There IS money in sugar pills. If you call them by a vaguely scientific name...vitamins, supplements, eye serum, antioxidants, CBD, stem cell therapy...no one regulates you and it’s all gravy. Human’s capacity for self deceit as a mechanism for survival is endless. Right now, the climate change deniers are the most amusing to watch.
3
Placebo effect is mind over matter it appears. You are as you believe you are.
3
Final breakthrough for all suffering from Parkinson's disease...My father is 73 and was diagnosed with Parkinson's about 2 years ago. He deals with a lot of anxiety, so much so that he doesn't want to go out, doesn't want to be with people. My brother has to beg him to be with family. I feel that natural supplements are so important, but he depends only on the drug levodopa, his meds for the a-fib, and anti depression medicine. Last three months my brother working in India purchased herbal remedy from herbal health remedies foundation. Contact there email:([email protected]) or there Website at (http://herbalhealthremediesfoundation.com) My father only used the herbal remedy for 6 weeks without levodopa and all his symptoms was completely reversed. My father is now happily living Parkinson's diseases free now..I recommend this Parkinson's herbal remedy for all Parkinson's Patients.
1
Kudos to Paul Sahre for this article's illustrations!
Intertaminophen...refrigerate (or not). My new go-to drug!
3
I read through most of the comments. What I find heartening is that, with a couple of exceptions, all of the comments were about the article's contents. None discussed politics. None were trolls. None were rants. Way to go, commenters.
2
Look for the subtexts, look hard. Unlike New Jersey, as Gertrude famously said, there is a 'there there.'
"What is it?"
I'm delighted you'd ask.
In Academia, our pantheon where the immortals recline in symposiums and with the dialectic, divine all things...a move is afoot to "check the privilege of Western modes of knowing", specifically, the "scientific method", credited with the advancement of Western culture.
In a drive for equity, academics of CRT would allow 'other modes of knowing', including elements of non-traditional and tribal knowledge, to take their place beside western science. This is sometimes referred to as 'decolonizing science', or 'decolonizing the space around science as the only privileged and legitimate means of knowing', and admitting of other modes of knowing from the marginalized and colonized communities.
Having said all that, if you are faced with, say, stunning weight loss and a family history of pancreatic cancer, will you be quick to see the medical doctor or the "non-traditional healer?"
Without data, efficacy can't be measured, and understanding will remain limited. But along with 'futurism' and some other fanciful 'studies', data isn't really required, or even sought, unless it comports with other 'studies' findings demonstrating that colonialism, nay, white supremacy and the kkk are everywhere on campuses...
...so we must be in the age of hyperbole. I liked the age of skepticism a bit better. More science from the latter.
1
Welove: To prescribe to our many followers here in the great realm, potions, poultices and balms that contain only cornstarch, gelatin, a bit of colorful vegetable matter, and a wee bit of alcohol, that are nothing but placebos. We are amazed that the healing and cure rate for mundate maladies is well over 97.655 percent. Side effects are miniscule, the positive reactions manifold and, best of all, we create these placebos at very little cost and can charge the follower full price for a consulation. Profitable and effective at the same time. We steer clear of followers who have really serious conditions. Don't want legal action against us in our region.
Several years ago, I performed a hypnosis show at a resort on the May long weekend. After the show, I was talking with some members of the audience, very informally, when I noticed one woman, in her 50s, had a wart on her thumb. I asked about it, and she told me she had had it for at least 20 years, and had tried everything to get rid of it. I offered to buy it for $1. Naturally, everyone thought I was crazy, but I said I collected warts and would really love to have hers. She accepted my dollar, and I said “That wart is mine now, and you can’t have it anymore.”
Labour Day long weekend I was hired by the same resort to do a kids’ magic show. Afterwards, I saw the same woman, so I went up to her and asked how her wart was doing.
“It is GONE!” She said. “About a week after you left, it just crumbled to dust and disappeared!”
She showed me her thumb. There was no mark to indicate it had ever been there. In fact, she was no longer sure which thumb it had been.
I’d love to know the MMPI profile of candidates for a successful placebo treatment.
Perhaps they wear red hats emblazoned with “MAKE America Great Again”?
And their position on a bell curve?
2
Another worthy read after this article is the book by Peter McWilliams, "You Can't Afford the Luxury of a Negative Thought (The Life 101 Series)." The book speaks exactly to this, we act and behave as we believe and allow ourselves to be convinced of.
Mr. Greenberg’s excellent article emphasizes the known fact that the strongest placebo effects occur when the placebo is “delivered by someone in whom they have confidence…”
The other half of that equation is that the physician delivering the placebo must have confidence as well. It is this confidence that is conveyed midbrain to midbrain, as we know now from neuroscience. A state of mind is contagious, and confidence is clearly a state of mind. The confidence of the patient resonates with that of the physician, altering physiological responses in the patient’s body.
Ted Kaptchuk, head of Harvard Medical School’s program and placebo studies and the therapeutic encounter has addressed the effect of placebo resulting from complex conscious and unconscious processes in the practitioner-patient relationship. If the practitioner believes that placebos are fake medicine, this belief – the lack of confidence of the effect – will not be conveyed.
David Krueger MD
www.MentorPath.com
Many years ago I saw an ad in a magazine for a nostrum - I've forgotten what it was supposed to treat - that declared that the contents were "genuine placebos." I chuckled. Now I'm wondering whether I shouldn't have stocked up.
I lived in Brasil and saw first hand the placebo effect in operation (Candomble and Macumba are two forms of spiritualism followed there (voodoo in common parlance). As an Anthropologist, "You Gotta Believe In Your Doctor" is enough to know as to why placebos work, Patient Heal Thyself (as it were).
I'm surprised that the author didn't reference the work of Joe Dispenza whose New York Times best selling book, "You Are the Placebo" proposes a scientific based explanation of this phenomenon.
Notice the reference to 'sugar pills' and pictures of 'sucrose', modern trials use biologically active 'placebos' supposedly so patients will always notice an effect. The 'placebo' often selected by the Pharma funding the trial.
Is religion a placebo? A good massage? Relaxing music? A walk in nature? How about just 'use the force': "these aren't the droids your looking for..." (only works on the weak minded).
The last two paragraphs seemed to start to see the light, so much of the rest is typical NYTimes urban dwellers lost in the trees unable to see the forest.
Doctors used to just look at patients, talk to them. Now it's blood tests and pressure cuffs and sitting behind a computer. Look up 'scientism', a plague that has replaced religion and true science.
"How many times has observation confirmed what common sense suggested, yet contradicted by published studies.
Only to find out the studies are funded, directly and indirectly, by the for profit medical industry."
"Communicating scientific information isn't about persuasion and convincing people of the rightness of a position. It's about theorizing and gathering evidence and remaining aware of the uncertainties and limitations of the process."
Without having had any "tests" to confirm this, I think I am one of those persons who are sensitive to the placebo effect. I also wonder if this isn't, at least in part, due to the increasing isolation that modern life inflicts on us. Those of us from an older, more interactive, time likely feel more need (and therefore more comfort from) being treated as if we (and our problems) were important and that we mattered to the practitioner. I would like to see this pursued.
2
The article quotes a researcher hoping to find a biochemical process underlying the placebo effect as follows: "For years, we thought of the placebo effect as the work of imagination. Now through imaging you can literally see the brain lighting up when you give someone a sugar pill."
What this gives us in a nutshell is the Cartesian myth of mind-body dualism, as if we should not be able to see the brain light up when someone imagines, thinks, says, does something.
The research may produce something interesting, but confused Cartesians are unlikely to interpret it accurately.
That the "work of imagination" in the brain and the rest of the body is real and can be tracked, if not yet understood, is exactly what we should expect, unless we enslave ourselves to Cartesianism.
1
The headline is completely misleading- any feeling or perception the body has has a biological/chemical basis- it's just that in many cases, we haven't been able to identify what that mechanism is. Just because we haven't been able to identify the exact mechanism in the past, doesn't mean it was ever a "trick"
2
Know this. One important thing about placebo effects, seldom noticed, but key to understanding.
Placebo effects don't cure. No ever.
Placebos are often compared to "real medicines" as if there were a substantial difference.
Know this. One important thing about real medical effects, as compared to placebo effects.
Real medicines don't cure.
Now, of course, some real medicines do cure. But with medicines that cure, placebo effects are not an issue. If a medicine cures, we don't need to compare it to a placebo.
Placebos, and placebo effects are only a challenge to medicines that don't cure. Clinical studies using placebos only test placebos against medicines that don't cure. Placebos are only a threat to medicines that don't cure. Placebo effects only exist when we deliberately take actions that we know will not cure. Placebo effects are a direct consequence of the doctor's intentions to "not cure".
When a medicine, or a placebo makes the patient, or the doctor "feel better" about treatment results but does not cure:
We have no idea if the medicine or the placebo is moving the patient and their illness closer to a cure, or farther away from a cure. We are only measuring a temporary change, which makes people feel better, but makes no attempt to cure.
If we want to study placebo effects, and truly make effective use of them, we need to study cures over treatments, not the reverse. Placebos are effective treatments.
To your health, tracy
Founder: Healthicine
2
In randomized controlled double blinded drug trials, it is of course necessary to determine how much of an effect, if any, is attributable to placebo.
This is not to denigrate placebo effects, but merely to determine how much of the effect is caused by the drug itself.
Drugs are prescribed to persons with varying baseline conditions and susceptibilities to placebo.
You would not want to prescribe an antihypertensive drug to multiple persons with varying severities of high blood pressure, which had ONLY placebo effects.
Even when there is a significant placebo effect, it may irrelevant for treating the condition for which the drug is prescribed.
It may be nice to have a feeling of well-being after taking a drug to reverse osteoporosis. However, if it does not reverse osteoporosis, then a better drug for that purpose is needed.
2
There is another important difference between active drugs and placebos.
Most active drugs will bring about their intended effects whether or not the patient is aware of receiving it.
An infusion of insulin will lower blood glucose with or with patient awareness.
By definition, no placebo has this property.
3
Having this property is what it means for a drug to “work”.
2
"much as a deli-counter worker subtracts the weight of the container to determine how much lobster salad you’re getting."
People who actually believe that are prime candidates for the placebo effect.
3
The placebo effect definitely is real. Physically, I felt better than I have in months just reading this article.
5
There is a chasm of philosophical difference between eastern and western medicine. Asian medicine, like Mesmer, acknowledges a vital force, chi, which underlies all physical and chemical reactions in the body. Disease is viewed as a disruption to the harmonious flow of energies and cure is a return of balance and flow of vital energy.
Western medicine is more mechanical viewing the body as a machine without a soul. What is needed is a bridge between the two philosophies bringing the unquantifiable into a means of accountability and reliability. This research may be that Rosetta Stone, but, as the author warns it can also trivialize the depth of the mystical and spiritual aspects that underscore the data being scrutinized. A fair balance will require respect both the art and the science of life.
5
Much of the chasm between Western medicine and Eastern medicine is because of the inefficacy of the latter.
2
Having just had major surgery two weeks ago I read this article voraciously. I believe the placebo effect is real and operates on many levels. I picked my surgeon based on empirical evidence of his qualifications but I stayed with him because of his manner, confidence, empathy and care. I believe caring is at the heart of healing and look forward to seeing how this research is received. I noticed the difference in my hospital experience vs my mothers 20 years ago, my caregivers were warm, professional people who explained every thing they did and solicited my opinion on how I was feeling. Being made to feel, as a patient, that your thoughts and feelings are important to your recovery matters a great deal. It wasn’t always that way, we are moving in the right direction. Kindness, compassion, care are medicinal values as well as emotional ones.
5
I believe I'm experiencing a placebo effect right now, and I am loving it! A couple of weeks ago the NYT published an article about getting better sleep.
I am a dreadful life-long insomniac and installed one of the recommended sleep apps. It's told me that my sleep is far superior than I'd assumed. It provides graphs and other data about my REM sleep, light sleep, deep sleep, and wake-up times/duration throughout the night. It tells me when I'll feel alert and physically strong. My sleep score has been consistently high.
Aside from seeing these numbers, I - irrationally - want to perform well for my app. I am better focused on my sleep at night, and I want a good grade, in a sense, so that it will tell me I'll be alert and focused. As a result, I've been more alert and focused.
I'd thought I was going to try another app after this tallies my initial data, but my sleep and daytime wakefulness has so improved, I don't want to ruin this marvelous, and (at least partly) placebo, reaction to the app.
5
My blood test showed very low Vitamin D. At my doctor's suggestion, I started taking 5000 units/day. After six months, my blood test indicated that my Vit D had increased to normal levels. While I don't doubt that the placebo effect exists, I would be shocked if I could have achieved the same results with a placebo vitamin pill that contained no Vit. D.
3
You are correct. Unless you consume more vitamin D, are exposed to more light, or somehow decrease the elimination or metabolism of vitamin D, your blood vitamin D levels would not increase.
If your doctor told you to eat plenty of vitamin D-rich foods and take “this pill”, and this motivated you to do so, then that isn’t what is meant by a placebo effect.
3
Paul Sahre's illustration for this piece is wonderful. It engages, delights, makes its own statement, and of course urged me to read onward. Bravo.
4
Fascinating article. It brings home the fact that we cannot claim at this time to fully understand how healing occurs in every instance. I found it interesting that Dr. Kaptchuk is a student of the Torah and the Talmud. I wonder if he has considered the healing prayers described in the Kabbalistic tradition, such as those contained in the writings of the Jewish mystic Moses Cordovero. Is it possible that in the end our scientific work will lead us to discover what was written in the 16th century?
2
Think of a panic attack. people have palpitations, shortness of breath all lead by the mind and the body to get worked up. In the same way body can perform whatever the mind says. It can heal the body too. Placebo is one way to trick the mind to get it done.
3
Many commenters argue that Kaptchuk's rejection of "science" goes too far. I agree, but for different reasons.
Science, simply put, is rigorous inquiry into the causal foundations of observable events. As so understood, to reject science is to reject either the idea of rigorous inquiry, or the coherence of the goal of establishing causal foundations.
But as the article brings out, what Kaptchuk is really objecting to is the tendency to jump to simplistic, single-cause hypotheses, such as ones that identify "the" cause of action with single molecules - in the present case, COMT, or glutamate. Similar examples abound: depression is the lack of enough serotonin, fellow feeling is the same as elevated levels of oxytocin; and so on.
Lurking in the background is what is known as "functionalism" - the view that some causation is due to general functions, not specific molecules. For example, a functionalist view of stress may hold that it is the kind of state that increases the devotion of resources to fight or flight readiness, and in the process, reduces their availability elsewhere. Glutamate may be one of those affected resources; so may oxygen availability to muscles, so may melatonin production by the pituitary gland, and so on. As such, what matters is less WHICH resource molecules are reduced in efficacy, but THAT resource molecules, of whatever stripe, are reduced.
If correct, then caring would count more than COMT. But also, such a result would still be science.
2
The description of rs4680 in this article seems to suggest that it is different than COMT, when, instead, it describes a variant of COMT.
It is also worth reading:
Kienle, G. S., & Kiene, H. (1997). The powerful placebo effect: fact or fiction? Journal of Clinical Epidemiology, 50(12), 1311-1318
for a (somewhat older) critique on Beecher's placebo work mentioned in the article.
1
Weenjoy (except Mkoo): Placebo Domingo the fabulous opera singer. We never miss his concerts.
1
There's no question that the Placebo effect is random noise.
For an excellent explanation see:
2012 The Skeptics Guide to the Universe, Authors at Google - Steven Novella
https://www.youtube.com/watch?v=jSiWK9BwxyU
A lot of information about the progression of an idea through multiple scientific studies and how most of the preliminary test results are wrong. Also a good explanation of how the placebo effects are subjective and do not have a clinically objective improvement associated with them. Test data is shown from the following paper:
Active albuterol or placebo, sham acupuncture, or no intervention in asthma
http://www.nejm.org/doi/full/10.1056/nejmoa1103319
Here's the full paper, note Fig 3 and Fig 4 are the ones in the Google talk by Steven.
http://www.nejm.org/doi/full/10.1056/nejmoa1103319#t=articleTop
1
I'm pleased at the thought that I can be healed without enriching the pharmaceutical companies, merely by a kind word, a few rituals, and the ministration of a harmless substance. Collectives should form in which friends and neighbors can provide each other with this kind of care at no cost, thereby bypassing not only the profit-driven insanity of the American medical system but also the overpriced therapies of holistic healers
2
We think we understand the human body but we really don't. The implications are this research are stunning. Basically you could heal someone from anything just by giving them something that is supposed to heal them, even if there is no evidence that it actually does.
Nobody is suggesting that placebos can cure everything.
That is demonstrably, and obviously, false.
5
@Daniel Polowetzky, RN That is basically what the article is suggesting and it clearly isn't false as you will see when you read the article again.
1
I read article. It does not assert that all ailments could be cured using placebos.
Try treating someone with methanol poisoning with placebo and let me know how well that goes.
6
The placebo effect also works in reverse. In carrying out clinical trials it is necessary to provide full disclosure to the participants. If the disclosure includes a statement that the test drug may cause headache, nausea, and malaise, people in the placebo arm of the study will invariably report having headache, nausea, and malaise at a significantly increased level, even though they did not receive the drug. It is one reason that whenever possible the people managing a clinical trial want to rely on some physically measurable outcome rather than on the participants verbal response as to how they feel.
2
i searched the journal Pain for the 2015 study to look at the 27% vs the 9% claim and effect sizes reported but couldnt find the article.
please reply with link if you know it.
News outlets should hyperlink (?) studies cited in their articles so readers can look at the evidence themselves rather than trust second hand inferences.
4
so does this mean I can make my hair grow back just by believing it will???
1
Donald Trump’s did.
Eponymous root of the word 'mesmerize'?
What you're witnessing are medical efforts to expressly avoid taking the risk and solving a disease like Parkinson's.
It is so easy to analyze other's data. It's like tracking Uber and noticing they drive back to wealthy sections of NYC when Lincoln Center let's out.
Indeed, supplements do not work, it's like spitting into the ocean. Quackery will find it's home!
1
I have never understood why people have a problem with the placebo effect. Your thoughts, your faith, all take physical form, because you live in a physical body. Why wouldn't it be likely that your thoughts would affect your health? I mean that's also what stress is--the effects of your thoughts and feelings on your health. I mean, where do you think thoughts exist? They're not out in the ether somewhere. They're in your physical body, causing neurons to fire at each other, hormones to be released, etc. Of COURSE they affect your health.
3
This actually goes to the heart of other aspects of rs4680, also known as the Worrier/Warrior snippet. As mentioned in this article, those with low COMT -(A:A) at the rs4680 location -also known as ‘the worriers’, these women have higher rates of heart disease, likely because they handle stress differently. At the same time, they have higher memory and task-based attention spans. Further examples, at least in studies of this snippet to date, that behavior and the mind do impact physical response.
Living organisms are probably some of the best synthetic chemical plants in existence. As a chemist, I am intrigued by the effect of positive and negative stimuli on the production of chemicals in the body. I think we are at a point where we are ready to start moving deeper into the nature of chemical production both as a result of external stimuli and as a host for the billions of bacteria that are symbiotically living in us. We have pretty good mechanistic explanations for induced drug responses but need to create deeper questions on body /mind created chemicals. The production of GABA is still not completely understood nor if there any difference if it comes from endogenous or exogenous sources.
I think there will be big breakthroughs in research in this area and in the area of bacteria induced responses. For example, if you crave sugar, is it the body that craves it or is it the bacteria in the gut that is craving sugar for energy and is it releasing a chemical in response that your body is interpreting as a need for sugar? There is so much more to learn.
6
The placebo effect has never been a trick. The physiological, pain reduction and psychological changes have been recognized for a long time. There is also a nocebo effect, in answer to one commenter. I used to be involved with a research group studying placebo (and nocebo) effects. We were able to record clear physiological changes before the blind was broken and those findings were published many years ago. Probably there were people long ago who understood that the mind, i.e. beliefs, and the brain (which is a physical organ) play a role in the placebo effect. That the effect syncs up with molecular changes was suspected even before there was a lot of proof. Welcome to the party Mr. Greenberg. The placebo effect is not a con, not a scam and not cheating. The question is how to harness this powerful phenomenon for good. Feeling better and having hope are definitely healing and not in a "woo-woo" way. That said, it cannot overcome all diseases. These are also quite real.
4
Scott Miller wrote about the factors that produce change in psychotherapy. He found the following: 30% Relationship
15% Technique
15% Hope - placebo
40% outside forces (luck)
I wonder if the is the same for physical issues?
3
To me these findings point out the immense impact that stress can have in so many medical conditions. It doesn’t surprise me at all that IBS responds well to placebos, IBS has been proven to be caused by stress. Make patients feel as if they are being treated and stress surrounding their condition decreases, thus their condition improves. The ubiquitousness of the placebo effect should prompt researchers to look into whether more conditions than previously believed are caused by mental factors like stress.
1
I think the first thing to ask about these findings before chiming in on their implications is: "Are these findings actual findings?"
It is unsurprising to find unusual interactions, differential effects depending on illness, etc. in small n studies. We have no idea from this interesting piece about important questions and so should pause before swallowing this particular pill...
Kaptchuk's belief that "the placebo effect can't be totally reduced to its molecules"-- that attempting to scientifically understand the phenomenon will "suck out what was previously there and turn it into science".
The effort for "understanding" is not a process or a goal we can be said to understand. At least it is not something whose achievement we can assume we will agree upon. For one person it is "finding the molecules" and for another it the the feeling of healing that they experience.
Our beliefs influence our experience. Disease is a paradigm case where we quite regularly cannot clearly distinguish whether somatic conditions or experiential reports are better markers of a disease. Abnormal body tissue signals disease but the pathway back to health entails understanding the multi-causal nature of the problem.
Molecular understandings assume a limited number of causes and cures. The more we delve into the placebo problem the more we cannot disentangle humanity's part in framing the question.
The placebo effect has always been about ‘hope’. Nothing tricky about that.
1
Greenberg goofed when he wrote, "It was possibly the first-ever blinded experiment, and it soundly proved what scientists today call the null hypothesis . . ."
It is impossible to "prove" a null hypothesis. This is an extremely common, and very misleading, misconception of statistical hypothesis testing.
Experimental data sometimes allow us to legitimately reject a particular null hypothesis. However, if data do not allow rejection of some null hypothesis, all that can be concluded is that the null hypothesis under consideration cannot be rejected. This is NOT the same thing as "accepting the null" or "proving the null". Check any modern textbook in the fields of epidemiology or statistics.
3
Some comments betray the idea that there is a wellspring of undiscovered non-Western cures to serious illnesses waiting to be tapped into if only we would utilize the mysterious power of the placebo effect or stop focusing on standard medical research/clinical trial methodologies.
I suspect not.
5
What this study shows is truly profound. It indicates a biophysical embodiment of social interaction among humans. It disproves the wild individualism that is rampant in the USA and is also the basis of modern medicine and pharmaceuticals. Very fundamental kind of knowledge that is sure to be disputed and to bring huge disruption to many industries and professions.
3
The entire field of psychoneuroimmunology was founded as a result of the discovery of the measurable power of placebos on rejection in transplant. I find it surprising this article implies so many scientists or physicians (two groups, not one) don't believe it exists.
The worst thing one could say about the power of placebos is they are no stronger than prayer. But if you think prayer helps occasionally, well there is your placebo effect. It's not nothing, though (needless to say) it has nothing to do with a supernatural Goddess (or God) intervening as an answer to someone's prayers.
The latest studies support that placebo is about as strong as anti-depressants when it coms to the treatment of mental illness. That can be read different ways, of course, but I prefer to split the difference: placebo is weak but not nothing, and the same for anti-depressants.
Another way to put it: if you want your anti-depressants to work, it helps for them to be prescribed by a doctor you believe can help you. Helplessness defeats all placebos.
7
Wonderful piece and so glad it was written and published.
In the end, the reductionist approach to health [by chemical pathway, splitting the mind and body, etc.] is a bad one. Humans are integrated systems....and any condition must be viewed in this light.
6
no one ever said it was a trick...next stories in this series-- what if the moon is not made of cheese, what if Trump is not the best president ever??
2
Great stuff! I'm so glad people are seriously researching this. I've been wondering about it for years, ever since I read a piece around 15 years back about how several mood drugs, including Prozac, were not working better than placebos, that the manufacturers had cherry picked from literally hundreds of studies to get their 2 FDA required passing studies.
We're all getting sick all the time and our immune systems are kicking in and curing us all the time. Mostly we don't even notice.
We only notice we're "sick" when the illness beats out the immune system to the extent that we start to notice symptoms. Then at those times, we find, that with a little extra "help" from some drug or other, we get "cured" again.
But the healing process is innate to our bodies. It just needs some extra help at times. That seems fairly obvious.
So the question is, what forms can this "help" take? Obviously, certain drugs do their thing, helping to support specific healing processes. But what if changing the basic living conditions can also help, conditions such as the amount of physical or emotional stress people experience at work or at home? When people are sleep deprived, and over stressed from work and turbulent personal lives, this affects their overall energy levels. They're tired... I know when I get like that I feel weak. Does this weakness extend to a reduction in my body's effectiveness in healing itself?
3
After thoroughly reading this article, I was surprised that the field of psychoimmunology was not mentioned at all. Studies similar to what was published here were done at the University of Rochester as well as UCLA at least 30 years ago in order to investigate the placebo phenomenon.
As a matter of fact, as just published by PR Vannenman, the opposite of the placebo response is the nocebo response, which is the expectation of something negative that is going to happen when treatment is explained or applied to the patient.
Based on my own clinical experience of 35 years in the diagnosis and treatment of soft tissue injuries, there is no doubt that taking time the time to listen to the patient as well as physically contacting the patient during the course of a thorough examination, has a powerful influence for the start of the healing process.
The key is to be honest with the patient regarding your objective findings, resulting in the monitoring of the placebo or nocebo affect during the course of treatment, if the patient accepts your recommendations.
5
Nothing from nothing leaves nothing! Feel better?
1
Anyone who thought that the placebo effect is a "trick" is a fool.
1
I learned about the placebo effect from an early age. Occasionally when my bother and I were behaving badly my mother dispensed 'nice' pills. With a "take this and you will be nice!" stated with confidence. I would say that this 'treatment' worked to alter behavior about 50% of the time. Not to shabby for a humble multivitamin; maybe sometimes a 'B-complex'. Also still seemed to be efficacious even when we were a bit older and knew the true contents of the 'nice' pill.
2
pharmacologically speaking, inert. This says it all, yet no mention of homeopathy, a huge business involving distilled water.
3
Homeopathy is the mother of all quackery.
6
Humans need human contact of the caring and kind nature. “Medicine” has unfortunately become mechanistic and profit driven. This makes people sicker and more depressed. Drugs cause side effect that are often worse that the cease they are supposed to contro...never cure.
Loving care goes a long way to improve out comes and extend life. Placebo? No, I don’t think so rather I think it’s the real impact of feeling loved.
1
The placebo effect does not cure anyone of disease or remove tumors or kill cancer. Palliative care will certainly make a person feel better and that is difficult to measure accurately. Yet some people will go to their grave believing the non-existent efficacy of homeopathic remedies or acupuncture or any other types of witch-wiggler—non-scientific—therapies due to its misuse.
With drug therapies, the placebo effect will be felt by persons taking the real drug and persons taking the fake medicine. Assuming a large enough sample of people, the placebo effect is therefore just a wash. Both groups would “feel” the same placebo effect and therefore it can’t be isolated.
3
I'm a physician and I see the placebo effect, for good or ill, all the time. One striking example (at least to me) is the notion that medications could cause someone to think about suicide. If medications made us think about suicide, why wouldn't meds also make us think about doing laundry, getting a puppy or calling our exes? Maybe medications don't cause suicidal fantasies, maybe researchers, doctors, therapists asking about whether medications cause suicidal ideation causes suicidal ideation. Those same people insist this isn't true, but, really, how do they know? Why couldn't there be negative placebo effects?
When drugs don't improve patients' lived experience, they feel especially discouraged. When this happens, it seems wisest to get them off meds and onto a therapy that helps them feel and function better. I know as often as not, antipsychotics don't resolve patients' experience of hallucinations, but participating in support groups with others who experience hallucinations seems to provide meaningful relief, understand and coping capacity.
Too many of my patients report "depression" when what they're experiencing is emotional, physical, financial, environmental trauma or adversity. It's acceptable to prescribe $1000 worth of meds but not $500 worth of housing or food. Why the difference?
Doctors too willingly let Big Pharma and corporate interests hijack our role and duty. We can't treat people with 6 minute visits and a prescription pad.
6
@hey nineteen There are definitely biochemical reasons that some medications can cause depression or suicidal ideation. For one example, Chantix, a stop-smoking drug, attaches to nicotinic receptors in the brain so the nicotine can't attach. It allows some dopamine to be released, but not as much as without Chantix. Therefore, someone with already-low levels of dopamine may end up feeling much more depressed when taking Chantix.
2
That rational thinking people read and believe this just about says it all. Is this where we are headed?
2
@Chris Anderson - I'd be interested to hear your arguments against this article. Being a rational person, my views would likely change in the face of more compelling evidence.
@J Jencks Too bad we can't do this on here. I would love to change your mind.
Is there any evidence that our current medical procedures will be thought of more favorably than the procedures of 100 years ago? How much better is is cardiac surgery than a jug of Dr Goods snake oil tonic? Can we see some numbers on that? What do you think our great grandchildren will think of our modern Heart Surgeons? Let's just get real. Our modern medicine has not extended our biblical three score and ten lifespan, and may be much more painfull than our ancestors endured. Medicine has more in common with shamanism than it has with science, and often a guy dancing around our bed with a rattle wearing a chicken bone necklace is at least as effective, and far less painful and expensive than our current medical priesthood has on tap. Medicine has never offered proof that is more effective than a placebo. But what is a fellow to do?
3
@Liam - Right now I'm thinking of the several close friends of mine who survived advance stages of cancer, thanks to chemotherapy and radiation treatments, and who have gone on to live many years. I'm also thinking of a few who did not survive it. None of them would have survived 50 years ago.
I'm thinking of my niece who, had we lived 100 years ago, would have died in childbirth, but who is now raising 2 beautiful children, thanks to the ceasarian section.
I'm thinking of the great artists of ages past who were lost to us at a young age due to tuberculosis and other diseases now susceptible treatment and immunization.
Karl Maria von Weber ... John Keats ... Charlotte Bronte ... Lili Boulanger
3
Insulin, antibiotics, blood transfusion, radiology, anesthesia, surgery, vaccines, hemodialysis, IV fluids, defibrillation, antihypertensives, diuretics, analgesics, organ transplants, anti-retroviral medications, oral contraceptives/IUDs, anti-tubercular drugs, the eradication of Smallpox....
4
@Daniel Polowetzky, RN: Throughout history people believed in their healers and priests. It is part of our socialization to accept our healers arsenal as the best ever, However, we should thank the plumbers, the sanitation workers, water supply engineers and soap makers for our good health today. The Doctors do what they always do, guide us through life's mysteries to the River Styx hopefully with understanding and dignity.
Kilgore Trout was right!
"Ideas or the lack of them can cause disease."
(Kurt Vonnegut, 1973; in *Breakfast of Champions*)
1
A really interesting article and I hope we will see more from this author on the subject. I do think that it's inaccurate to say that all investigative drugs, to be FDA approved, have to be shown effective against a placebo in clinical trials. In specific therapeutic areas, the research test is almost always conducted against a control, for example the currently accepted standard of care. In fact, a placebo arm in many of these trials would be deemed unethical and rejected by an IRB (Institutional Review Board).
4
I read the article with interest growing to fascination (great writing, by the way). Although my career was in engineering and management, my Cornell degree was in social psychology - the effect of the group on the individual, and the individual on the group. Since retirement, and particularly since the 2016 election, I've been considering some questions about what seem to be fundamental behaviors in humans, and how social components contribute to them.
For instance, religion - what is it about religion which causes people to adopt, immerse themselves in, and even viciously defend such obviously counter-factual narratives? For instance, does prayer, like some meditations, induce endorphin production? Does it act on the stress hormones? Why is peer pressure so powerful, and yet some people immune to it? Why do people cling to social rituals, repeating them on demand - from communal prayer to recitation of the Pledge of Allegiance to Christmas trees and presents (or, of course, Purim, Passover, etc.), while others find them tedious? Is there a neurochemical reward to this participation, but only in some people?
Kaptchuk and Hall's work, it seems to me, are addressing these very issues, albeit only one corner of the phenomenon. The demonstration that ritual, regardless of type, enhances the placebo effect is significant. I'm going to contact them with the suggestion that they broaden their research group to include some developmental brain chemists and social psychologists.
5
There is a danger of lumping all results of improvements in subsets of patients into placebo effect when in reality some are due to influences or factors not yet understood or measured with acceptable instruments. Even more problematic is to immediately dividing the positive and negative responders and come up with instant subset analysis to milk the study results for new hypothesis that cannot be confirmed.
2
I recently visited my primary care physician for some physical complaint. I have only seen him I think once other than for my annual physical in the two years he has been my PCP, so I do not have that much experience with him. He was obviously running behind schedule; I waited quite a while for him in the examining room for him to arrive, which was a half hour after my scheduled appointment time.
After he examined me I brought up another matter and started to go into some lengthy background information, which I admit may not have been strictly necessary. I could sense some he wanted to move on and asked him if had time for this to which replied no. I was a little taken aback.
This doctor was unable to find an inguinal hernia that he had diagnosed a few months ago during my last physical exam (but which never made it into my charts). That coupled with a feeling I was given the bum's rush has left me feeling less than confident in him.
I have seen in other people's comments a reference to the "nocebo." If I am not sure the doctor has hit upon the right diagnosis and therefore the correct treatment, even if he was correct in his diagnosis that treatment will perhaps be less effective.
5
Eastern philosophies have known this for centuries. Having tai chi classes for a couple years now, I never cease to be amazed by how good I feel afterward.
But I wonder if it is also an hour in the pleasing company of positive-minded people, in a quiet room with soothing music, and concentrating on breathing and postures instead of all the things going wrong for a bit?
12
If I'm not mistaken, the thrust of this article fits neatly into the body of evidence showing that stress reduction is a powerful cure. Put another way, the biochemical response of the body to stress and inflammation are pernicious if sustained. Perhaps some inclusion of the effects of high levels of cortisone-type molecules.
7
While practicing in a rural town in NC 35 yrs ago I had the thought, if pharmacists put their patients' medicines into culturally appropriate containers, patients would be more likely to take their pills. This article lends its theories to this idea. If I'm into rap and my anti depressant or hypertensive medicine is contained in a package that speaks to my love of rap, then I'm more likely to take it and, would have greater effect..
3
I have always been mystified at doctors' and scientists' contempt for the placebo effect. It is, at the very least, startling.
And when you think of it, even when a medicine is involved, it's the body that effects the cure. The interaction between a medicine and the body is pretty complex. If it were reducible to the merely mechanical, then medicines would work largely equally for everyone.
I have also always been mystified at some people's insistence that if science hasn't yet defined or detected something, then it can't exist. Science has repeatedly discovered things that were previously undetectable.
4
It is important to recognize that all the examples cited in this article for the placebo effect involve pain perception. Pain most likely involves the mind, but pain is not really understood. Functional MRI looks like an objective measure of a person's response, but fMRI is itself measuring subjective responses, and in reality might not be better than self-reported responses. That said, the experiments reported in this article make a good case that placebo and hands-on attention can be helpful in reducing pain and other noxious perceptions. But these experiments do not generalize to the organ-destroying effects of diseases like infection, cancer, or dementia. In such cases placebos might lessen discomfort or anxiety, but when my time comes to deal with such things, I will be looking for a treatment that has passed a double-blind, placebo-controlled trial, preferably conducted by an independent agency.
4
Does anyone know whether the inverse relation has been studied? Today the knowledge about the process to make sure a drug is really working is wide spread. But how do drugs work when the patients explicitly do not know whether they receive a sugar pill or not. Would scepticism decrease the effiency of the drug?
1
See “the mechanism of placebo analgesia” published in the Lancet in 1978 to understand how naloxone mediates the placebo effect.
1
Perhaps this research can explain the dentist miracle effect.
I have noticed that when I enter the dentist’s office, or sometimes even the car park, my toothache miraculously disappears. Of course, I am terrified of dentists, reliving the terror of a 9 year old child when a drunken dentist slipped with his cutting burr, and ripped a hole in my tongue. My mother tells of hearing my screams from afar, and finding me with blood gushing from my mouth, and the dentist vomiting into the sink.
Talk about PTS - even writing about this, and reliving that event over 60 years ago, gives goosebumps.
Another avenue for investigation- how PTS affects responses - likely a flood of stress chemicals with this.
Please note, Prince Harry, the patron of Invictus Games, recommended that PTSD be changed to PTS. Invictus Games, recently held in Australia, is for disabled, sick and injured Veterans, a most worthy cause. Prince Harry served in the front line of Afghanistan for 4 months, so has a personal interest.
Prince Harry and Meagan Markle are excellent ambassadors, both for Invictus and the British monarchy.
1
@Chris Blair - I don't know . . . I've had the same experience, as have many of us, I'm sure. But I can also say that when I drive my car to the repair shop, it's also likely to quit making that sound or vibrating obnoxiiously, or whatever other ailment I've taken it in for.
1
My question is this: Does the Sugar Pill cost $500.00 and will the insurance company cover it?
2
This is a fascinating article which does not get into the question of the placebo effect in self-medication. We all exercise a degree of discretion in how we take medications prescribed for us, not to mention the plethora of over the counter and alternative medications available to everyone. It's very difficult for an individual to be both the experimenter and subject, but it's not impossible for something like such an experiment to take place. I have been taking a certain medication daily for years, and had no reason to believe it was not effective, but not long ago came to believe it was really no longer needed. I stopped taking it and promptly forgot all about it. In due course, I began to experience a great deal of physical discomfort. I began to wonder: what had changed in my diet or daily life that might have brought this quite bothersome discomfort? Only then did I remember the medication I had stopped taking. There was no reason to think it would in any way be connected with my distress, it was intended to treat something else entirely. But I resumed taking it, and lo, gained quite noticeable relief, though I had no real reason to expect that the medication would have that result. I was grateful for the relief, though it didn't really make sense. And it was only at that point that I remembered that I had had this experience at least once years ago, and just discounted it because it didn't seem "reasonable." Placebo effect or unanticipated pharmacology? Does it matter?
2
The comment, ‘it’s all in the mind” has interesting historical origins, starting with Aristotle and Plato.
This is the philosophy of mind-body dualism, where the mind and the body are distinct and separable. This theory is closely associated with Descartes - ‘cogito ergo sum’. As with much philosophical work of those times, these theories are intertwined with religion, and the conflict between observed reality and theological teachings.
Modern science has shown that this separation is not valid, yet the theory persists, especially when the placebo effect is discussed. Often made by scientists who should know better.
The placebo effect has been demonstrated in laboratory studies. The LD50 is the amount of a drug that is fatal for a nominated cohort of animals - usually a particular strain of mouse. One particular laboratory showed consistently higher survival ratesfor a particular drug being tested compared to the other laboratories involved in the testing.
Investigation of this outlier revealed a laboratory worker who loved her mice, and treated them with love and care, a contrast to the other labs.These cared and loved for mice responded by having a greater tolerance to the fatal effects of the drug being tested. A statistically significant difference.
Oxytocin levels rise in both dogs and their owners during happy interactions, much the same as humans enjoying friendly interactions.
Maybe the placebo effect is coupled with release?
7
If the placebo effect is related to caring interactions, could that also be related to longer life being associated with strong social networks?
4
Some thoughts I had while reading this: Sounds like a cousin to the Hawthorne Effect could be in play, Form follows function, Neuroplasticity, And, with the carpal tunnel outcome, competitive inhibition. Just the idea that all of these things could reasonably pop up during a reading of this piece suggests, one, that it is well-written and, two, there is a heckuva lot we still don't know about the human brain. Thanks for a stimulating article. I feel better already!
6
Jesus, when making the lame walk or the blind ser, never said God made them well. He said, "Your faith has made you well." (He didn't say beliefs, he said faith. It's powerful medicine.)
8
That leaves me out.
This article is very interesting, but the last portion of it exasperated me. What could possibly be wrong with finding out that the benefit that we now only see with "warm" encounters with clinicians could be turned into a medicine that even a jerk can give a patient? It can only benefit patients.
1
When I read these kinds of articles, I always think-Why don't they introduce the finding conclusion(s) in the introductory paragraphs? This would motivate non specialists to plow through it. In this case, a lot of plowing.
3
The value of this article alone more than justifies the cost of my year's subscription to the digital NYTimes. And give the writer a Pulitzer or some equivalent for his lucid, eloquent, expansive exposition.
5
The sugar pill cure is mostly all in the mind. The argument for substantial benefit conferred by the placebo effect in treatment trials has been around for a while. Clinical trialists do not deny that inactive sugar pills and IV medications or sham surgery have some quantifiable benefit when compared with doing nothing.
In addition to the genotypic receptivity to placebo treatments discerned by the Harvard scientists, patients who consent to participate in treatment studies tend to be more motivated and confident that they will get better than those who refuse to be enrolled, despite having only a one in two chance of receiving a potentially beneficial therapy. Randomised controlled trials attempt to discern whether new therapies result in a clinically relevant benefit (improved survival, reduced symptoms), in addition to that conferred by the human mind's empowerment to enhance immunological and psychological defences from participation in studies.
Furthermore, the awareness of being closely observed and monitored for clinical progress or deterioration is an incentive for patients to do better (the Hawthorne effect, aiming to gain approval from investigators and other participants), regardless of whether a study subject receives the tested or inactive treatment. The placebo effect is able to be measured physiologically but its inherent mystery is expressed in our improved psychology.
My grandfather sold whiskey under the guise of it being a health tonic for iron poor blood. Nearly every pharmacy in America sold it and touted the efficacy of this miracle tonic to add vim and vigor to every day. They even made a highly alcoholic junior product that in many ways resembled today’s fireball liquor. Oh the product was named Geritol. Perhaps someone who reads this remembers it?
11
@Warren Bobrow It helped many to keep their wives, no?
Expectations and compassion can combine to produce results. Generally, who cares where the results come from, if they are good?
Modern insurance-based medicine pays for this approach: "Well, let's wait and see if your dead by Monday. Call the office Monday if you're still alive."
The doc used to say something like: "While it may be painful, I think you'll see some improvement soon. Some of my patients find that they feel a lot better if they take Ibuprofen and smear a blob of Vicks on their left toe... Please call me Monday and let me know how you're feeling."
Unfortunately, one too many doctor-seminar golf trips to Maui with lawyers have caused the second approach to become extinct. It's been replaced by the placebo cyanide of the always-off-the-record first method.
This is a fantasy. If witch doctoring worked we would use it.
2
I would argue that the “opening of a Pandora’s box for Western medicine” (the subtitle of this article), occurred over the past 75 years as the art of medicine was largely supplanted by the technology of medicine. This revolution gave rise to life-saving antibiotics and surgical procedures as well as to ineffective, invasive, costly, and harmful tests and treatments that now plague modern medicine. One need look no further than the current opioid disaster to realize that something is seriously wrong in a country that boasts of having the most technologically advanced medical practices in the world.
Over 90 years ago, a highly respected Harvard professor named Francis Weld Peabody concluded his lecture to Harvard students with “One of the essential qualities of the clinician is an interest in humanity, for the secret of the care of the patient is in caring for the patient.” It was the abandonment of this wisdom in the rush to embrace the explosion of new and shiny technologies that brought serious harms as well as benefits that opened a Pandora’s box for Western medicine. The growing scientifically rigorous evidence for the limitations of these new technologies and for the beneficial effects of “the caring for the patient” provide an opportunity for medicine to reconnect with its fundamental role of relieving suffering and doing no harm.
6
This is a great article. But is the author combining the placebo and Hawthorn effects? The Hawthorn effect says that patients in a clinical trial have better outcomes because of all of the people, care, attention that they receive simply by being in a trial. I wonder if that’s an adjuvant to the placebo effect or works thru the same molecular pathway?
Just a thought...
4
Once tried placebo to get rid of a flu. Hopefully, it worked! Ever since I’m using only homeopathy.
Any effects from homeopathy, aside from those of the diluent itself, eg, water or saline, are purely those of placebo.
This is because homeopathic products, by design, contain only diluent after multiple dilutions, resulting in 0% solutions of whatever solute they began with.
It is impossible for them to have any effects other than those of placebo.
Homeopathy is not mere “alternative” medicine, where there are some dubious, although not impossible, claims for efficacy.
2
I remember the late seventies as a young Nurse... an MD in Vermont ordering placebos on his older patients who were anxious and complaining of minor discomforts..I was a new Grad and this had never been taught at the Mecca Of MGH , Boston where I received my training,,,,Thus I was skeptical as I gave my first patient,, an older woman with a sweet smile as she washed down the sugar pill I gave her with her tea,,,,I also had time to sit w her and chat for a bit,,,,,I returned about thirty minutes later and she was napping .....later she requested another pill,,which I gave her and she looked up at me saying they were wonderful relief,,,,,,I saw many patients receive relief with their sugar pills and elixirs,,, also with a friendly chat,,,a hand held,,,a back rub,,,and a hug from a young Nurse who watched over them......
8
There's a lot of bad science here. People have milked the idea of therapeutic touch, a whole host of "alternative therapies", "holistic health" approaches and even a return to witchcraft, all of which are bogus, just wing nut commerce, something to which California followed by the rest of the US is particularly vulnerable. Good quality studies show care, compassion and tailored treatments make zero difference in the case of serious mental disorders, including serious depression, zero difference in prognosis or life expectancy, zero difference in the natural history of serious diseases like cancer. Placebo effects are mostly in the realm of pain and distress -- i.e. nicely situated in the emotions because pain and perceived stiffness, gastric and bowel upset, irritable bladder and bowel, and back pain are mostly brain constructs, heavily mediated by belief and emotion. This has been shown over and over and over again. That's why cognitive behavioural therapy is the best therapy for chronic pain syndromes, irritable bowel, etc. assuming there is no obvious physical pathology, which there rarely is in these cases. In short, the problem is in the patient's head. It's not imaginary, but its not physiological either. Acupuncture, shark cartilege, alt therapy, etc. are a waste of time and money, even though the recipient may temporarily feel better. They're better off going for a walk in the park, having a swim or taking a nice hot bath.
2
No, people do not like to be cheated. But people prefer confirmation of their own ideas and tend to ignore information that goes against their prejudices.
3
Just think of all the medical disciplines that were viewed skeptically, and now are mainstream and in some cases generated sub specialties. Oddly, a few days ago, I was thinking of the arrogance the scientific community engages in because there is no measurable proof to support a supposition. Yepper, mentally inventory the measuring equipment that has been developed over the last hundred years that enables the scientific community to view, what had been, unseen phenomena. We got a long way to go.
I had high expectations for this article. Sadly it lacks any real teeth. I felt as if I just wasted my time listening to another preacher on a corner. The history was interesting. The science was lacking. And let's not forget that "science" comes from knowledge. It's not a religion. And really nothing was provided in the way of statistical study sizes and rigor. For entertainment I prefer science fiction.
2
Fascinating article and no doubt required reading for doctors and researchers everywhere. But why no mention of oxytocin as another potential mediator of placebo response? It’s the “being cared for” hormone.
4
When a resolute patient with a serious illness has exhausted all conventional treatment, it comes as no surprise that she lobbies for experimental therapy, even if that only conveys a faint glimmer of cure or symptom relief. Even if it proves to not have worked, experimental therapy confers empowerment from access to a diminishing armamentarium that the patient could arm themselves with to go ino combat. One is unlikely to concede defeat, or lose all hope, with an additional weapon to stoush with the mortal enemy. Regardless of the ethical conundrum surrounding being granted access to unproven therapy, clinicians cannot ignore the enlivening power of the placebo effect in desperate circumstances.
1
NYT Magazine is very interesting. I became to love its assortments of topics, ideas, observations, and opinions, which can be said as a treasure box of true varieties. This piece expresses the writer’s balanced views on the subject matter with intellectual attractions and moderations. The interaction between mind and body has been a crucial question intersecting diverse fields of human knowledges, historically as well as today and the days beyond tomorrow. Whether soul unconditionally demands body or the latter can contradict the former may be a vague deviation from psycho-neurological effects spoken of on a molecular level. Scientists may say, even the belief in Divinity is analytically correlated to magnetics and molecules, via, or not one’s cerebral receptivities. Not being in a by-gone era mood, but the piece made me, slightly, think of Jung.
1
Given that the article highlights the importance of caring and warmth for healing, I wonder if this explains much of the difference in the higher rate of illness in women. Women, especially mothers, often have no one caring for them when they are ill. As the caregivers, they are often expected to go on caring for others even when sick themselves. I wonder if more care and compassion were given to women when they are ill, would greatly reduce chronic illnesses for them.
5
Sort of like hooking up electrodes to monks skulls in an attempt to understand why meditation works - it had been understood for thousands of years, but such understanding comes in a different way. It is progress for western medicine to explore the boundaries of their craft however, but perhaps what's needed is humility and an attitude of 'I don't know'. Perhaps these bonds between 'healer' and 'patient' are more subtle that we think - that patients that feel more empowered in their 'treatment' respond differently.
2
Fascinating piece.
I place a doctor's caring nature first and their medical abilities a close second, but there are others that reverse that order in choosing a physician. Is it possible that we self-select doctors based on what kind of treatment will be most effective in relation to the placebo effect? This article makes me wonder.
Not sure what the author is up to. The placebo effect was never "out" of medical practice, nor does any real scientist follow the notion that healing was "the application of mechanical tools".
The point of controlling against placebo is quite simply to isolate the effect of the tool from the effect of doing something, anything, that has nothing to do with the tool at hand. If TLC has the same effect, I don't need to buy a drug.
There's nothing unheard of about the placebo effect being mitigated by neurobiochemical processes - that's the obvious route of effect. The problem the researchers in the text are working on is elucidating the precise mechanism.
6
Our brain is still an unknown mysterious organ .
Beside it’s physiological functions that allow us to breath, to have a heart beat, to move , etc .. it reigns over the quintessential actions determined by our psyche.
I am a strong believer in “ placebo “ , I have seen it’s positive results in several people.
Western medicine in general and American in particular have too much faith in drugs , the stronger the better , high dosages , to the point of depressing and counterbalancing the normal response of our cerebrum , that is there to help us cope with pain and other illnesses, but has been relegated in a lethargic state by Big Pharma .
Yes , I know that prescription drugs are essential in fighting illnesses and promoting good health , my humble opinion is that we are not allowing enough time to our body to assist us in achieving a status of wellness without the aid of some chemicals.
4
What if the effects of an illness or condition are improved by love, affection, genuinely concerned empathetic doctors and nurses, touch, affection and appreciation?
What if 50% of what ails us could be cured by hugs, massage, being listened to and a feeling of connection?
We already know that the body is a marvelous chemist capable of manufacturing hundreds or thousands of its own essential molecules. What if, more than anything, we just need love and affection in order to stimulate our own biological factory?
11
@Moderately
Just remove that word 'just' from your last sentence, and I fully agree with you.
There are indeed many people that crave for love and attention.
Unfortunately, there are also many people that enjoy mistreating others.
3
My takeaway from this article is that the "gold standard" for clinical studies should be modified to include a "no treatment" group and extended to include DNA samples.
6
For ethical reasons, assigning subjects to a no treatment arm of a study requires that there is no effective treatment for the ailment involved.
2
I love this article. Thank you for discussion of this topic.
I wish I could learn Drs. Hall and Kaptchuk's ideas regarding animals that do respond very positively to acupuncture treatment. It is said that for animals there is no placebo effect.
Yet what this article describes suggests that there would be a placebo effect in animals as well as in humans. This would make a case for "clinician warmth". Quite a few years ago my daughter, a newly licensed wildlife rehabilitater learned some acupressure techniques suited for aiding injured birds. I know they worked because I helped to release several "broken birds".
It seems like an exquisite balance of placebo-non-placebo.
3
Can we please stop referring to placebos as "sugar pills"? Especially in a comprehensive review article such as this. The term "sugar pill" should not be wielded as though it were equivalent to "placebo". It sort of is like you are talking down to someone who doesnt know the word placebo by saying "it's just a sugar pill!". However placebos do not necessarily contain sugar, and sugar actually could have active effects depending on what condition you are looking at. The only use of the term "sugar pill" in a proper article such as this would be perhaps to simply state, "Placebos have sometimes been referred to as 'sugar pills', in parlance designed to explain the concept to people who are not familiar with the term placebo, though this term is not quite accurate since sugar may be an active compound and placebos do not necessarily or even usually contain any sugar."
3
Being a scientist, I can be very skeptical of solutions that aren't tangible - in this scenario, a drug vs a placebo. Having said that, I had some long lasting pain on one side from a fall and during a massage, the practitioner did some Reiki. I can't really do justice to the intense feeling of energy that seemed to be released from that side - it even took the practitioner by surprise and made her jump. I didn't know she was going to do that but I know when she started it. I didn't believe in Reiki when I walked into that room but I could not deny the benefit walking out.
10
My father was an osteopath in the 1950s when any physician other than an M.D. was considered to be a “quack.” He always had successful results by implementing the so-called “placebos” of deep-tissue massage, Rolfing (body realignment), placement of hot towels on sore muscles and mild electrical stimulation to an intense “charley horse” cramp. Of course, we now know that, although still largely scientifically unproven, such treatments do appear to “reset the body’s equilibrium” and partakers of such treatments swear that they do, indeed, feel better. I say, bring on the placebos and give ‘em their due. They help people, for what ever reason, to get back to their lives and that fact is no placebo!
3
We need to recognize that not everything concerning the human being is biological. There is also a spiritual side which includes the mind and our sense of being. At this point in time we do not even know what consciousness is and we won't until we reach the other side of death.
7
Alternative medicine advocates are not simply suggesting that placebo effects may be used therapeutically. They argue that their remedies either work by as yet undiscovered standard scientific mechanisms or by non-scientific mechanisms.
They would argue that their remedies are not MERE placebos.
As a patient, I expect treatments to be demonstrably effective, based on rankings of the evidence involved.
4
It is hubris of science and particularly of medicine to believe that just because we can reduce and understand the basic chemistry of the body, that we understand the system.
To use an analogy from mathematics, we may understand how to count, but we still don't understand prime numbers (the Riemann hypothesis is one of the greatest unsolved problems in mathematics).
It follows that just because we can see how drugs bind certain receptors, we have no real understanding how the drug will affect the system as a whole. Understanding the pieces is not the same as understanding the interactions. Our western reductionist science quickly shows its limitations with confronted with large systems.
The problem is that the medical profession is not known for its humility. Many doctors would like to believe they have all the answers. However, these are more or less the same people that were using leeches a century ago.
3
@bruceceng
Our western reductionist science certainly has limitations, but we know of no other method for reliably determining truth. And your statement that the modern medical profession comprises "more or less the same people that were using leeches a century ago" is nonsense; there was no scientific medicine a century ago, and the intellectual heirs of "the people that were using leeches a century ago" are the holistic medicine practitioners.
3
But isn’t a leech just as good a placebo as a sugar pill? That’s what the Ted Kaptchuks of this world would have you believe.
2
@Hugh D Campbell
When a few of my fingers are surgically re-attached, I don't want a sugar pill to improved my circulation. But I'll take the leeches!
The human brain is an amazing, mysterious, and complex organ. Science is just beginning to scrach the surface of fully understanding its potential. Excellent article!
4
All "energy therapists" and their clients, understand, or at least acknowledge through their practice this fact about the mind, body, spirit inter-connection. Quantum physics too is proving that form - the human body, along with its ailments, just like time and space, are illusions. They do not exist in the solid, 3-dimensional shape and volume that we imagine, and therefore, can be manipulated into any other form we want them to assume. However one finds relief from pain is both fine and a part of the same illusion.
3
I am fascinated by sleep and have worked over the years to become more conscious of my own transition from wake to sleep, and from sleep to wake.
One startling realization is that apparently my body has a way to "turn off" headache pain while I sleep. (A couple of times a year I have week long periods of non-stop 24-hour allergy headaches.) During these periods, I have taught myself, upon waking, to be alert for the exact moment when my headache kicks back in. Obviously, my body has some chemical or neurological way to turn off the pain. If science could harness this natural process, that would be pretty awesome.
6
If the sugar pill is indeed proven to be effective, it will be only a matter of time before the American pharmaceutical industry finds a way to raise the cost of each pill to $500. The medical industry has no interest in anything that doesn’t earn them money.
4
Remember that people taking Placebos in clinical studies are getting 1 additional glass of water per day.
And we already know the health benefits of drinking one more glass a day.
1
Not in Flint Michigan.....
1
A few years ago, in a scientific publication, I had read that the cells of the soul were bigger than other bodily souls. Unfortunately, I am not able to locate that fact right now. But it was fascinating in that it made the soul real - not simply what we feel, but an actual living presence.
"Everyone may respond to the clinical setting, but there is no reason to think that the response is always positive. According to Hall’s new way of thinking, the placebo effect is not just some constant to be subtracted from the drug effect but an intrinsic part of a complex interaction among genes, drugs and mind."
everyone may respond to the clinical setting, but there is no reason to think that the response is always positive. according to some people's ways of thinking, the effect of clinical trial drugs is not constant but part of a complex interaction among genes, phenotype and mind.
all drugs have side effects, at least for some in the population. clinical trials rely on averages, statistical significance and law of large numbers.
...
"What if the Placebo Effect Isn’t a Trick?...possibly opening a Pandora’s box for Western medicine."
it isn't a trick. why it sometimes works for some people is the real question. i think that western medicine can continue to flourish nicely by recognizing the placebo effect, as many already have.
why not study effect of multivitamins and minerals--widely used pills that probably have some placebo effect at regular doses and definitely have some side effects at high doses--not just viatimin e?
1
Question for the authors: Is it correct that a percentage of the population is genetically predisposed to responding to placebos? If this is true then wouldn’t it be unethical to prescribe them other medications with side effects when all they need is a placebo? Which implies there maybe good reason to have testing available for such a gene?
Additionally, what is the impact of knowing that one maybe predisposed to placebos? Would that increase or decrease the effect of placebos?
8
How can I create electro-chemical impulses and cascades, just by thinking? How can I render inactive body parts active, just by using my mind? How does a thought start and when does it become physical, how does a non-physical thing lead to a physical, very evident outcome? I'm not spiritual in the least, but I think its becoming apparent there is no such thing as "psychosomatic" - there is no mind-body separation.
3
This is one of the better written articles I've read on this topic in a long while. Thank you for including it. The author (and researchers) don't mention the field of epigenetics - where our environments (or "nurture") actively affects gene expression (or "nature") and can be affected by our grandparent's environments. If our genetic expression is affected by both our current circumstances, and that of our parents (and their parents) it would make a "doctor’s bedside manner tailored to their genes" be nearly impossible.
6
Does the placebo effect work in other species? What is the animal model of the placebo effect?
10
Remember that imagination, along with perception, has something to do with the placebo effect. The question would be, do animals have the imagination which, coupled with the perception of good care provided by a caring person, serve as the conduit for the placebo effect?
@boognish How would one communicate healing intention to another species?
My dogs (and children) have been treated by homeopathy all their life..... other than broken bones (pneumonia and radiation ) we have not touched conventional drugs...). Hmmmm....... BUT finding a good homeopath is almost impossible and a visit lasts at least 1/2 hour and is not reimbursable.....
I think that there is also an anti-placebo effect. I go to the doctor with some vague but slightly concerning symptoms (or no symptoms if a check up); the doctor says I have X and suddenly I feel bad and/or worse than when I didn't know whether something was wrong with me or not.
This repeated experience makes me reluctant to seek medical help for anything the isn't 100% clear. Is it possible that the doctor saying I'm sick is actually making me sick or at least feel sicker?
30
This is called the nocebo effect.
4
Self healing - or placebo effect - accounts for much of the benefit of most medical treatment. The purpose placebo-controlled studies is to test for therapeutic benefits beyond the placebo effect. Any properly presented treatment will elicit the benefit of a placebo - but treatments that have been demonstrated to provide additional benefit offer the additive benefit of both. But no thoughtful physician dismisses the importance of marshaling both healing forces. This is the reason that "good bedside manner" is universally acknowledged to have a crucial role in the provision of the most effective medical care.
25
The distinction between mind and body is an artificial construct; in reality there is no such thing. Of course the body responds to chemicals in the brain, that's how it works. Whether these chemicals are associated with a cognitive, emotional or non-conscious process is irrelevant.
11
I am a baby boomer who was raised by devout Christian Scientists who did not believe in medical treatment. With one exception (when I almost lost my leg due to an untreated infection and my parents finally took me to a doctor), I did not have any medical treatment until I went to college. I have eschewed this religion because for a number of reasons, including the fact I have had lifelong impairment due to an accident as a child where I received no medical treatment . But, I have personally seen “healings” occur of documented ailments for Christian Scientists after prayer and positive thinking by the individual and the “practitioner”. I think the placebo effect described in this article explains some of these healings. Ideally, Christian Scientists and others would use multiple methods of healing, I.e. the spiritual, placebo and the conventional medical. The mind can heal, but in my personal experience, sometimes you really need an anti-biotic. I recall as a 13 year old who had been in excruciating pain with my untreated infected foot for six weeks that antibiotics were a miracle when within a day the swelling and redness that was moving up my leg was reversed.
27
“the F.D.A. had determined that the only way to sort out the real from the fake in medicine.” In what way(s) is the FDA, a system, and its range of professionals “infected,” and constrained, in their work by an either/or, binary banality, which could influence how “placebo” is considered.This national agency is underpinned by science-as-methodology. Evidence-informed as mantra.Mandated to enable, promote and sustain types, levels and qualities of health;however delineated. To affect diseases, whatever their etiologies.Processes. Prognoses and delineations.IT does not seem to consider the inherent, interacting, dimensions of reality: Uncertainties. Unpredictabilies. Randomness. Lack of total control, notwithstanding the types of efforts one plans and carries out. Alone and with others.In a timely or not timely manner. One time, or more. In the traditional, consensualized, “scientific” research paradigm one:Collects relevant data. Analyzes it. Appropriately. To achieve generalizable information-knowledge. Which is then, if possible, transmuted into needed understanding. At times, “wisdom;” using IT appropriately.In our daily world there is what is “factually” known. Which may not be understood. “Caused” by. “Associated with.” Exists/happens. Religiously-a miracle. Secularly- No one knows why! Accepted? By some. Many. All. There is also the currently unknown; gaps in needed information, technology, etc. There may also be the UNKNOWABLE, challenging human hubris.A placebo IS!
1
"The ability to hold two contradictory thoughts in mind at the same time..." This is the essence of Hegelian Dialectics, in which Thesis and Antithesis, struggling against each other in a proper, respectful forum guided by the principles of dialectics, give birth to a Synthesis. The Synthesis is not a compromise between the two, not a mishmash, nor a victory of one over the other, but rather something new, something true, that is discovered only by observing the clash of opposites.
The clinical trial paradigm is a scientific idiocy, one that prevents us from making any real progress against the most formidable diseases (cancer especially), because it (and the approach to drug development that it necessitates) is based on the assumption that only one or two variables are involved in a disease. In fact, scores of variables, clustered in networks, are always involved. The placebo is one of these variables, and more likely than not is a bio-electrical rather than a bio-chemical phenomenon.
Thank you for a most worthy article.
7
I feel that medicine as practiced today misses the point in a rather huge way. We are not individuals but conglomerates of trillions of organisms, kind of like mini universes simply walking together. Medicine seeks to caolesce each one of us to a macro machine quite like the kitchen sink. Till we acknowledge the complexity of each individual collective organism, we will be doomed to a medical practice that pretends to understand the body but is unable to pinpoint certain cause.
Medicine needs to instead change its focus and address the environment within each one of us and the environment outside. Then it needs to address how to balance a change in the inside, due to disease or the outside elements. We must research how to change the environment the disease thrives in, to change its outcome, instead of targeting single bugs. We have recognized outside environmental hazards and can take sensible steps to better our lives, we must use the same approach inside of us.
All these angles of placebo, drugs, it's all pointless. In the west, the philosophy is towards analysing each piece of the puzzle to such microscopic details, that with the passing of time, no one has any clue as to the exact picture they might be trying to configure.
4
Like the blind scientists describing an elephant from their local perspective.
By the same mechanism, loneliness and sadness can allow or even imagine illness. I couldn't help but think of all the drug ads we are bombarded with, suggesting symptoms to millions of otherwise "well" people who simply need the human touch, or maybe a dog. When drug advertising became legal after so many year of prohibition, it became a Pandora's Box.
I once told a friend who didn't think she could quit smoking, that the cravings would completely disappear after 3 days. And that's exactly what happened. I told her a year later that it was a complete fabrication on my part.
24
I quit smoking after a few years of heavy (~2ppd) use. Nicotine cravings lasted 48 hours. Hand to mouth relaxation response almost two years.
Interesting - there is much about healing that we do not know. But, molecular biologists going around thinking her acupuncture worked because of placebo affect is laughable. If she had bothered to do deeper research about acupuncture with an open mind she could have learned something. So what creates the emerging molecules? Hint, it’s the mind and the power of subconscious belief. It’s a pity we lack the technology to “prove” it to the disbelievers. We always will, as no technology is required, only a shifting of beliefs. The irony is rich here. Quantum physics is the closest science that is figuring out the mechanisms of how this works. For anyone interested i suggest the book The Self Aware Universe written by a quantum physicist.
1
”What if the placebo effect isn’t a trick” silly title of course it’s not a trick the placebo effect is stronger then any proven possitiv effect of psychiatric medicine. I apologize if the artikle states this but it didn’t seem to have any new information. Hope this cleared things up for you silly person who picked the title.
1
We have a clear functional knowledge of the laws of physics, and – consequently – a flawless understanding of how mechanical systems work. Example: an automobile transmission where gears interact in prearranged ways. We have numerous theories of how the mind functions, and – consequently – many approaches to psychology. Example: the origin of emotions and the nature of consciousness. (Note: Many challenges exist to explain free will.)
At a boundary level, we have biology – with an extraordinary number of variables and a nearly infinite set of permutations of interactions.
When we define the relationship between the body and the mind as purely involuntary, we reduce humanity to a collection of finite machines.
In a strict sense, this mechanical view is scientific. However, it does not appear to encompass the entire interaction between a practitioner of healing and someone who is suffering. When we limit our understanding to proof by valid and reliable experimentation, we may be excluding essential truths.
We are more than the sum of our parts.
1
@Arthur While I agree with your point, I would take it further: I submit that we don't have a flawless understanding of how mechanical systems work, and that any honest mechanic would agree. Obviously biological systems are more complicated than mechanical ones, but we don't have perfect knowledge of any system, even ones that we create.
3
There is no placebo effect. When a medicine is compared against an inactive placebo or nothing, placebo always = nothing (no treatment). Source: Kienle GS, et al. The powerful placebo effect: fact or fiction? J Clin Epid 1997;50:1311-8.
2
Magic. Religion. Science. Love.
All real.
5
In the good old days docs could actually prescribe a drug called Ceebocaps. They actually came in different colors. The first time I dispensed it to a severe hypochondriac I was morally perplexed, but not surprised that she was convinced of its wonderful effectiveness. Now we have a plethora of garbage that we consume convinced of its curative powers. Gabapentin, Lyrica and many antidepressants are my favs. When pharmacologists tell you we are not exactly sure of the mechanism of action then my mind goes back to Ceebocaps. Don’t get me started with politicicians.
4
This effect is not just about healing, but far more general. It covers almost any kind of performance that could be measured quantitatively. In particular, athletes would do the craziest silliest things, if they believe they would help them compete - and they do help. It is purely psychological, but at a basic level psychology is just a chemistry of the brain. So there is little doubt that some chemicals are indeed involved.
1
So is it possible that a person could become the leader of the country and convince the citizens that things were getting better all the time even if that person was doing almost absolutely nothing?
21
THIS MAKES SENSE. Think about it not in terms of medication but in terms of HYPNOSIS. Auto-hypnosis, to be exact. Some people are low susceptible to hypnosis and hence they must be the low-dopamine, low-placebo effect DNA people. Those minds are just a bit too suspicious and open to the existential pain of being. But the rest of the populace however are capable of being hypnotized and by virtue are quite open to suggestion. "Take this magic elixir, it'll cure all that ails you- except grant you immortality, give you hair on the top of your head..." People, by believing in what they are told, are just convincing themselves of a lie.
1
As a treatment seeker — Mind. Blown. This article is fascinating. Thank you.
...”the placebo effect is a result of the complex conscious and nonconscious processes embedded in the practitioner-patient relationship” seems to explain how I have experienced it. However, the modern day MD intent on his laptop database while he talks to you is not exuding the caring certainty that makes the placebo effect work. And we all know the database and the insurance companies are the real purpose of medicine, right?
3
At Kaiser the primary care MD is exactly that. Only the specialists actually touch you and talk to you, without the laptop.
1
See "The Placebo Prescription" NY Times magazine by Margaret Talbot circa 2000.
Doctors probably know that at least half of their healing success comes from wearing a white robe, being looked up to and making lots of money. None of these would be necessary if the pills were really all that counts.
2
The article treats an issue, difficult to frame. It is about a chain I am tempted (as a physicist) to describe as model – reality- model. There is a descriptive part of sorts, followed – we assume – by a real process in the patient’s body, followed again by a statement by the patient.
The word “better” occurs 11 times, the majority of which (7) in connection with “feeling/felt better” and “get(s) better“, followed by “perform-“, “works/worked-“, and “did-“. The latter seem more objective but they are not referenced and one fear they may emanate mainly from the patient’s statements.
In these times, where science is looked upon with skepticism by many, including your White House who points to “alternative facts”, I would like to promote a scientific interpretation of facts, which is not (necessarily) the same as a narrow-minded view as Prof. Kapchuk seems to think.
(I do this treating i.a. psychoanalysis and psychology in an essay “The principle of physicalism applied to a few example areas” I believe in good faith if I may say so myself. It is available on ResearchGate).
1
L'elisir d'amore - Opera by Gaetano Donizetti - “the elixir of love” - he drinks it (cheap wine) and gets the girl - check it out next time it’s at Met Opera!
1
One of the best kept secrets of medicine is it doesn't really matter what treatment modality you use, what matters is how the patient feels and that is very much a product of the interaction between the healer and patient. You can have the best equipment, drugs, techniques, whatever, but it doesn't matter, not if your doc is a jerk who hates you or thinks of you as a lump of dirt, which is typically the case.. Conversely, you can have the lousiest most ridiculously absurd quack methods and the patient gets better, but only because the practitioner was really really really good. They've known this since forever, it's why people still go to chiropractors and homeopaths or addiction therapy or whatever. But nothing has been done with this incredibly useful, valid, well-proven info because, well, there's a lot of money involved and a lot of lousy practitioners would be toast. That people would be better off is pretty much the last consideration, if it is considered at all. Given that medial costs will break and destroy us as a nation and society, possibly even as a civilization, I think we should be considering it. I also think we won't.
5
When will scientists stop treating 'the mind' as something independent of the body?
8
I certainly felt better after reading the article.
6
I wish the article had given more of a sense, in quantitative terms, of how great the placebo effect is.
"[M]ore than one-third of patients would get better when given a treatment that was, pharmacologically speaking, inert." How many would get better if left untreated? People often do get better, naturally. Regression to the mean.
The article leaves me unconvinced that the medical establishment is overlooking anything that would pose a fundamental challenge to the way it operates. And if the placebo effect is robust and pervasive, what difference does it make whether scientists fully understand the mechanisms by which it works? Say doctors can give us a speech that makes us actually want to exercise more. They wouldn't have to understand the neural basis of the cognitive mechanisms involved to see that it makes us healthier.
3
Perhaps, we have an opening for scientists to grapple more fully with a comprehensive understanding of being human. Just as there are mysteries in the physical sciences (dark mater & energy, a definitive understanding of the square root of negative numbers…), we may need humility to appreciate the complexity of the mind / body / spirit connection.
When we define the relationship between the body and the mind as purely involuntary, we reduce humanity to a collection of finite machines.
In a strict sense, this mechanical view is scientific. However, it does not appear to encompass the entire interaction between a practitioner of healing and someone who is suffering. When we limit our understanding to proof by valid and reliable experimentation, we may be excluding essential truths.
We may be much more than the sum of our parts.
1
As a retired psychiatrist specializing in psychopharmacology and the treatment of medically ill patients with psychiatric problems, I was aware of placebo effects from early in my career. It appeared initially in two ways: first, some patients given an antidepressant which should take three to four weeks to work if dose is adequate reported benefits early, often when they had experienced a minor side effect that suggested to them "the drug was doing something." So called "active placebos" are used in clinical trials today. Second, I began to notice that I often found, over time, that I got better results than clinical studies, suggesting that the time spent on 20-30 minute follow-ups with my boyish charm and charisma, unlimited, same day phone calls back to patient (I had call every third night) probably did something additional. I noticed people responding to doses that shouldn't work, people who took meds on strange (to me) schedules that they said were "the only way it works." Research with antidepressant medication has shown that they do help...but may only be lifting 20 percent of the load; once they start to work "something" (confidence or whatever) kicks in and adds a great deal more. So you needn't be concerned when you see the flawed "science" supporting Prevagen's jelly fish magic; it could help you feel better and perform better though I don't recommend it since research is scanty on safety. Alt. Medicine has a place in medicine...but beware, it is easily abused.
13
@Bobby You sound like you must have been a wonderful psychiatrist. I hope that there are psychiatrists today who have your humility and willingness to use whatever works for their patients, but I hear too often of 15-minute consults whose purpose is to keep people on meds indefinitely.
Of course place is are a trick, but that doesn’t mean the basis for the trick can be researched, understood, and even leveraged. It’s also just as unfair for placebo proponents to categorically claim doctors dismiss placebos as it is for us to dismiss the placebo effect; many of my colleagues and I feel the placebo effect can be valuable in the right setting. I wouldn’t want placebo instead of chemotherapy, but my mother as a girl was cured of motion sickness by Necco wafers (sadly now discontinued) administered by my savvy grandfather.
1
Fascinating article. Thanks to the author for such clear explanations and thoughtful reporting.
Two things came to mind as I read the article:
First is the idea that biological systems, like the human body, are analog in nature, subject to infinite effects that span the entwined spectrum of mind/body interactions. For example, at one end of the spectrum, if you break your arm, you need to immobilize it to allow the bones to knit correctly in place, and no placebo can replace the physical splint or cast. However, at the other end of the spectrum, once the arm has been immobilized, it seems that the speed with which the bones knit, and the pain felt along the way, are subject to placebo effects, arguably the latter more than the former. Moreover, once the cast has been removed, the subsequent physical rehabilitation phases may be very much responsive to placebo effects.
The second thing that occurs to me is how placebo effects, particularly rituals, play roles variously in religion and politics. For example, with religious rituals, you can start with the comfort that many people derive from regular attendance at their chosen house of worship, and continue all the way to rituals of faith-healing and so-called exorcisms. In politics, you have the effects of charismatic leaders, rallying crowds, and the subsequent belief, despite incontrovertible contradicting evidence, that their leader, and only their leader, can solve all their woes and grievances.
10
I have been a physician for many years. Before we had to chart on the computer we would have more time to speak and interact with patients. The computer charting takes precedence over the patient Dr. interaction. No Patient wants to be in the room when the doctor is typing on the computer as they speak with the patient. If you look where the doctors and thenurses are in the emergency room ,they are mainly at their computers documenting what they did which is what is required. You must fill in all the fields necessary for billing. The medical chart has become a billing and documentation form to make sure that if they were a lawsuit,you have documented everything. This placebo effect has been mostly reading moved in the settings. You only have a short time to interact with the patient or else you’ll end up spending many hours after the patients have gone doing your documentation. Therefore, there is little time for this powerful effect to be realized.i believe the placebo affect is real and it has to do with the Polyvagal of Stephen Porges which show the powerful effects of the warm smile and social engagement of the encounter. This is lost often in the way modern medicine is practiced, both for physicians and nurses.
17
As a retired physician who came of age professionally during the Paper Chart Era, now, with the emergence of The Electronic Health Récord, When I visit my PCP, it feel like there is a second patient in the room, Big Data. No doubt he is a treasure trove for research but a competitor for attention the patient should get. And for those who can, check your electronic record. I recently found 15 errors in my problem list and history that needed correcting. Never has any clinician at the academic medical center I attend, asked me to do this.
6
This calls to mind that when my PCP went to EHRs, to justify my taking a statin, she had to diagnose me with high cholesterol, when in fact, I was originally prescribed it from an previous internist as preventive due to family history. The consequence was much higher premiums back in the bad old days with insurance on the individual market. There is no way to "correct" what I see as an error in my record. The highest my cholesterol has ever been was 237 many years ago.
Along the same lines, everywhere else I've had my blood pressure taken, including other doctor's offices and an ER (!), it's low. Only at my PCP is it borderline high, but that's what goes into my record. Despite my best effort to call this issue with her equipment or the PA's reading to her attention, my doctor just dismisses it with "I'm not concerned about your reading." But I am, doc! This is wrong. And it could affect me down the road with our health insurance system and politics. Maddening.
4
@Anne Hajduk A friend of mine was pestered for years by his physician to take statins because of a high cholesterol reading. For almost a decade, he put him off. Finally, he agreed to do a CIMT test, to measure plaque buildup in his arteries, on the condition that the issue of statins be dropped if the results were good. His score was a zero; no buildup whatsoever. His physician still wouldn't let it go.
1
Does anyone know: Does the placebo effect work with self-directed therapies - maybe discovered on the internet - such as eating a certain food or tea? That would seem to remove - or clarify - the therapeutic care aspect of the treatment...and the theory.
1
I think that the placebo effect may be explainable evolutionarily:
Presumably, our ancestors' bodies had to continually re-prioritize their scarce metabolic resources between repairs (i.e. immune response, healing) on one hand and physical actions (fight, flight etc) on the other hand. Oral reassurance of support from others relieves pressure to allocate resources to physical actions such as defense and frees up these resources for repair, hence the placebo effect. If true, this means that a key target of medical practitioners should be to relieve patients' anxiety and related emotions that would make the patient's body allocate resources away from repairing itself.
21
thank you Gary, for writing such a thought provoking article. first hand experience with healing, medicine and state of mind have me understanding and appreciating many of the points made here by researchers.
1
" identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention"
This is simply the power of suggestion. If you hand her the same pill and say "there is no reason to believe this innocuous substance will help" that's a very different matter, and bad medical practice.
2
I've been saying this for years: the placebo effect is a red herring. It's a distraction along the pathway to healing. I know this from the thousands of failures I've made in my practice when I gave people the "right" treatment and they failed to respond. Why didn't more of them respond? I've also seen people get the truly correct treatment improve and get better, even after having been given numerous incorrect treatments without improvement.
Also, no one ever gets healed with the placebo effect. The placebo effect is merely an activation of the parasympathetic nervous system through reassurance, achieved also through acupuncture, sympathy, and other energetic systems that trigger the vagus nerve, and it produces transient symptom reduction, and nothing more. No one was ever cured by the placebo effect, or at any rate could be proved to have been cured by it.
True healing is an exceedingly difficult task, and far more difficult to achieve than the legerdemain of giving placebos. Sorry to rain on the placebo parade -- the human mind loves itself so much, it so much wants to believe in its own power to master the physical universe -- it never wants to admit its own limitations. This is why the placebo effect will continue to fascinate and inspire, in spite of its uselessness as a true agent of healing. The true placebo effect, I like to say, is thinking that if you believe the placebo effect exist, then it must (also known as magical thinking).
16
@Mark
Brilliant response.
So factually correct.
Michael, M.D.
1
May sound silly, but I was “cured” of plantar warts by the placebo effect. The doctor was very open about it. He told me he was going to paint some black stuff on the bottom of my foot, and even though it was not real medicine, the warts would go away because, on some level, I’d believe in it. I laughed, but the funny thing is that the warts did go away! It’s been at least 20 years and they’ve never come back.
5
@Mark My understanding is that there are people with multiple personality disorder who exhibit different responses, such as allergic reactions, when one personality manifests versus another. See Bruce Lipton's book The Biology of Belief.
2
As someone on the periphery of medical care for many years (I am a manager, not a practitioner) I’ve observed two miracle ingredients — Time and Attention. This is not a scientific study of course, but I’ve consistently seen that patients who are given time and attention from their providers do better than others. Unfortunately, the American push for efficiency and our messianic belief that technology cures all has made these valuable resources indeed. Perhaps part of the placebo effect is related to the positive human interaction that often accompanies its administration.
39
If my doctor chanted and played a glass harmonium, I'd be so tickled I'd probably cure myself. I wonder if I can get him to do that?
8
The fact that the "direction of the effect" goes in opposite directions based on genetics and the particular disease goes a long way towards explaining why people -- given the choice and an open mind -- will choose traditional medicine or alternative medicine, or a combination of the two.
2
On the chance that the researchers here don't follow marketing research - (as an evolutionary ecologist/behaviorist I do) - I want to bring a highly germane study to their attention.
Researchers at the University of Bonn - put identical wine into different bottles; with different price tags. Tasting was done- with fMRI. Result - not only did the subjects report that the expensive bottles (same wine!) tasted better; but the brain scans showed - the brain was perceiving, registering, higher pleasure.
For all intents and purposes; the expensive versions DID "taste" better. Not imagination; but belief and expectation- caused perception to change on the organism level. There would be no way to differentiate between a truly superb wine that tastes wonderful - and the experimental high priced bottle. Every scrap of your brain readout; which is where "taste" registers - looks the same.
https://phys.org/news/2017-08-expensive-wine.html
It seems very likely to me that medical placebo effects will have parallel aspects. Expectations- built on trusted input- cause altered REAL perception.
Medical placebo has the additional aspect that the effect can last for days, even weeks; indicating the brain is - likely chemically in part- signaling the entire body to regulate complex responses according to expectations. Then; over time- the brain perceives feedback is not as expected; and the placebo benefit "fades." So many factors! But you are on the right track!
11
The real question in this discussion that is mostly ignored is what causes illness and pain in the first place? A therapy only works, placebo or otherwise, if it shifts the patient's mindset from believing himself to be sick to being cured. Are bodies are constantly fighting imbalances and cancers. We are constantly healing ourselves from environmental and psychological damage. The biomedical model of 'rationality' currently does not account for the brain's roll in illness: how our perceptions of our pain and health have real consequences in terms of diagnosable conditions. Belief and self-perception play an integral role in every form of healing. There is no purely chemical mechanism that explains a drug's efficacy, despite the scientific community's explanations. The placebo is a phenomenon that makes a dent in biomedicine's universalizing explanations. Indeed, biomedicine works best when the science gods, the healer and the patient believe that biomedicine is the only truly effective modality of healing. The time has come for biomedicine to incorporate social interaction and psychology into clinical care, though as many have pointed out, patient-doctor interaction interaction has decreased systemically. In our consumption driven society, taking a pill or performing a surgery is deemed to be the only option. But the power of mindset, community, ritual, nourishment, somatic practice, and all of the other things that make us human besides consumption should not be forgotten.
5
@David Hedges
"There is no purely chemical mechanism that explains a drug's efficacy, despite the scientific community's explanations."
Wrong! If I treat a lymphoma patient with rituximab, I know precisely how and why that monoclonal antibody is effective.
6
@Thomas V Holohan M.D.
But does that explanation account for each patient's full immune response? Does it account for the interaction between the patient and yourself? What about the other effects that rituximab might have? What about the cultural setting in which the drug is administered? I am just saying that there may be more to the efficacy of the drug than simply the biochemical explanation.
@Thomas V Holohan M.D.
Further, based on multiple placebo studies, it is possible that if you theoretically gave a lymphoma patient a placebo, they would produce endogenous antibodies that combat the lymphoma cells.
If you realise that there is no such thing as "the body" and "the mind" (such are abstractions) and one does not have a body or a mind (one is rather "a human being" and "a person", the latter involving our higher brain and our acquired language-dependent self-understanding encoded therein in particular) then such is much easier to understand. WE ARE NOT JUST AS WE UNDERSTAND AND EXPERIENCE OURSELVES TO BE. WE ARE CREATURES OF A KIND, NOT OF OUR OWN MAKING AND QUITE APART - BUT NOT COMPLETELY REMOVED - FROM OUR PERCEIVING AND UNDERSTANDING SELVES.
Some have described this situation - ironically - as "our brain having a mind of its own", but really it's a reflection of who we are being primarily our alive and awake and functioning (or processing in time) higher brain, but our brain having other parts to which it is connected. Belief is a physical or higher brain (as well as mental) reality that can have physical consequences (on our lower brain and the rest of us) independent of our agency - just as we breathe without telling ourselves to do so. Go figure.
I would suggest if the placebo effect is a more potent force in the US it is because such is a domain of particular denial that one is more than one's self-understanding and indeed that one is primarily one's physical self. A person convinced they will be cured or healed is a human being already on the road to being cured or healed. Again I really must say: go figure. So now you understand how hypnosis works too -right?
3
A pleasant coincidence to read this piece while currently researching the Roman Baths in Bath, U.K. The site was a place of cult-like worship for centuries, famed for its curative waters and healing powers. Eventually, the power of the mineral waters was discredited by science: it was only because the water was hot that it healed. Yet the baths were one big, public placebo pool! People believed in the water, ritualised it, revered it. As such, it made people feel collectively, truly better.
6
'then what is to stop a drug company from manufacturing a drug — a real drug, that is — that activates the same process pharmacologically?"
These drugs already exist. Namely, MDMA and psilocybin.
9
“Oops, the medical community has been experimenting on people for centuries in the name of capitalism. Mea culpa.”
It's about time. I've been telling people "There HAS to be a chemical basis for it. What if that chemistry can be turned into a treatment?"
Really. All of the effects listed here have been known for decades.
Also known for decades, and longer? "Physicians" suffer hugely from what I call "Physics Envy." Since physicians once used to be - barbers; and physicists were professors- the MDs lust after the respectability of mathematics. We only deal in what we KNOW, they claim; never mind that that attitude repeatedly has led them to deny - the existence of bacteria that cause stomach ulcers, the reality of Lyme disease, and on and on.
"If we can't explain it, then it doesn't exist." is a policy historically proven to be total fallacy.
Ask any physicist to explain - gravity. It does exist, you know; and we know SOME things about it- but "how" and "why" - not a clue. And yet we still use gravity every day- it's what keeps your car and train on the ground, helps calculate the orbit and forces needed to keep communications satellites in the right orbit; makes the water actually drain out of your dishwasher- useful stuff, you know.
Fear of the unknown- so embarrassing. And incidentally, MDs - so VERY unscientific.
6
While I strongly agree that there is a whole host of important ethical dilemmas raised by our evolving understanding of these effects - I take issue with the "either/or" or dichotomous nature a lot of this has taken on.
The reality, particularly in our understanding of the human body and all that impacts its function, is that we will never know everything. Future research will show us that our understanding was wrong, or incomplete, or oversimplified; but that by no means warrants dismissal of that current understanding. It's the best we have.
Work like Kathryn Hall's is essential to that evolving understanding and its implications to how we practice medicine in future. I also understand Kaptchuk's unease with the scientific machine, but I think much of that unease is misplaced or misunderstood. High quality scientific research will continue to propel our understanding of medicine and health more than anything else possibly could - that's why it is so central. But this doesn't have to come at the expense of empathy, compassion, and relationship-building between doctors and patients. I'd argue that it's not the scientific mindset that undermines that type of relationship - it's our healthcare system and the pressures placed upon doctors (time, money, etc).
I can't speak for everyone, but it is that very combination of science and humanity that draws many of us to medicine in the first place. Good medicine requires both.
5
It seems pretty clear that the medical profession would not have maintained itself over the centuries if the placebo effect did not exist, given that until about a century ago, most regular medical practices (e.g., bleeding for fever) were essentially worthless, if not more dangerous than the illness. The smart physician followed Hippocrates (“first, do no harm”) and undertook as little active intervention as possible while cultivating an elaborate and authoritative bedside manner, similar to the rituals alluded to in the article. That was because most medical complaints were self-limiting and physician could essentially con their patients into believing they were helping them get better. The point of a diagnosis was to identify those ailments that were NOT self-limiting, so that the wise physician would know to tell the family (but not the patient) when the case was hopeless. The medicine prescribed in such cases would be essentially designed to make the patient feel better, with hefty proportions of alcohol or opium. In a few cases, the patient recovered, and the physician was then considered a genius. Considering the current addiction crisis in America, I have to wonder how much has changed.
7
Psychotherapy together with physical medicine is known by researchers to be more effective than either one separately. And the research shows that the common factor in the effectiveness of psychotherapy is the positive relationship between therapist and patient, regardless of what kind of psychotherapy is used (and there are many, many different models of psychotherapy.) However, behavioral and physical medicine doesn’t yet know how to maximize these factors.
3
If only we could give US voters a sugar pill instead of Trump !
7
Some experts disagree. They say that placebos have no effect. The apparent effect is no different from no treatment at all. In other words, sending the patient home with no treatment has the same outcome as giving the patient a placebo, because nature often cures disease.
See this article in the New England Journal of Medicine:
Is the Placebo Powerless? — An Analysis of Clinical Trials Comparing Placebo with No Treatment
https://www.nejm.org/doi/full/10.1056/NEJM200105243442106
ABC news:
Study: Placebos Really Don't Work
https://abcnews.go.com/Health/story?id=117429
3
This is indeed a tiny window in the world of allopathic medicine that is opening, albeit very cautiously. My 13 year old frequently points out that my lectures have little effect on him because of Xeno's paradox. Using the same analogy he asked me in wonder the other day when he fell and hurt his leg if his mind was responsible for the damage it was perceiving to receive. It really got me thinking, is it possible that anything in this world is curable of we dissassociate ourselves from this reality? Perhaps the way to health is by allowing all of us to go mad :-)))). Who even needs physical placebos then.....
2
This concept ties in with the work of Dr. John E. Sarno regarding the Mindbody connection.
3
A few years ago I pulled the original 1955 paper by Dr. Beecher while doing research for a book. I was investigating how the power of suggestion worked during the spread of popular conspiracy theories and rumors. In this context his paper suggests that about 1/3 of all people will believe whatever you tell them, and that the effect is very reproducible across the population. He also found that the effect becomes more pronounced when the object of the study is under stress. Thus, if you're going to tell a big fat lie to someone, then the lie will be more effective when the other person is under stress.
According to Beecher (1955): “Thus in 15 studies (7 of our own, 8 of others) involving 1,082 patients, placebos are found to have an average significant effectiveness of 35.2 +/- 2.2%, a degree not widely recognized.” “The constancy of the placebo effect (35.2 +/- 2.2%) as indicated by the small standard error of the mean in a fairly wide variety of conditions, including pain, nausea, and mood changes, suggests that a fundamental mechanism in common is operating in these several cases, one that surely deserves further study.” (p. 1602-1606)
Cite:
Beecher, Henry K. M.D. The Powerful Placebo. The Journal of the American Medical Association (JAMA). Vol. 159 (1955), p. 1602-1606
10
@W - you would be very interested in Dr. Carl McDaniel's years long analysis of how the Shackleton expedition survived. The entire story is in his book "At The Mercy of Nature", first recommendation on the back by E.O.Wilson.
He separates out and identifies multiple factors, one of them being "belief" - in something. That was extracted from the diaries; most (maybe all) expedition members believed firmly that some "Providence" wanted them to be there, and was guiding them.
McDaniel is a high-powered biologist (ask Wilson) - and finding that factor in this study led him to look at "survival value."
"Belief", per se, has genuine survival value; proven many times, over millennia. Which then led McDaniel to this statement: "Homo sapiens has EVOLVED - to be able to believe - anything."
He's serious. He's right. Give it about 100 years and that insight will be listed along with Newton's apple.
I believe. :-)
A book review here: https://littlebloginthebigwoods.blogspot.com/2016/03/recommended-book-at-mercy-of-nature.html
1
Is it possible that the placebo effect may have some relationship with quantum effects? In this case a condition may change simply because it is being observed or attention is given. The double slit experiment is probably the most famous example of this where photons exhibit qualities of either a wave (energy) or particle (matter) depending on whether or not the operation has been observed consciously. By the same reasoning, conscious attention given by a health care practitioner or healer, including treatment (real or fake) or providing or dispensing a bona fide medication or placebo could change health outcomes.
11
"What if the Placebo Effect Isn’t a Trick?
"New research is zeroing in on a biochemical basis for the placebo effect — possibly opening a Pandora’s box for Western medicine."
Nobody who knows what the word "placebo" means thinks it's a "trick."
What would that even *mean*?
5
Exactly. The whole headline is based on a red herring of what "Western medicine" is. The placebo effect was coined by scientific medicine. And my understanding is that it is a phenomenon that has multiple causes. It could be that a sugar pill, for example, reduces your stress response and promotes immune health. As one commenter said, it could also be that "time heals" and the placebo helps you perceive the pain less. The placebo effect could include only one of these causes, both, or none, depending on the disease being treated.
1
@polymath Yes, headline writers these days (as for the last half-century) are exceptionally bad, even at the Times.
1
Exactly how do you do a placebo controlled trial for the effectiveness of a placebo pill? Surely, for example, a trial that shows that acupuncture works when needles are not inserted shows that acupuncture is quackery.
How long before "alternative medicine" practitioners fraudulently claim "cures" for cancer. Surprise, surprise: it's happening now.
I note that all the "positive" results reported for sham treatments are only at the end of the trial, with no long term follow up.
Fake treatments, fake science.
4
“Your faith has saved you”.
2
I just want to say this is an excellent piece of writing on a fascinating topic. This is worth my nytimes subscription, thank you.
23
The problem these days is getting pure placebo. Most of the time, it is cut with stuff that does nothing.
69
@ThePB
This clever punch line is worth more than the price of admission. I will laugh for weeks!
Like the Towering Bore in Bored of the Rings, "I wish I'd said that!"
"You probably will," muttered Frito.
1
@ThePB - I love it!! :-)
1
The potential genetic underpinnings of the placebo effect were predicted several years ago by a biotech soap opera called "All My Clones." If you Google Placebolomics, you will get a BioWorld hit "Episode 28: Placebo Your Bets."
I suspect this will become the only healthcare most of us can afford soon enough!
2
Haha! So, pay hundreds of dollars to put a piece of GOOP jade stone in your private parts? Hey, it’s not fake medicine! You’ll feel wonderful! Just ask Gwyneth!
2
I would like to quote in this context F. Moinat in his book Le vivant et sa naturalisation: " The fact that the biochemical and physiological processes that compose the living being (le vivant) put to work the same natural laws and the same matter that does inanimate nature does not mean that the living being does not have an ontological specificity that comes out of the overall formatting of those processes." (My translation)
1
Important correction re chronic stress-related conditions responding best to placebo: generally true I don’t doubt. But OCD is chronic and stress related, and has a low placebo response.
2
As a practicing Acupuncturist for twenty years--who had sometimes effected "miracle" cures similar to that as described by biochemist Dr. Hall--I've also constantly considered the role of the placebo effect in my work. Or rather, how to maximize it's impact in each therapeutic interaction.
That Hall & Kaptchuk have identified COMT, and its role in catecholamine synthesis, is truly a remarkable breakthrough. But I share Dr. Kaptchuk's suspicion that there may indeed be other, as yet undiscovered biochemical variables involved in fully harnessing the power of the placebo effect.
It's curious that Dr. Kaptchuk, who thirty-five years ago inspired me to pursue a career in Oriental Medicine, should reappear in such a profound manner.
4
Snake oil always sells.
Feel good about it?
4
If the body can be persuaded to help heal itself by a positive interaction between patient and physician, then I wonder if there could be an obverse effect on the patient's health when the interaction is a negative one. When a physician enters a room without making eye contact, begins typing on a laptop while the patient sits half-naked before them, and prescribes without involving the patient's input, then I imagine the patient might feel worse and not better by the "treatment."
492
A fascinating article. I’ve been interested in this phenomenon for years and I see it in my patients regularly. With regard to the negative response, or expectation, to a healthcare system interaction (be it with a practitioner, procedure or otherwise) there is also the inverse concept of the nocebo, which has been around for a while.
33
The nocebo effect is the placebo effects slightly less known sibling, it basically works in the opposite way.
If you give people sugar pills and say they contain poison, some will display real physical symptoms of poisoning.
That's why the health professionals demeanor is very important regarding drugs and treatments. If someone in the chain subconsciously raises doubt by their behavior the actual effect might be lowered - even for otherwise effective treatments.
We have an responsibility to preserve the patients belief in the treatment (unless there is actual error of course).
24
This fascinating article led me to think of the children in Romania orphanages who were so deprived of human interaction / caring that the result was failure to thrive syndrome.
28
An excellent article. These findings come as no surprise to clinicians familiar with the work of Michael Balint who pointed over 50 years ago to the importance of viewing the doctor as the drug in clinical encounters.
While the evidence from biochemical and fMRI studies on the placebo effect will reassure and perhaps energize materialist, reductionist thinkers, please don't let it become commodified.
71
There was an episode of MASH in which they run out of medicine so they dispensed sugar pills. The sugar pills did help some patients.
Personal anecdote: I’m a swimmer. My right shoulder was hurting for a long period. Medical doctors were able to treat the pain but the problem was chronic.
One day my coach says I want your hands to enter at 10 and 2 not 11 and 1. After that the pain was gone. If you look at instructional swim videos or elite swimmers the hands enter at 11 and 1. I am pretty sure that I think 10 and 2 but what I actually do is 11 and I. Probably when I thought 11 and I, my arms were crossing which is well known to cause shoulder trouble.
5
Richard Bandler has long lamented that the FDA blocked his Placebo pills. They were clearly marked. Was even willing to have them as prescription only.
They apparently worked quite well for a goodly number of patients. Now he is also quite expert at hypnotic conversation and suggestion. (As almost all of us are at least occasionally, such as suddenly realizing in a fine conversation that we have been freezing for the last hour of it yet still talking, or in good sex.)
If we labeled them as such and the doctor told the patient that following her suggestions and for usage of when and how many, that might resolve the ethical questions and maintain patient respect.
Not specifically discussed is the patient who cannot stand touchy, feely medicine but prefers cold, intellectual, ‘expert’ doctors. Perhaps genetic? Would possibly interfere with the effectiveness of some medicines?
2
No money in sugar pills? What about the supplement industry? It's not big-pharma money, and not literally sugar pills, but plenty of money has been made selling inert supplements that are probably exerting the placebo effect on their buyers.
5
Here's a simple, uneducated hypothesis on placebo effect, just out of the blue.
When someone is ill, they are liable to become anxious. The anxiety causes a stress response within the body, releasing chemicals and hormones of a hundred types. The chemicals, though well-meaning, exacerbate the symptoms and the illness. A self-perpetuating cycle.
This person now goes to the doctor. The doctor says that this illness is not life-threatening. Everything is going to be fine. The doctor will prescribe a pill (placebo) to take once a day. This will cure the person.
Now the person feels less anxious. They have the cure in hand. The flow of stress chemicals and hormones ceases. The cycle ends, and the symptoms stop.
I wouldn't pretend that this accounts for all cases of placebo effect, but it does seem like many cases involve a mental component. By healing the mind with information and optimism, the body is no longer burdened by a constant stress and anxiety response.
12
My beloved mother, who qualified as a medical doctor in India in 1950, came to use homeopathy more and more in her later years of practice. We argued many times about its efficacy (I am a scientist) and why it worked as well as she claimed it did, and I always thought it was because she would sit and talk at length to her patients, take a detailed case history, sometimes ask about seemingly peripheral issues (homeopathic medicines are associated with symptoms, rather than diagnosis), a process that would bring issues to the forefront that a 10 minute appointment with your primary care physician rarely does in this day and age. I think this research is fascinating, and if a placebome can be identified, I hope it cannot be reduced to a set of biochemical markers that can be marketed by big pharma.
32
Can someone please file a patent on sugar pills before Big Pharma does?
2
A human can have an allergic response to a plastic flower. Mast cells degranulate and the cascade follows. Like sirens in the distance, Hope is a powerful motivator
1
Morality can be subjected to a scientific study too. Looked at from the evolutionary standpoint, it must have evolved because it offered some utility in the survival of humanity as a group or individual. Likewise the placebo effect. No belief in God or "an infinite reserve of wisdom and imagination" required.
Beautifully written article, BTW. This is why I read NYT.
5
Much of this article is interesting and informative. But Kaptchuk's belief that "the placebo effect can't be totally reduced to its molecules"-- that attempting to scientifically understand the phenomenon will "suck out what was previously there and turn it into science"-- is a paradigm example of the kind of confusion to which many proponents of 'wholistic' medicine are susceptible. We are biological creatures; ultimately, we will only completely understand the placebo effect when we understand the biological processes in which it consists. And we will only completely understand those biological processes when we understand their chemical basis. If there is a risk here, it is in assuming that, having discovered COMT, we've discovered the *only* pathway through which the placebo effect operates, or the only causal factor relevant to its efficacy. I seriously doubt that Hall is that naive, though some consumers of her work may well be. -Jake Zuehl
119
"We are biological creatures;" That is an identity-I AM- delineation. Which is your prerogative to make. Each of us creates our own sense of an "I." Others can and actually do also create and project valenced + -/+ - labels. There are many other interacting "Is": social. Somatic. Spiritual. Psychological. Economic. Political. Etc.etc. All operating with and within ranges of types, levels and qualities of behaviors, role-related, as well as not, in ranges of environments, contexts, networks,
"happenings," etc. As for " we will only completely understand:" Is understanding a static STATE, to be achieved or not? Hopefully humans will continue to ask the kinds of necessary questions which stimulate critical ongoing quests-inherent in helpful questions- which can seed, grow and harvest one of the potential outcomes of menschlich understanding: minimizing and preventing the range of human and nonhuman created pains and enabling equitable, well being for ALL.
4
@Jake, I agree with you except that I would remove the word "causal" from your statement. I didn't see any evidence in this article that levels of COMT have been shown to be a causal factor in placebo efficacy - only that they have been shown to be associated with differences in placebo efficacy. It may turn out that COMT levels are a marker for some other factor(s) that is(are) the causal elements.
1
@s einstein - There is the possibility of such a thing as "objective truth".
In which case, "we are biological creatures" could be a simple statement of fact.
I am not prepared to discount the possibility of objective truth, to be replaced by "Each of us creates our own sense of an "I"."
Of course, the "sense of an "I", itself may be part of objective truth but may have only a peripheral connection to the objective reality of "I", even though the sense of it may dominate our own perceptions of who we actually are.
In short, the sense of "I" and "I" may be 2 very different things.
1
Watch Derren Brown's Netflix special called Miracle and you will see the power of the brain, especially when he convinces people he is a religious healer. Our minds are the builder but they can also be the deceiver.
4
What would it even mean to say that the placebo effect is or is not a 'trick'? What is the allegedly interesting and contentious claim at issue here? That the placebo effect exists? No, everyone agrees that the effect is real. That the effect is mediated by some underlying physiological mechanism? Surely that's not news. No educated person thinks that the effect is magic, and somehow floats free of material reality. So what's at issue?
4
The homeopaths may get some effects because their procedures of dilution, mixing and pouring off can separate surface active molecules, which would include most biomolecules. If you know what to look for, real operations and real effects may be found. The fact that they are misled by attributing their effects to the wrong physics would not be a surprise at all, considering how long it took to understand electric and magnetic fields, atomic and sub atomic particles and quantum effects. Measure contact angle and be very careful about the surfaces of your containers and tools.
Also placebo effects can be negative, and so the introduction of screen or pad based medical forms which take the doctors gaze away from the patient can make a terrific difference in what the patient sees, and what the doctor sees as well.
6
Can’t make money off a sugar pill ? Just look at Nutrasystems et al!
4
There are some fundamental flaws in science's approach to areas that are beyond its grasp. When they seek to test a psychic's powers, for example, they create a test set up on their own terms, rather than one set up according to how a psychic's abilities work. They treat it as if it is mechanical, constant and abstract, which it is not. A psychic, or anyone, cannot determine what numbers will win the lottery or influence the numbers picked. But they might know who is going to win if shown a group of people including the winner.
Likewise, if the so-called placebo effect relies on what is called magic, or the hitherto unexplained realms, then ordinary scientific testing will always fail to explain it. There may be a biochemical basis, but that doesn't explain what directs the biochemical response. All people are capable of basic telepathy. When you watch a play, and an actor enters the stage with a clear and strong intention, you know what it is. Witch doctors have real power when they master psychic influence and manipulation of energy fields. Acupuncturists are able to control and influence energy fields in a patient when the patient gives over control to them. Energy fields are a very real and palpable thing, yet the only ones we can yet measure are the magnetic and electric, but there are more. When science admits what it does not know, then it shows wisdom.
8
Acupuncture works... but it does not matter where they put the needles. Well written, but wrong.
These researchers are finding a molecular basis for the placebo effect and the response to the healing interaction. We should be investigating whether some failure of that receptor explains a variant of patient I see occasionally in my practice (and on the comments to health care articles): the patient who seems not to respond to the healing interaction, and who experiences medical interactions of all kinds as profoundly frustrating and exacerbating of their ills. Every squeeze of a blood pressure cuff hurts: every attempt at a kind "how are you doing" from any provider, whether medical assistant, homeopath, acupuncturist, nurse or doctor, ends up being intrusive and triggering both conflict and suffering. These patients have chronic pain, inflammation, a variety of chronic illnesses, genuine serious problems; and interactions with providers make them worse at every turn. They present reporting a long history of an anti-healing effect from many previous attempted relationships with healers -- these can't all be the fault of "that jerk Dr. So and So." or even of our health care system, flawed as it is.
It is like an anti placebo effect. Would that it could be explained with a simple genetic receptor effect that isn't working -- because surely science can find a way around that.
1
@Ace J
Have you looked into Polyvagal Theory of Steven Porges? This may shine a light on your difficult patients.
This seems more a conundrum than it is . It is necessary to isolate the placebo before expecting to identify and measure it. Thus the answer is simple and surprisingly obvious: conduct a true double blind test of the efficacy (and perhaps safety) of the placebo itself. Double blind. With placebo control. NP, as they say.
So data proves there is something real and physical going on and it is time to attack data?
In an excellent article why is there no attention to the mortal threat that differential diagnosis addresses?
Many sick people have physical disease that if treated placebo faith healer style will kill them. Do the differential.
Just like a real doctor. What is the problem?
2
So. . .prayer works? We can will gods into existence? You don't need to buy a ticket to win the lottery? A circle can be squared? And, I suppose, despite what the Zen Master says, the world DOES exist?
HUMBUG!
Just want the drugs that don't work before their placebo effect wears off.
Wait, you mean the mind is what the brain does? How can that be?
What about the "nocebo" effect: a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.
Origin
1960s: from Latin, literally ‘I shall cause harm’, from nocere ‘to harm’, on the pattern of placebo.
Survival length from cancer may be affected this way.
7
I am surprised that there is no mention in the article--or in the comments, as far as I can see--of the ethical dilemma in giving placebos without informed consent. Most of the placebos mentioned in the article were dispensed in controlled trials, but once you get into a general clinical setting, there are clearly ethical issues.
Furthermore, there is some moral hazard that can make widespread dispensing of placebos impractical. If patients learn that doctors are giving out placebos, then they may have less confidence in other medications that they prescribe, and other aspects of the doctor-patient relationship could suffer, as well.
I'm not saying that placebos have no role in medicine, but I'm very surprised to see no mention of these issues.
107
@Gert What a strange way of thinking. You think that only medicine helps someone heal. You are completely convinced that the body itself can't heal itself.
6
@Gert
Yours is the most comprehensive comment on this page. Informed consent is a pillar of medical ethics, and ignoring same (or worse, outright lying to patients) should be actionable. Greenberg tries to skirt this issue with the "open-label" dodge, wherein a placebo response can be elicited and "you don't even have to deceive the patients." However, this dodge doesn't work: you still have to have the authority of a doctor/researcher and explain to the patient that "placebos are powerful medicine" -- in other words, you must still lie to the patient to prime expectation, the cheerleader effect, and patient desire to please (see Foucault). Every country doctor would love to restore the sugar pill to their armamentarium for treating the common cold and the "walking well." Doing so would mean a return to paternalism and victim-blaming and be devastating to the doctor-patient relationship.
9
@JSterritt, no. in my experience “informed consent” is — unless the patient has signed a consent form to participate in a study — lies entirely on the shoulders of the patient. I have seen this in my own medical treatment. My primary physician ran me through a long list of medications, over several years, in an attempt to treat some chronic issues. Each drug was presented as a “might help, so give it a try” option. There has never been any discussion of possible side effects, how the drug works, or even what I need to avoid consuming while taking the drug. A pharmacist is required to provide that information, but it’s still up to the patient to read and understand exactly what she is taking. So “open label” is not a “dodge.” We are all responsible for our own health. When I get a new script I always research it before filling the prescription.
16
Give me an atheist physician with a giant ego determined to practice evidence based medicine as taught and practices academically. Notwithstanding, healing is cognitive art however subject to peer review and criticism. The placebo effect is an artifact of the limitation of the scientific method and is a shiny object that teaches inquiry needs to improve.
2
There are reported cases of "spontaneous remission" of some cancers. This is a rare occurrence. What is less rare is that new cancer treatments often work very well for months or even years, but then lose their effectiveness for some -- but not all --patients. It would be interesting to explore the COMT levels etc. of patients who initially responded to a cancer treatment (chemo) and those who do not, and again if/when the cancer may return. Perhaps the lurking/quiescent cancer cells are mutating/morphing in response to changing COMT and co-factor levels. Patients given a series of chemo agents, as one and then another "fails" to beat back the cancer to effect a "cure," may be held in placebo-effect-mediated remissions for extended periods, turning their otherwise quick-killing cancer into a chronic condition that responds to the next new hope--until it doesn't. Seeing whether there's a correlation between duration of drug-response and placebo-effect chemicals might be useful to know to improve cancer-treatment protocols.
3
I am a physician and scientist who has been fascinated by the placebo effect. It is often looked at with derision in medical research and practice circles ("all in their minds"). In reality, it taps into the internal ability to heal oneself. Many physicians AND patients subscribe to the concept that the doc will provide the cure. I certainly did for a long time.
I have come to learn that the true role of the physician is to support the patient to allow him or herself to heal themselves. The placebo effect, or the internal power to heal (and prevent new disease) is absolutely HUGE. Tapping into that internal power would also prevent a lot of disease. Another implication of this recognition is that it puts a lot of the power and responsibility for good health into the hands of patients.
68
Such an interesting topic & I agree with comments that the article starts a long overdue conversation. At the beginning of the AIDS epidemic, behavioral & social scientists recognized the multi-dimensional nature of this new syndrome & the need for a multi-disciplinary approach to understanding its pathophysiology & treatment. The term “biopsychosocial” has since come to be recognized as an essential approach to all forms of chronic disease, & new studies reinforcing the concept that the mind and body are interrelated on many conscious and unconscious levels appear daily. So, to treat physical symptoms without attention to both the patient’s attitudes/expectations/beliefs & the importance of a trusting relationship with the provider is always suboptimal. It is thus unproductive to talk about “alternative” therapies administered by providers outside the treatment team, but instead broaden the concept of primary healthcare to be integrative and multidisciplinary.
A few comments to specific questions: There are established experimental designs that eliminate placebo responders by incorporating a phase when all potential participants are given placebo, & then entering only the non-responders into the placebo-controlled phase of the study, but these methods further limit the generalization of study results to a non-representative sample. And empathy, long a key therapeutic tool of psychiatry, has been systematically downplayed, to the detriment of our profession and patients.
12
When I was in solo dermatology practice for 40+ years, I utilized the well known power of the placebo effect a lot.
I gave the patients the appropriate medications, of course, but then often added a small dose of "shilling": accurate science delivered in a professional, but personal, way encouraging patients to take the prescribed meds, and the usefulness of the therapy.
In my office, incidentally, patients were seen and treated by me alone: no PA's, RN's or other such staff.
My method clearly made meds work better in some patients!
11
Undermining the assumptions of double blind testing seems to be hugely important, because it impacts all the other drugs too.
Assumptions are always dangerous. We can't examine them if we don't even realize they can be a question.
We've been assuming more than just placebo is inert. We've been assuming that all test subjects were the same in their placebo effects. Now it seems none of that is true, and we don't really know enough about it to adjust.
5
It's been shown that being subjected to constant stress can compromise the immune system as well as leading to self-destructive behaviors such as over-eating... Could things like placebos and prayers actually work by simply reducing the stress felt by the patient?
Like the overwhelming majority of living creatures alive on this planet, I've never practiced any religion nor have I worshiped the medical profession. Somehow I've survived these 58 years without any major illness and avoided thousands of dollars in expenses paid to "professionals".
8
Who was saying the placebo effect is fake? Various psychological-physical coupling effects have always been recognized. But telling people that specific medicines or treatment will be beneficial when they are not the critical element can be trickery or fakery, although in many cases practitioners are fooled themselves. Medicine needs to identity the actual elements which are responsible and find ways to take advantage of them without fakery. When there is reliance on non-scientific or pseudo-scientific remedies there is too much opportunity for exaggeration of effects and actual swindling.
Was there a placebo effect for taking a half-pint of blood out of your arm? Maybe, but we are much better off for recognizing that the "theories" behind this and other common remedies in use in past times was false. There are still many false "theories" of curing.
2
@skeptonomist
Many old remedies worked without understanding why. For some bizarre reason, an ancient soul with a headache tried chewing on willow bark...Eureka: aspirin! Fyi, Ye old "Bloodletting" in fact is still the ONLY treatment for hemachromatosis, but now it's called phlebotomy, exactly like donating blood, initially done weekly (or more!) to reduce toxic high iron levels which affect liver and many other organs. Fascinating genetic disease, 1 in 300 of northern European decent, often undiagnosed, appears midlife in men, later/postmenopause in women, for bologically obvious reason.
This is perhaps just my limitation, but I am having difficulty appreciating why Dr. Kaptchuk thinks it isn't moral to treat people based upon how we can come to understand how they respond to treatment ritual. Isn't the differing response to placebos another version of the idea of N=1 medicine?
Thank you for this facinating article. It raises possibilitiess for me on why I don't respond to the rituals of religious faith... maybe I'm not wired for it.
Placebo comes from the Latin placere. To please. Many people are suffering in ways that have no precise medical definition. They are lonely, desperate for human touch, needing compassion. That emotional pain can manifest as physical pain and depression, which are definable medical conditions. But a pharmaceutical solution for either issue will not address the underlying source of suffering, and most of the commonly used medications bring unpleasant side effects. So why not start with a placebo, paired with a sympathetic ear and a healing touch? If that doesn’t bring the patient back to physical and emotional health, then the next step may be drugs.
Healing is about more than chemical processes or cutting out diseased tissue. The entire organism needs to be considered. If I go to a gifted acupuncturist and find relief from pain, it doesn’t matter whether that happened because my chi moved through my meridians in a beneficial way, or because any needling anywhere has been shown to relieve pain, or because the practioner has a calming presence, or because I simply needed to be nurtured. If the acupuncturist prescribes tea pills that do no more than make me feel I am doing something good for my health, that element of belief is still beneficial to me. Isn’t that why we pop a multi vitamin every day? As an act of faith?
2
@Passion for Peaches Many of these patients are labeled with a diagnosis of fibromyalgia or myalgic encephalomyelitis/chronic fatigue syndrome. Some latch on to a belief they have Lyme disease or other infection that can't be cured. They will be sure to point out that there are no tests that are 100% accurate for Lyme disease. They search out doctors and naturopaths who are willing to treat them with year round IV antibiotics, chelation, hyperbaric oxygen and ozone.
Research long ago established that when it comes to psychotherapy, the key variable is not the therapist’s method, but the quality of the relationship they develop with the client/patient. This has always made sense when treating emotional issues and helping people develop better relationships, because the interaction between practitioner and patient could serve as a model as well as a healing corrective to past abuse or neglect. But perhaps there are other reasons that this relationship is key. And if the same is true for physical health issues, how will our current managed care model ever effectively treat many illnesses?
4
I couldn't help but ask myself about the role that ignorance had in the effectiveness of a placebo - it seems that for it to work one must be under the impression that something else is at play. Would placebo lose it's effect if we knew it was just that? How can we use placebo effect in our own lives... would it be possible?
@Vanessa Sepul-Azcarraga
"Would placebo lose it's effect if we knew it was just that?" YES!
It only works if you believe in it with all your GUT!
@Vanessa Sepul-Azcarraga
Some tests seem to indicate that a placebo can work even if the patient is told s/he's taking a placebo. This NPR article refers to another Kaptchuk study, published in the review, Pain.
https://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo
I think there is also some parental programming of body attitudes, whatever the underlying genetic makeup of the young organism. The parents, who "kiss every boo-boo" and go to the ER and the family physician too much, are coding their young ones to do the same and not see their bodies as strong and able to heal.
This attitude keeps getting passed down in families. The adult person, who can still walk and might gain from physical therapy, is prescribed a motorized chair.
I think this article just barely touches the tip of the iceberg of what we don’t know or acknowledge. We are so much more than dense, material beings. We have an energetic being that allopathic medicine and science seems determined to eliminate from the healing arts and carefully sift out of the scientific study of healing. I am a homeopath and energy healer - yes, one of those charlatans and snake oil salesmen. I would love to see clinical trials in which epigenetics were mapped before and after homeopathic treatment. Or before and after energy healing treatment. I think the results might be very interesting. It’s time to stop peering myopically at what we can “see and touch” and accept that we are much more than a physical body.
7
@Sandra Seaman
Totally agree. If a placebo is believed to be a cure , it triggers the "mind over matter effect". I am living proof of this. Years ago I was diagnosed with a 40-50% carotid blockage and told that the best I could hope for was that it did not increase, and that what was there would not go away. I started taking flax oil on the recommendation of a spiritual healer and within a short time the blockage disappeared never to return again even after 35 more years. I told a friend who was a cardiologist about this and he promptly scoffed at the idea. I told him that I really did not care if the flax oil worked or not but because I believed it did and that was why it worked. Also did a similar thing with a torn meniscus and was told it would have to have surgery. I said I will come back in 2 weeks and you can do another MRI. In disbelief they scratched their heads as I told them my favorite three words. "Mind over Matter".
4
I'm curious to what extent people studying the placebo affect have actually looked at the content of the placebo being provided to patients, especially if it actually is a literal sugar pill. Sugar's ability to produce a dopamine response is pretty well understood (and reported in this paper by Gary Taubes).
I'm wondering if "sugar pills" actually have more than a placebo affect on patients and what is actually being labeled a placebo effect isn't actually a mood-enhancement byproduct of the sugar itself.
1
@Mobocracy, but at such a small dose, the effect would be far less than that of consuming a piece of hard candy. Or a Tic-tac.
Effect, please, not Affect.
Pain seems to be where placebo play a greater role, because it has a lot to do with one’s own attitude towards pain: a scratch could send someone delicate screaming, while the same scratch would be shrugged off by someone else.
In a more clinical setting, it is easy to imagine that some people would overreact to say an mild chronic elbow pain. A doctor could read their patient’s attitude towards pain, and figure out that giving some fake medicine (or maybe some mild painkiller) and pretending that it will allow them to grow back some damaged cartilage will indeed have a better outcome than going through a lot of diagnosis, treatments, surgery and opiates, hoping for the pain to completely disappear.
The problem is that this approach requires the patient to trust the doctor to actually give them real medicine that works rather than sugar pills. Not only might the previous example not work as well if the patient doesn’t trust the doctor, but generally speaking the patient-doctor relationship does not really function when there is no trust, for many reasons. For example a drug might be actually working but the patient might not be noticing it, because a patient own diagnosis of how their condition is evolving is not necessarily reliable.
In short: the placebo effect depends to a large extent on the fact that placebos are not considered fair game in real medicine.
1
I explored homeopathy years ago and came to the conclusion that done correctly it is a very precise, effective placebo. I get annoyed when the “pro-science” community scoffs at homeopathy because of the lack of actual molecules in the remedy. I appreciate that researchers are exploring the genetic basis to the placebo response, and that it will be complicated to figure out. In the meantime, I hope the scientific/medical community is willing to explore patient outcomes to various alternative treatments with an open mind and not disparage the treatments because the traditional mechanism is not consistent with current scientific understanding. I had my elbow fixed with a single acupuncture treatment, and went on to learn acupuncture and successfully treat many patients with a single treatment. I was really surprised how effective it was. I think acupuncture is a way for a healer to talk a patient’s nervous system into fixing itself.
6
@Diane Acupuncture and homeopathy are two very different things: homeopathy has been proven to have no physical effect beyond the physical effects caused by people’s own perception of their condition. The fact that homeopaths (people who have studied it and prescribe it) deny it and talk non-sense about things such as water memory (that you can easily demonstrate does not exist) actually hints about the fact that they are disingenuous.
Acupuncture however has some direct physical effect: the needles stabbing you are real, it is just that we do not know what they are doing when they seem to be working. You could in theory demonstrate that it works for certain conditions (and that it doesn’t for others), the problem is mainly to get a proper scientific process to assess it, since practitioners do not work with consistent methods that depend on objective realities, but rather on intuition and imaginary concepts such as “energy flows”.
The “science community” is not just one side of a debate, with their opinion against the one of homeopaths and acupuncturists. They are people who only consider what can be demonstrated. If you demonstrate them that homeopathy or acupuncture or astrology work, they will be onboard. The problem is that if your demonstrations are full of holes, then obviously they will be ignored.
4
@Bob Robert. what I learned about homeopathy is that the homeopath takes a really detailed history and plugs a person into an archetype. The person gets a ton of attention, then is given a remedy that is tailored to them. From the patient’s perspective they are getting more than a sugar pill, they are getting a sugar pill that fits their unique personality and quirks. It is more skin to 5 element acupuncture than standard TCM. My point is that science should stop judging what tradition says is the mechanism and just focus on what science is good at, looking at results and how it works. This is a really interesting topic, I’m glad the N.Y. times is covering it.
1
As I read this article I kept expecting to get to the part where the scientists suggest all patients get offered a placebo as a first line in those conditions which have been identified as sensitive to placebo treatment. Pharma may no profit from sugar pill research, but the health insurance industry may very well.
3
I'm curious if any effort has been made to correlate drug effectiveness with noticeable but well-tolerated side effects. I would think such drugs would defy some of the attempts to control for the absolute placebo effect since patients can feel the side effects and may correlate side effects with effectiveness.
I also think this plays into opioids for pain relief. While I think the biochemistry suggests that opioids actually do reduce pain, has anyone ever considered that the euphoria effect (considered generally a negative due to its contribution to addiction) may actually be nearly as valuable as the pain relief? It's something like the placebo effect because it doesn't technically block pain, but the mood elevation it achieves may actually contribute to well being which reduces felt pain.
Maybe in the rush to develop new, addiction-resistant pain medication which does not have euphoria as a side effect will prove frustratingly elusive as it doesn't make people actually *feel* better.
1
@Mobocracy Your curiosity is in good company. Some small amount of research has also gone into looking at the nocebo effect, that is, the side effects that some people experience when they receive a placebo. It's the flip side of the beneficial aspects of the placebo effect, when a placebo seemingly makes symptoms worse, or causes side effects.
1
@Mobocracy, my experience with opioids is limited to treatment for acute injuries (broken bones and ripped ligaments, mostly), but for me the opioid sensation you call euphoria was more of a cozy feeling. A warm, happy blanket of pain melting away. It is 100 percent a physical, chemical process. Yes, it doesn’t block pain, but does change how your brain perceives it so the pain dissipates. Addiction is a different — or perhaps I should say more complicated — channel. That’s why addicts need more and more drug to keep getting the kick. After a while, they are treating the habit, not the pain (that is, if they started on the drug for pain).
I take sumatriptan for migraine. It works by stimulating the seratonin receptors in the brain, so when it kicks in I get a brief sensation that is somewhat similar to that of an opioid. Like an opioid, it changes perception of pain, but does not block it. I feel my intense pain draining away, and my muscles relaxing (my entire body tenses when I am in a full-blown migraine, and my neck muscles spasm). I get that same warm, comforting blanket of relief. But that only happens when I take the medication while in a full-blown migraine. If I take it when I feel one coming on, all it does is stop the cycle. No warm blanket. But I still feel better.
1
I wonder if you have personal experience with opiods. I am a prescription user, and have never experienced anything like euphoria, not even the slightest happy feeling, just some moderation of chronic pain.
1
Few things in life are absolute. Christian Science used to treat diabetes will have a fatal outcome, but it might provide great relief to migraine sufferers or help to ameliorate certain kinds of heart disease.
We lost a lot when shamanism was marginalized and scorned by practitioners of Western medicine. There was a failure to understand that the language of metaphor could be as exact as science. Isn't being infected by a bacterium equivalent, in effect, to being possessed by evil spirits? It's just a matter of applying the right tool to exorcise the evil.
The treatment provider who makes clear that he or she hears you and understands your distress--physical and mental--will help your body best respond to whatever treatment is rendered. But our insurance and coding-based system of treatment delivery is the very opposite of caring.
Yes--it's expensive, in terms of time and emotional involvement, to provide the best care.
6
@SCA
Ah, expensive. Continuing to mine coal is expensive as well, but it "creates jobs!" Maybe the way to sell care-based medicine it to say it creates jobs.
1
@s parson
Sadly there is a shortage of physicians.That needs to be solved if we decide to make more and better care available.
The placebo effect allows an economy of medical fraud. Though the fraud can be unintentional, as when people sell alternative medicines they themselves believe in, it is still a disconnect from reality, and manipulates people to invest money in certain ways according to belief, as well as influence how they may think about things in general. That some people are more susceptible to the placebo effect than others, whether because of their genes or their imagination, doesn't make any difference. Using double blind studies to determine actual effects of drugs makes perfect sense.
3
@Brian Wood: Using double-blind studies to determine the actual effects of drugs makes perfect sense, unless the studies don't actually reveal the actual effects of drugs. As this article describes, the actual effects of drugs may be masked or enhanced by the placebo effect. It seems increasingly likely that the differences in placebo responses among drug recipients need to be taken into account. With that additional information, double-blind studies may yield accurate, reliable, and useful results that would not be obtained otherwise.
3
@Brian Wood
We appear to have a nation well disposed to fraud. Think of the 2000 election in which counting every Florida vote was too time consuming and "unfair" to the brother of the Florida governor. Think of the invasion of Iraq based upon weapons of mass destruction that no one could ever find. I could go on, of course, but I am guessing you get the point.
Today the press would have us believe that there has been some victory in taking the House from the party headed by an admitted fruadster and documented liar.
What is the placebo effect in voting?
@s parson
It’s too soon to tell whether taking the House back will have real effects or not.
1
Take care. Eh?
“Take the time to deliver that message with warmth and close attention,” describes effective medical treatment and psychotherapy. Edward Johnson explains what evaluators have known for a long time: empathy trumps objectivity every time. https://theconversation.com/the-surprising-secret-to-successful-psychotherapy-104301. Of course, medical doctors who show a caring “bedside manner” foster better health in their patients.
The corollary is that medical physicians who score low on an empathy scale may foster unremediated symptoms. This argument recapitulates decisions made in the mid-twentieth century when North America adopted public health systems. In Canada, psychotherapy and dentistry were excluded from health care coverage. American health care – driven by insurance bureaucrats – altered the system by including different practitioners on and ad hoc basis. Canadian psychologists have been excluded from medical care, at least partially to re-assure MDs of their place at the top of the health food chain.
Professor Kaptchuk’s worries unnecessarily about how his (and Hall’s) research will change medicine. Changes may impact health care providers, but he can take assurance from his underlying goal: “I want to know what heals people.” Healing has to be our overarching focus.
2
Well, I recommend you (yes you) get your hands on The Magnesium Miracle by Dr Carolyn Dean, drink yerba mate everyday and get a medical marijuana prescription (for whatever ails you). You will feel great, lose the weight you want, be pain fee, and have fun all at the same time! I knew it was real :)
1
@hear I am
You have never encountered a patient with a magnesium problem, have you?
2
We all know thoughts have physical effects, (for example the popularity of porn) and and physical substances affect thoughts (examples use of alcohol or other substances of abuse).
Thus we need to reject dualism if we want to perceive the truth. This article seems to be written from a dualistic point of view, which causes great confusion.
4
exactly why the Osteens, Joanie's and Tammy Fay's have an audience. Religions invented their cures with absolutely no proof their drug, god exists. But if the converted are better people for it, and not just zealots, pray your brains out.
Any reason to think they are better rather than worse, for it? Maybe it should be tested. Double blind of course. With placebo. Good luck!
@D
They’re better? but broke from donating what little they have to allow their “saviors” to live in luxurious splendor?
1
Brilliant essay: more please.
3
Truth be told, illnesses like irritable bowel syndrome and fibromyalgia should respond very well to placebos because those illnesses have a huge psychological component attached to them. That is plain and simple. Tried on somebody who has pancreatic cancer and watch them die.
11
It's well established that "expectation", positive or negative, has a real effect on outcomes. Even the same drug (colored differently), dispensed by a doctor with a positive or negative prediction, has different effectiveness.
I actually had a TM on "The Placebo Remedy".
On the other side of the spectrum, curses and evil spells also work.
8
Being raised in the humanities, with a low IQ in the sciences, I've never been worried that science will despoil the less understood aspect of healing, i.e.," imagination." I do believe that molecules are at the foundation of life (biologically, of course), but the more science tells us, the more the mystery is multiplied.
If a placebo effect is studied, I'm convinced the more two things will happen: we'll learn more 'important stuff' about the physical/medical world to help people (or so I hope!) and the more we'll discover creatively that we'll have to attribute to what we don't know: mystery, mysticism, spirituality, etc. It's as though science is the plumbing, and mystery is a gorgeous fountain with the water flowing and sunlight through the plumes and the artist trying to capture it all in oils.
The human 'touch' of engagement, 'drama,' voice, eye contact, empathy -- that's what's healing here in the placebo effect. When doctors are forced to devote five minutes or less per patient now, empathy is not even molecules, to say nothing of an empathetic bedside matter. The pharmacy clerk might be more likely to give you a quick smile when checking on your insurance when you pick up your painkillers....
4
Any physician who has been in practice for more than a few years will tell you that medicine is more of an art than a science.
At least, if they are honest they will.
I have practiced medicine for over 25 years and long ago realized that our artificial separation of mind/body does not mirror reality.
Truly, real healing, in my experience, does not come from gobbling prescription patent medicines. Not only do all of these pills have unwanted effects ( euphemistically called side effects) but they work on the premise, which is bogus, that we are no more than a bunch of biochemical interactions.
Patients need to take back their power and realize that the human mind, for better or worse, is the milieu in which we live. We can speak to ourselves, encourage ourselves or, as is often the case unconsciously, discourage ourselves.
What some call placebo I call reality, how the human mind really works.
The idea, as the heading of this article states, that " new research is zeroing in on a biochemical basis for the placebo effect" shows, once again, just how limited the thinking is of those who believe that everything can be reduced to chemistry.
Think for yourselves, people.
82
@simon sez Appreciate your honesty, doc.
Western medicine emphasizes external force ( like drugs, surgery, implant) to fix body's internal problem but fail to mobilize the internal power (homeostasis ?).
In many cases, it is about coexisting with the condition, not about conquering. It is about adaptation.
I see the same problem with our politics.
So not organic.
1
The cost of drugs in the US means that fewer and fewer people can afford medicine. The placebo effect may become again the medicine for the poor.
This is what the Church of Christian Science was doing last century, incidentally. Now they as well as magicians and faith healers of various backgrounds can use the emerging science to do a better job of healing the poor.
5
Kaptchuk wants to think that there is an eternal spirit in people quite independent of their physical existence that accounts for the placebo effect. It’s Descartes’ crucial irrational presumption that was pretty necessary to avoid being badly treated in a time when most people still believed in supernatural forces at work in the everyday world. But it does appear that aside from his own magical thinking he has uncovered a whole new area of inquiry that will benefit human knowledge, including those skeptical scientists.
I tend to think of myself as a strict rationalist, and I have little time for the explanations offered by "alternative medicine". I don't doubt, however, that some or even much of what they do works, albeit for reasons probably more closely related to placebo than their own traditions.
The notion that the act of healing and caring is directly implicated in the outcome for the patient is very appealing to me. Nevertheless, I doubted that we could ever find a "rational" explanation of how this could work.
And then, some years back I came across some utterly amazing research work:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682215/ "Epigenetic Mechanisms and the Transgenerational Effects of Maternal Care"
To make a fairly long story short, the author proposed an actual biochemical mechanism by which the style and level of maternal care among rats could alter the maternal behavior of the next generation.
I mention this only to point out that many people, even many biological and medical scientists, still have an overly simple view of how living systems (including humans) work, and there are likely mechanisms whose complexity, and grace, will astound us as we uncover them.
Healing care promotes a biochemical healing response in the patient? Is it any harder to believe than the idea that rats licked by their mother will go on to be better mothers? We may understand a molecular mechanism for this, and so why not placebo healing too?
269
@Paul Davis: Until recent decades physicians had very little trully effective medication at their disposal. Even so, people, who were suffering and declining, often perked up and recovered after a visit by some reknowned physician. What else could that have been but placebo effect?
3
@Paul Davis placebos don't heal. Healing comes from health, not from treatments.
1
It's amazing! I feel better after just READING this!
No, really, this is an excellent article- thank you.
29
Big tobacco has “abundant evidence to prove it” that smoking doesn’t hurt you. Big Cola has even more evidence that drinking soft drinks every day doesn’t make you overweight. And of course Big Pharma is on the level about all its products. But sure I’ll believe these guys cause their evidence must be the real deal. And it’s “abundant.”
1
Where is mention of Daniel Moerman’s classic Meaning, Medicine, and the Placebo Effect, published all the way back in 2002? The idea that there is a single biochemical cascade represented by “placebo effects” seems almost as ridiculous as presuming that the effects of placebo in RCTs *don’t* reflect the biochemical complexity of psychology, which plays out in our neuroendocrine-mediated immune, inflammatory, and metabolic responses.
2
It's wonderful to see a door open, even when yesterday the door was not there.
3
I am a firm believer in the placebo effect. That's why whenever I go to the doctor, I ask him to prescribe the strongest placebos he has.
Seriously, though, when placebos positively impact a significant portion of the trial population, that's a clear indication that there's an effective path too valuable to be ignored.
5
The article came close to, but avoided, any mention of prayer circles. And if you read the Bible, it would seem that the laying on of hands, or perhaps the suggestion of healing from a spiritually connected being [Jesus] could cure people.
Today, I would hope that the will of the people could heal our president. But that might be expecting too much.
6
@Don Reeck
That IS expecting too much.
2
It used to be called 'bedside manner.' It's gone out of fashion with the increasing role of insurance companies, corporate hospitals, physician assistants, and medical malpractice and ambulance chaser lawyers etc.
12
Let me know when placebos work on a bacterial infection.
3
@Mitch4949
We may all get bacteremia from time to time, but our immune systems fight back and it goes nowhere. Clearly our general state of health and what we do when we feel bad...sleep more, drink and eat our personal prescriptions for getting well, a day off work...are not MD pharmacy orders.
2
The result of treating gonorrhea with placebo is gonorrhea.
Treating syphilis with penicillin G benzathine has nothing to do with the attitude of the person being treated.
This is the beauty of antibiotics. I
This is a wonderful exposition of the "mind over matter"debate and a hope for the pain and suffering of bodily ills that may soon be relieved by the placebo effect, the mind's powerful remedy over the pain! Thank you.
3
Excellent article. Nicely structured and well written. I learned a lot from it. Thank you!
3
Real science is frequently warped to suit the needs of those wishing to exploit new findings and trends for profit. (Think of our ever-evolving food pyramid.) Faith-healing charlatans and anti-vaxxers will have a ball with this one.
In other words, placing more value on 'warmth' and placeboes in medicine may create better treatments and environments for our sick and injured, but placebo effects should be carefully researched. All limitations and exceptions must be emphasized.
3
I must live in a different country that the author does. In my country our health care is the third leading cause of death and the number one cause of bankruptcy. It also is responsible for creating and maintaining the opioid crisis and they are a direct line to our vile justice system. There exists NO reason to outright trust any of our doctors until things improve a lot. You can do all the studies you want but note all studies fail to include the abysmal state of our quack health care system which is getting worse not better.
18
“Especially if you take the time to deliver the message with warmth and compassion”...no doubt, this where Medicine has lost its way, whether placebo sham or “molecules”. If you pay the doctor on a per hour basis less then a massage therapist you get, well, what you got, which is sick.
This is a classic snipe hunt.
Combine weak correlations on a bunch of unreliable tests (fMRI, GWAS, metaanalyses of underpowered studies examining subjective phenomena, etc.) and you end up with a Rorschach. People will see what they want to see. Just wait until you read the rest of the comments to this article…
1
One more example of materialist science's inability to make the simple distinction between means and causes.
1
Wonderful article on a difficult subject!
1
The healing rituals of native peoples the world over might prove far more effective than science had previously assumed.
2
It makes sense in the evolutionary way that the placebo effect can heal. For most of human’s existence there was no FDA or great surgeons to help the sick, only plants with healing properties and those like shamans who made a show of healing without any real medicine, but our bodies evolved to allow us to think we’re being healed because that’s all we had. There is nothing fake about this, it’s how we’ve survived all these centuries.
3
Benny Hinn et al, rejoice. Science has come around to the notion that Faith Healing just might work!
1
We can change our body chemistry with our thoughts. Why is it so hard to accept the placebo affect? Maybe because we call it placebo, instead of the name of a proper healing method. An Ancient Greek healer Asklepios built a retreat center in the hills, where Greeks came to heal. He insisted that theater, exercise, diet, and peaceful surroundings were necessary for healing. He also administered medicines and surgeries. When Hippocrates came along, Asklepios’ was diminished. Now we in the west are locked into a regressive healthcare system by corporate insurance interests. The human body has many natural healing mechanisms if we only encourage people to use them.
12
A fascinating read!! Hope Family Village is rooted in acceptance and caring, with implications for how we view our goal.
We are caregiving families who have loved ones living with us who have been diagnosed with a serious mental illness. We have become completely frustrated by the system, which is nothing more than acute care, stabilization, re-hospitalization at tremendous family (and societal) financial expense. To what result?
Some 8.4 million family caregivers suffer like their SMI family members. Not exactly in the same way, but similarly. Their life expectancies are shortened from their suffering.
We have been gathering best practices, from around the world, for four years now, to create a community design. Ours is an experiment that will depend on the commitment of 25 caregiving family residents. We are turning to ourselves for mutual support, not depending on the mental health care system to solve our problems. Live our lives for us.
Two basic models and practices that we will incorporate are cohousjng (188 communities nationwide) and Fairweather Lodge (100 homes in regular neighborhoods). The first project will be located at Eastern State, nearby the oldest mental health hospital in North America.
Over time we expect that our country, with this new generation, will finally address mental health care as an advanced society should. The irony here is, We can probably learn much from the least advanced societies, where their survival depends on caring.
4
Some people get better, or feel less pain on their own (otherwise we wouldn't be here). Separate from that, placeboes can have psychological effects, such as relief of anxiety or feeling cared for, which can reduce pain. But placebo will not stop a genuine, potentially fatal bacterial infection or manage cancer. Most of the article is not new info. A little bit of historical interest. Low on real science (fmri does NOT = molecules). But unfortunately; confused, unscientific thinkers use placebo studies to bolster pseudoscience.
2
This was a good article, but I'm surprised that the author made it through several paragraphs on Mesmer without mentioning that the word "mesmerize" comes from his work. It's a nice tidbit to throw in there.
6
Is this why brand name drugs work better than generic?
@Peter Persoff From the article: "Give a drug a fancy name, and it works better than if you don’t."
2
Of course there is a biochemical basis to placebos. Of course there are brain events when they work. Where else but the brain is belief supposed to exist? How else can the mind affect the body? It is obvious that placebos work in the mind, which affects the body. Though they may this be described in detail, that doesn’t mean that they are understood. We are embodied consciousness, as Merlau-Ponty said. But scientists who think they have reduced the mind to the brain are mistaken!
7
Great article and perspective...The real question is the predictability of health improvement by the intervention. All else is wonderful science
1
What a brilliant article! It's a pleasure to read something from a science writer who is fully equal to his subject and able at the same time to communicate so clearly, ably, and yet subtly with readers. Bravo--I hope to see much more from this writer in the future.
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@John
He is NOT a science writer, nor does he even understand the scientific method. It’s a “brilliant” piece of philosophy, nothing more.
1
An important fact mentioned but not emphasized by the article: The placebo effect is _not_ a panacea. Some medical conditions are amenable to placebos, others are not. I don't think cancer is ever going to be cured by placebos.
9
@J. Wong: I agree. Neither will a broken leg mend properly without a cast!
I can comment though, on one thing -- I have had irritable bowel syndrome (IBS) for almost 40 years now. It started right after college graduation, when I faced incredible stress and pressure trying to find a job in down market & recession...with my parents almost cruel in their anger and pressure they put on me (Depression babies, they believed a college degree BY ITSELF guaranteed someone a high level job!).
On top of that, I found out my dad had A. cancelled my auto insurance coverage, right before I drove 2500 miles home from college and B. secretly for 3 years had taken out thousands of dollars in college loans, in my name, by FORGING my signature.
The stress, anger and depression were incredible, and the result was...IBS. I can only imagine how, back then, a compassion doctor who gave me a "magic pill" might have relieved my stress and misery -- just a KIND WORD from anyone would have helped at the time. (There was no treatment of any kind for IBS in the 80s and I had no health insurance anyways.)
BTW: this is also why when we are sick....a bowl of hot chicken soup served to us, gently and lovingly, actually makes us FEEL better. It's not the SOUP itself. It's the compassion and kindness that works.
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@J. Wong
Cancer isn't one disease and some cancers may either be caused or made worse by stress hormones like cortisol or inflammation. If the placebo effect can reduce these cancer-causing or worsening effects, maybe existing therapies become more effective or in some cases it becomes a "miracle" cure.
1
@J. Wong
Perhaps cancer won't be cured by placebo alone, but cancer treatment delivered by care providers who have the trust of the patient likely do respond more successfully to the treatment. That is placebo at work too.
I was in a double blinded randomized clinical trial at the NIH almost 40 years ago where people having their wisdom teeth removed were given either pain medicine, placebo, or nalaxone to answer the question of was the placebo effect mediated by endorphins.
The answer was yes since those in the naloxone group had more pain.
But what about outcomes which are not subjective? How much evidence is there for a placebo effect in cancer patients?
If folks were really taught to appreciate the essence of life science as communication within and among the myriad information-processing networks within and among cells, the truly marvelous capabilities of an organism, human or otherwise, for self-regulation and self-repair would reconfigure "placebo" to "biological capability."
15
Fascinating. However, I reject the alleged dichotomy of "science" (here also described as "molecules") and "moral medicine" -- whatever that phrase denotes. To me, what we have here is scientific curiosity about actual effects -- those of caring, receiving attention, expectation of good effects, whatever -- and how they may vary among patients depending on, among other things, their genomes. Most of us know from experience that some people experience biological effects that certain drugs appear to cause, without actually applying those drugs. The same scientific method that did not refute the idea that the drugs caused the effects can and should also be used to explore the observed phenomena and, hopefully, come up with a fuller explanation.
Can the path of a ball dropped from the Tower of Pisa not be affected by wind?
2
@joel bergsman
Please understand that Galileo’s demonstration was a physics experiment to work out the math of mass and velocity. Wind was irrelevant.
Thanks for a great article. Medical training needs to broaden its approach.
3
The mind is a physical entity, part of the body, and the body responds to it. We ignore that fact to our own detriment. That has been clear for a long time. This is why chronic stress is so physically damaging. This is why elderly people with relaxed and happy attitudes tend to live longer. This is why when elderly people lose a beloved spouse they often die shortly thereafter. This is why premature babies when allowed to have their mother holding them as much as possible thrive in ways that the babies left alone in incubators don’t. People who are abandoned or unloved as children can suffer irreversible psychological damage. Worrying about whether that glass of wine you drank in the evening is harming your health is probably more physically harmful than drinking that glass of wine.
I wouldn’t call any of this a placebo effect. This is happiness and positive relaxed thinking. And while it doesn’t overcome everything, if it is harnessed it is very powerful.
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@SkL: I agree. I lost two friends 9 years ago, who were IDENTICAL twin sisters. The one sister was very sick, with heart disease and in a nursing home -- but the other was doing reasonably well. They were both 59 years old.
Despite being identical...they had different lifestyles. One had married...had two children....ran a demanding non-profit....and SMOKED. The other twin was single & childless, more affluent, worked from home and had QUIT smoking.
Strangely...the two sisters were estranged, and had not spoken to each other in several years.
The sick twin died in January. The other twin...who had not even attended her sister's funeral....died in June. No major specific cause. She just died in her sleep.
Weird, but true.
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There needs to be some sort of systematic approach to the symptoms that we are trying to alleviate. Some symptoms are entirely SUBjective--pain and dysphoria for example. Others are OBjective, but may be under the influence of brain control that may change with emotional state--for example, GI motility, maybe even coronary blood flow, to some extent. Some OBjective symptoms may be independent of emotional state. I predict, for example, that there will never be a demonstrable placebo effect on compound fractures or traumatically ruptured spleens. (Although there may be placebo effects on the recovery process from such occurrences, pertaining to pain control and emotional healing.)
The point is, until we understand what is going on in the brain in relation to the interface between emotional state and corporeal symptoms, we cannot understand how to USE the placebo effect consistently and effectively. And this understanding will come from scientific inquiry, not philosophical speculation. So I find Kaptchuk's antipathy to science somewhat odd. Even when science arrives at some understanding of a complex situation, it doesn't eliminate the moral dimension; it simply defines what aspects of the phenomenon are understandable from a scientific perspective, and what aspects are not. So the solution is not to abandon scientific inquiry, but rather push it to its limits.
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@RDJ
I agree with what you state.
The major problem it seems to me, lays in the fact that people become partisan about one way or the other of affecting patient care and build "trenches" from which to fire at one another; not to mention the influence on care exercised by other, intervening factors such as greed, personal arrogance, and personal and general ignorance.
In reality both rigorous science and human empathy are needed to optimize healing. Why would any one work with one hand tied behind one' s back, when nature has given us two hands?
There, of course, has to be ethical scientific research into how each contribute, or detract, and interfaces to, from and in healing-with an understanding that since we are "individuals" the effects of both will individually vary. And please consider that how the research is designed, financed, and conducted will depend on the prevailing "philosophy" of those who design, finance, and conduct such research.
Our lives and well being depend on finding and applying a right, and ever evolving balance in the "healing arts"
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@RDJ - Are you familiar with people who claim that "compound fractures or traumatically ruptured spleens" can be successfully treated with the placebo effect or acupuncture or even homeopathy? Seriously? I also question your statement that pain is "entirely SUBjective". Is that person with the compound fracture you mention simply thinking that it hurts? H-m-m, how about that person who touches a hot stove? Isn't there something about pain being a warning? For the record, I do agree that pain in some circumstances can indeed be entirely subjective, but your blanket statement in my mind is inaccurate.
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@RDJ. I disagree that some pain is completely subjective. Do you mean not perceivable by others? There are pain pathways that get activated and stay hyperreactive for years or lifetimes. These pain responses are scientifically measurable. You can see what you think is causing pain with burn victims, people with broken bones and someone who is bleeding. They may be in shock and will only feel the pain later. It might be more severe afterwards, but it can be both objectively and subjectively real.
I have chronic pain, daily. I feel it right now. Some days are worse than others but I tolerate it pretty well. I don't take heavy pain medications. I used to when it was worse. I have also had some physical healing. Now I occasionally need OTC meds. What does this all mean? To me it is irrelevant. I do know when I am happy and when others do not minimize what I experience, it is more tolerable. My advice for those suffering pain is to find a doctor or doctors who are highly medically competent and also kind, caring and good listeners.
My approach to health care is, get all your physicians and related staff, under one roof as they say, so they can communicate when required. Choose from an army of physicians, and support staff. who you can work with, and who show they like working with you. A Doctor who likes you usually will veer from and make key comments what he or she is really thinking. One has to keep in mind Physicians are taught to use drugs . Modern day trails are very helpful for Physicians to witness how others will the same disease respond to their prescribed drugs. Acupuncture and Chiropractors are usually not recommended .
1
News flash: "Warmth and close attention" have a beneficial effect on humans. That this has a biochemical substrate is expected. Finding the biochemical basis for the placebo effect and exploiting it, there's the rub.
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There were actually three factors that Franklin’s commission revealed which contributed to Mesmer’s success: the patient’s imagination, expectancy, and cooperation.
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My physician mom who is 91, realized very early, sometime in the 1970s that the overprescription of antibiotics for ordinary cough cold fever, was harmful for human health. But patients demanded speedy recovery, injections of antibiotics, swift treatment. So she would make a nice suspension in a bottle of tasty vitamins and dispense it through the compounder at the pharmacy. Her patients were instantly gratified that this good lady doctor is so amazing she is giving us miracle antibiotics. Placebo effect, the power of faith in a physician, helped my mom cure her patients, over 4 decades of healing and treating poor patients.
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@Petey Tonei
Your mother didn't "cure her patients." Placebo and "faith" are not curative; those patients regressed to the mean -- they got better on their own, as your mother knew they would.
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@Petey Tonei
It is unethical for doctors to use placebos. It is lying to a patient. If faith “cured” people, we would have people dying of cancer.
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@Petey Tonei: I get it, but your mother was acting fraudulently and that is troubling in the extreme.
If she TOLD her patients that "I have a miracle, HOMEOPATHIC potion that I would like you to try" -- and they agreed -- then it was fine.
But if she told them they were getting ANTIBIOTICS and they were getting Kool Aid in a jar.....that is fraud.
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Let me put it this way: Healing depends upon the patient feeling understood and cared for by the healer. That is a subjective state, experienced by the patient. Some healers may be especially adept at nurturing relationships or may be especially adept at connecting with certain patients or personality types. And some patients may find it hard to connect, hard to allow themselves to cared for, or hard to trust.
Research in psychotherapy has settled on the “relationship between therapist and patient” as the most potent healing factor. And I am sure that this extends to all healing relationships. It depends on that interaction between healer(s) and patient. It doesn’t just flow one way. It’s an interactive event.
I think of my spouse who’s had many medical problems over nearly 20 years now. Including a number of surgeries. There have been some wonderful caring providers and in other cases definitely not. Where he as experienced caring, he’s done well. Indeed, we are both of the same belief that the care I’m currently giving - just by my presence and what I can do for him as he slowly loses lung capacity - is keeping him alive and enlivening our relationship of 51 years.
I believe teachers who love their students are more successful. I believe that is true in psychotherapy as well. I’m talking a non-possessive, non-controlling, professional relationship which includes an element of what we deem love. We all respond differently. But CARING really does work!
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@TheraP If you like and trust your doctor you'll be motivated to follow his/her advice.
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@TheraP
There is a whole lot of truth is what you have discovered. I am a nurse who worked with dying folks before hospice. Those who lived longest had the best relationship with the nurse. It was an interaction that worked.
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@TheraP: often what sick people want is not drugs or surgery....but COMPASSION. They want solace, someone who "gets it" -- who acknowledges their pain, sorrow, loss, loneliness....anger or frustration.
They want to feel acknowledged and of value, that they MATTER and mean something....that they are needed.
Modern medicine, despite many incredible marvels, fails most of the time to do this.
18
It seems like we're already benefiting from the placebo effect. The requirement of blind trials produces consumer confidence in approved drugs, and that public confidence improves the efficacy.
On the other hand, if we weaken standards and openly allow placebos as treatment, that placebo benefit enjoyed by most FDA approved drugs will collapse. i.e. Embracing placebo could result in a net loss of placebo based benefit.
15
While fascinating, this is wandering into uncharted territory that could result in unintended consequences.
If handing out placebos becomes the norm for anything involving vague symptoms, difficult to diagnose conditions could be ignored even more frequently. Anti-depressants are already sometimes used as modern-day placebos for physical ills. I'm thinking of a friend who was given Prozac by her gyn for her abdominal pain. When she got a second opinion, she learned she had ovarian cancer.
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By eliminating the possibility of mind-body interactions in favor of merely physical ones, scientists adopted a powerful set of blinders. Take off the blinders and look at the root of experience. Experience is rooted in the mind. The body is a perception of mind, and bodily experiences are dependent on that perception rather than the other way around.
Scientists further blind themselves when they eliminate energetic effects. We know electricity can affect the body. Electric shocks are quite palpable. Why not other frequencies, such as the ones that travel the acupuncture meridians? These effects have been imaged by Kirlian cameras which are used by the FBI. And the effects of acupuncture are well known.
The positivist philosophy that undergirds scientific reductionism was a response of the Enlightenment to Religion. Now Science is the new religion, with its own rituals and dogma. But what of healing? This is the important question that investigators like Ted Kaptchuk are asking.
26
It could be that going to see your doctor and then getting better is a function of the placebo effect. The patient sees the physician. The physician, by means of her authority, in a non-verbal way, gives the patient permission to heal herself which she does. In a more skeptical vein, Voltaire stated that going to the physician gives you something to do while your body heals itself.
22
I have no doubt that helps for medical issues that have a high stress related component, or involve lifestyle choices that one is more motivated to make after a conversation with a sympathetic health professional.
It’s not going to help with conditions that have obvious physical causes that need fixing.
4
@JamesEric: does that work on cancer? or on a broken leg?
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@Concerned Citizen: possibly it works on cancer. The placebo effect has been reported to shrink tumors. (Sorry, but the reference for this doesn't come readily to mind, and I'm too lazy to look it up.)
A wonderful article. Of course the mind and the body are one, and our mechanistic model for the human body has recently been shown in profound ways to have been hugely oversimplified, as we reckon with the microbiome and the interstitium. And who doesn't appreciate the healing power of attention and care and faith -- that is, love? When my daughter, as an anxious and hyper-aware six-year-old, developed warts on her fingers, no usual remedies worked. The warts multiplied and she was very distressed. Her father, a psychiatrist, had received training in the therapeutic use of hypnosis in medical school. So he devised a nightly ritual in which he calmed her, lit a candle, and asked her to imagine the warts dissolving and wafting away on the smoke of the candle when she extinguished it (with a very magical old brass candle-snuffer). The warts all disappeared within a few days and never returned. He said to me, "No one knows why this works, but it does."
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It works by improving circulation to the hands through relaxation and dilation of the blood vessels. Warts are an opportunistic virus that takes hold of the surface of the hands because when stressed or anxious, blood circulation is diverted from the extremities to the major muscle groups.
20
My mother, who grew up on a farm in Austria, told of "Zigeuner" (Roma, gypsies) who came by to cure warts. They rubbed a piece of string over the warts, then put the string in the gutter. The warts disappeared. Thanks for reminding me of this story.
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@B. Erbe
My grandmother made me rub castor oil on a wart when I was a child. Each night before bed. Eventually it just peeled off. She thought that castor oil or wiskey cured almost anything. A tablespoon of castor oil sure did cure a surely child. I prefer wiskey these days.
9
I believe part of it has to do with the rate of efficacy. Doctors are used to not only evidence based medicine, which has suffered its share of criticism, but also to high thresholds in efficiency rate to consider any therapy as appropriate. As a patient, I can certainly agree to a treatment that works 99% of the time than a treatment that works 30% of the time. And the rates of efficacy and therapeutic value of placebo vary significantly and tend to be on the lower side by current scientific standards. Maybe there is some middle ground to be found. I would certainly not risk an urgent situation to therapy with unlikely odds. But maybe it is time for doctors to also consider cases in which it may be valuable to explore therapeutic approaches that take advantage of the mechanisms behind the placebo effect.
3
@Hugo - There are certain conditions now that don't respond well to any treatment offered by traditional medicine. For that and other reasons, many physicians deny that the conditions even exist or insist that they are "all in the patient's mind" as an indictment that the person suffering is imagining the problem or making it up. It seems to me that some of these problems may well be related to the brain but not in the way the dismissive doctors are thinking. Rather, something has caused the brain to be sending signals that create real physical problems, not as the psychological issue usually considered but as a biochemical malfunction. In other words, it's not "all in the mind" but it is "all in the brain". Exciting research these days. Who knows where it will lead.
I can say for myself that I once cured myself of stress-induced arthritis by (a) relaxing, and (b) doing movements and postures that enhanced the flow of blood and lymph and whatever else moves around inside the body. For me stress always brings chronic physical tension, which interferes with flow, which I think can lead to an immune cascade because the waste products of immune action get trapped in that area. Stress also creates a pro-inflammatory hormone profile. Being able to relax, emotionally and physically, is huge, and a believable placebo can provide that.
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@Don
Sounds like yoga to me, and yoga works for pain. Of course, I'm predisposed to believe someone named Don, so there's that.
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@Don Reeck
hi, Don here.
In 1985, i had the worst lower back pain i ever experienced.
I spent 1 hour a day doing "61 points" (you can get a free guided version at www.swamij.com - it's essentially a version of yoga nidra).
The 7th day I felt what seemed almost like a spontaneous chiropractic adjustment rippling across my lower back, around 45 minutes into a 61 points session. No back pain for several decades (and only briefly on a few occasions in the last few years when doing overly intense exercise)
www.remember-to-breathe.org
2
The mind body connection is fairly well documented if often ignored by most physicians. Doctors have theorized the subconscious mind triggers physical reactions primarily to distract the conscious mind form dealing with unpleasant issues - anger & anxiety. The cure isn't a pill, its education. the Placebo effect is an extension of this concept or at lest a short term fix - convince your mind that the problem is manageable, the cure is within your own head. Not sure the majority of Doctors are ready to embrace this however, modern medicine is more pharmaceutical than therapeutical
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@WeegMc
Citations for this “proof” please. This kind of thinking is insulting to all the people who have “battled” cancer with prayers, positive thinking, and the rest, and lost. Your ideas blame them for just not trying hard enough.
2
@Pundette
I know Barbara Ehrenreich has wondered into this territory and written two irrational screeds that ignore the research.
Why in the world, if it's true that attitudes and thoughts affect the body, should blame be involved?
There is considerably research to the effect that stress, in about 25% of cases - particularly involving unexpressed negative emotion - raises blood pressure. I've tried over a number of years to lower my blood pressure using mindfulness and a number of other "inner" means.
It didn't work. Exercise and eating basically along the lines Michael Pollan recommends (eat real food, mostly plants, not too much) has brought it down to an average of 120-75 without medication.
I don't feel the least bit of "guilt" for not being able to do this by inner means. So what?
if it's a scientific fact, deal with it.
www.remember-to-breathe.org
@Pundette There is a preponderance of data on the mind body connection. One important study is the Adverse Childhood Experiences (ACE) Study which had a massive number of participants (17,000) and demonstrates conclusively the negative physical effects of toxic stress.
If you are feeling sad, and I say something to make you feel happy, what is the cause?
Scientists want to find a chemical for everything, which is a fool's errand. This may work for plants, but not for people.
How do you explain consciousness, an original scientific discovery, a dream? Biochemistry?
Chemicals are a result, not a cause. This is what makes human existence so profound, and science merely interesting.
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@George Locker
Or maybe not . . .
8
Sorry. That is s bunch of new age nonsense.
11
People are slightly more complex plants. There is nothing special about human beings. Plants "think"they're pretty special too...
6
The human body is made up mostly of space. Sure, we have molecules, atoms, and electrons all swirling around, coagulating into physical form. But what is in the space between all those circulating electrons? More space. Not only are we composed of more space than actual mass, the human body is penetrated every minute by billions of neutrinos - nearly massless objects than travel from the outer reaches of the stars. The body is like a fabric through which some of the oldest star dust in creation routinely passes. The body is not what we think but is perhaps more like what we imagine it to be. The body is consciousness in form but it is accurate to say it is also space interacting with space, than material object interacting with material object.
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@Amy Haible This was beautiful to read and has calmed me immensely... and I didn't even believe my self to be tense before! Such beautiful a beautiful image! Thank you for your post.
1
I get such a kick out of people who try to fabricate philosophy out of a ridiculous misconception of partial facts they've gleaned about physics.
8
This has been an episode of "how to take a mostly-correct understanding of physics and use it to make vague metaphysical comments that mean absolutely nothing."
7
Health care needs to be supportive, and affordable. If we are invested in our own health, by going to a doctor and not fighting for 8 months on whether it was an outpatient visit ($800), or an office visit (completely covered under my insurance). Our doctor may be able to become our ally, instead of a vehicle to restrict "unnecessary" care. Stop allowing medicines that should be the discretion of the family doctor to prescribe, create a 'need' by feeding its miracle cures directly to the public.
6
Since at least the early 19th century homeopathic practice has utilized the use of placebo to, in essence, resolve symptoms that are caused by the mind (i.e., as a placebo), so the [totality of] symptoms of the disease that needs a remedy can be discerned more clearly. God forbid that scientific medicine should ever think it could learn something from homeopathy, but here it certainly can, and it did. Mesmer is only one historical source of the idea, Hahnemann is the other. It is an elegant way to use the idea, but it depends on an entirely different way to measure the effect of, and prescribe, medicines. It is based on a different theory of the human, one that has not been distorted by the Darwinian physicalism. Hahnemann saw the person as an (naive) Aristotelian whole, and developed his school of medicine from that theoretical position. As a corollary, his theory of medicines requires that they also be considered as wholes, not as a heap of effects. Scientific medicine has trouble with placebo because of its deep ideological commitment to physicalism. That metaphysical position only permits reductionism as it cannot recognize wholes in any kind of robust and consistent way. Therefore its theorists want placebo to fit into the reductionist model of medicines, in which each effect is separate from the others. That is the source of the problem allopathy has with placebo.
12
@Huguccio unless the placebo effect works on animals too (and it doesn't seem too likely ) homeopathy is not placebo. It helps all my animals.
12
@Huguccio
my problem with placebo (as an allopathic physician) stemmed from watching its effect on cervical cancer. there was none apparent, allopathy could have cured. hahnemann's holistic approach to this illness was as effective as it is today; i'd avoid his elegance on tuberculosis and some other illnesses as well.
i was taught in med school it was the best medicine, lacking truly effective treatment. scientific medicine will figure it out and learn to use it better, as this article shows.
The placebo effect is known to work on animals. Do even 5 minutes of research on the sham that is homeopathy. That it is supposed to work with no active ingredient save water's memory of an energy.
3
What is fascinating to me about this area is that it edges into the territory of eastern beliefs, particularly the yoga idea that the mind has great control over the body. But it takes both training and belief to control it. I suspect this is a difficult area for western science -- which seems to prefer external mechanisms that can be isolated and manipulated to substantiate belief. What is interesting is that western medicine is rife with instances where certain diseases were ignored due to 'belief' in their reality or otherwise -- only later to be discovered as real. Lyme disease comes to mind but there are many others. Effectively, even in the west, the line between science and religion is a lot more blurred than would appear. Placebos are a good example.
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@Greg Latiak Some time ago the NYT ran an article about a Tibetan doctor using his means of measuring pulses in the patient (wrist pulse I believe). He was able to diagnose an astonishing number of diseases. His Yale Med hosts were fascinated.
5
@Greg Latiak
There is no “eastern” or “western” science. Just science. Scientists do the same things east or west. The scientific method is universal. Science doesn’t “prefer” anything, it goes where the proveable facts lead. When a formerly dismissed condition becomes accepted, it is because the facts established it, not because someone just decided to stop “ignoring” it. Ulcers being caused by H. pylori is a much better example. The introduction of the theory caused skepticism, but when it was proven scientifically, it was accepted. It is integral to the scientific method that minds are changed by evidence--and evidence alone.
6
@Pundette
Pundette, I guess you missed the follow up.
I remember when Dr. Steve Hyman announced with much triumphalism that ulcers are NOT care by stress but by H. pylori.
He was not quite humbled but perhaps had a small portion of humble pie when a few years later, it was discovered that with further more meticulous research, large majorities of the population have H. pylori residing in their stomach.
What then causes h. pylori to go into action?
Well, of course causes are multivariate, but one of the major causes?
stress.
www.remember-to-breathe.org
14
There are clearly multiple factors at work. They need to be separately understood and used And also jointly understood and used.
Some points to consider include:
1. Completely eliminate human interaction in clinical trials. It seems impossible to remove subjective responses of investigators to individual participants That might trigger emotional responses, muddying results.
2. Learn to distinguish genuine warmth and empathy from routine clinician behaviors that give only the appearance of warmth that is In actuality superficial. This relates to transference in psychotherapy.
3. Instead of trying to eliminate gene variants as a factor in clinical trials they should be actively engaged creating additional groups in trials, obviously adding to complexity, but also helping to tease out the different factors involved.
The desired outcome is of course one in which the benefits of emotions, of the biochemical effects of drug agents, and of genetics, are all used optimally. It’s heartening that we seem to be progressing in that direction.
7
@David Rosen
Let the patient find a doctor they feel comfortable with.
That’s how you search for a therapist. That’s how you should search for a doctor or dentist or audiologist, etc.
The patient is the one who KNOWS.
Years of research have failed to identify who would make a good therapist. That’s likely the same for whether or not a doctor would be a good healer.
Let the patient decide!
3
@TheraP Easier said than done, I think. It some places, choices of even basic practitioners are limited; almost everywhere, choices are limited for specialists. And in those places where there are lots of choices for whatever, it's really rather difficult to audition from doctor to doctor in the same way that one can examine house after house that one is thinking of buying. Further, there are physicians who have a bad reputation as far as "beside manner" is concerned but who have a great reputation for getting good results in treating patients. It is sometimes a question whether you would choose the doctor who gives you warm and fuzzy feelings or the one who is, based on what he or she has achieved in the past, the one most likely to actually cure you or treat you most effectively.
When performing pharmacological studies on pain control, the placebo effect presents difficulties because it can be very significant, thereby obscuring the effects of a test drug. The key is that the patient "thinks" they are getting the active medication. The brain is doing the rest by signaling various effect modulators. Many other conditions are also susceptible to this effect, particularly those with a strong stress component. I have never thought of the placebo effect as "fake" but as a genuine physiological response. However, its mechanisms are different typically than the test drug being tested which likely targets very specific receptors or antigens. The key to inducing a placebo effect in most patients is that they are unaware that they are being given a sugar pill, in a sense a "deceit" by the doctor. Also, the placebo effect is extremely variable in both intensity and duration i.e. is highly unpredictable. Attractive as the price and safety issues are with placebo, I doubt that using a placebo will ever come into use in modern medicine.
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@VonnegutIce9
Did you read the article? The results of experiments about whether it matters whether or not the patient knows he/she is getting a placebo? The differences in dna that determines whether someone responds better to a placebo or the warmth and attentions of a good caregiver?
Kaptchuk is well versed in both Western and Chinese medicine. He suggests, as I read it, that Western medical studies are so attached to their previously understood frameworks for understanding the body and how it functions, that they are not open to other paradigms that might expand the understanding. Your response, it seems to me, epitomizes that brilliantly.
17
Ted Kaptchuk is not “well versed in both Western and Chinese medicine.” He has a B.A. in East Asian Studies from Columbia and a degree in Chinese medicine from the Macao Institute of Chinese Medicine, according to his own website.
2