Mind Over Matter: A Deeper Understanding of The Placebo Effect
The Irony Behind The Fact That The Placebo Effect Is The Gold Standard By Which the Efficacy of Drugs and Other Medical Treatments Is Determined
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The idea that the mind can influence the body to promote healing has been around for centuries. Known today as the placebo effect, this phenomenon has gone from being dismissed as imagination to being widely recognized as having significant therapeutic value. In fact, the placebo effect is now considered the "gold standard" by which the efficacy of drugs and other medical treatments is measured.
What exactly is the placebo effect?
In short, it refers to beneficial health changes that occur after an inactive, benign substance (a sugar pill, saline injection, etc.) is administered. These changes are attributed to the person's expectation that they will improve. In other words, the mind triggers physiological responses in the body simply based on belief.
The term placebo comes from the Latin phrase "I shall please." It was first used medically in the late 18th century to describe a commonplace method physicians employed to placate or humor hypochondriac patients. They would prescribe inert substances while making the patient believe it was an effective treatment.
While this may seem unethical by today's standards, it highlights an important point - the power of imagination when it comes to health outcomes. Fast forward to contemporary medicine, and the humble placebo has become a pivotal part of clinical research. It enables researchers to separate the physical effects of a drug or treatment from the patient's psychological response.
Here's how it works.
In blinded clinical trials, participants are divided into two groups - one receives the drug being tested, while the control group receives a placebo. Since the placebo mimics the real drug, the participants don't know whether they are getting the true treatment or not. By comparing results, researchers can determine if the drug works better than the placebo. If it doesn't, then the drug is deemed ineffective.
For a drug to be approved for use, it must consistently perform better than placebos in multiple trials. This threshold highlights just how important the phenomenon is in medicine. It is considered the baseline by which therapeutic value is determined. If patients' belief in a treatment elicits significant self-healing abilities, then for a drug to be worthwhile, it must offer something more.
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Over the years, research has shed light on the neurobiological mechanisms behind the placebo effect. Using brain imaging technology, several studies have shown that placebo treatments modulate pain by activating natural opioid pathways in the brain. Placebos have also been shown to influence the levels of certain neurotransmitters like dopamine and endorphins.
Other studies reveal that placebos can activate specific genes involved in regulating inflammation. In patients with Parkinson's disease, placebo treatment decreased abnormal brain cell activity in areas impaired by the disease. This demonstrates that imagined relief can provide real physiological changes.
In fact, the impact of placebo treatments is so significant that its effects have been measured across a wide range of conditions. These include pain, depression, anxiety, fatigue, arthritis, Parkinson's, ulcers, and more.
For example, a 2014 systematic review published in JAMA Psychiatry looked at clinical trials for depression medication over a 30 year period. It found that more than 80% of the drug effect was duplicated in placebo groups. The remaining less than 20% was attributed to the chemical component of the drugs.
Likewise, a meta-analysis in the New England Journal of Medicine examined 114 drug trials for migraine prevention. It found that 75% of the therapeutic response was due to the placebo effect. A 2015 study on patients with irritable bowel syndrome had similar findings - placebo treatments produced significant symptom improvements comparable to the effects of the tested drug.
What these results indicate is that a large part of the relief patients experience from medications has nothing to do with the drug itself, but is based on their expectation that they will get better. Somehow, this belief unlocks self-healing capacities within.
As researchers explore this phenomenon, they’ve identified several factors that can maximize placebo potency. One is the perceived cost of the treatment. Studies show that a placebo pill presented as a new expensive drug provides more pain relief than the same placebo presented as a discounted cheaper drug.
The act of administering a treatment also matters. Placebo injections are more powerful than placebo pills. Even the color of a pill can influence effects. Interestingly, branded placebo pills yield stronger results than those labeled as generic. The more convincing the ritual involved, the greater the impact.
Of course, classical placebo theory states that deception is necessary for the effect to occur. Patients must believe the inert substance is real medicine. But recent research suggests placebos can work even when people know it's not an active treatment.
Several trials demonstrate that a placebo presented honestly, as an open label placebo, still provides benefits. One study had 80 patients with chronic lower back pain add open label placebo pills to their normal treatment. After three weeks, they reported a 30% decrease in severity, demonstrating placebos can work without concealment.
This raises an intriguing possibility. If healthcare practitioners could leverage the mind's power to cultivate healing without relying on deception, it would transform medicine. Harnessing the placebo element could also reduce our dependence on costly, potentially harmful drugs and procedures.