states of malnutrition, the body does not
carry out the fever response to infection. A raised temperature could harm a baby
or use up more energy than a starving individual can spare.

The evolved health regulation theory suggests that a strong belief in a medication
or intervention might relieve symptoms. The brain "decides" it does not need to
mount the appropriate response, such as fever or pain.

Examples
At one time, placebos were only used in experiments as a control. However, due to
their ability to make changes to the body, they have now been studied extensively
as a treatment in their own right.

Pain

A placebo's ability to reduce pain is referred to as placebo analgesia. It is believed

to work in one of two ways. Either the placebo initiates the release of natural
painkillers called endorphins, or they change the individual's perception of the
pain.
Additionally, genuine analgesics have been found to be more effective if a person
knows they are being given the drug, rather than the drug being given without the
person's knowledge. In this case, the placebo effect can be viewed as assisting a
genuine intervention

Depression

The effect of antidepressants is believed to be largely reliant on the placebo

effect. One review of eight studies found that over a 12-week period, placebo
antidepressants were effective, demonstrating the potentially long-lasting impact of
placebos.