In Latin, the word placebo means “I shall please.” And please it does, for up until recently, nearly all medicines were placebos. Even more astonishing is the power of placebos. Even though they are mostly used for pain relief, placebos have been shown to improve conditions such as sleep deprivation, depression, and Parkinson’s disease, heal ulcers, even grow hair on the head of a bald man!
The placebo effect is a widely studied phenomenon first discovered in the 18th century by a physician by the name of Elisha Perkins. His treatment consisted of two metal wands he called “tractors.” He claimed they were made of special pain relieving metals, but in fact, they were just steel and brass. However, they were shockingly effective at pain relief. Before long, placebos began gaining popularity with physicians. In fact, in 1807, President Thomas Jefferson wrote to a friend, “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of coloured water, and powders of hickory ashes, than of all other medicines put together.”
Henry K. Beecher was a doctor at Harvard who studied the placebo effect. His most famous demonstration of the placebo effect was in World War II when he gave wounded soldiers saline injections. The most famous example of the placebo effect is the story of Mr. Wright. In 1957 he had cancer and was it was estimated he had days to live. He read about a medicine called Krebiozen that was supposedly effective against cancer and begged to receive it. The doctors gave it to him and by the next morning his orange-sized tumors had mysteriously melted. He was released and for two months he was healthy until he read medical reports saying that krebiozen was worthless and fake. Immediately his tumors reappeared. His doctor told him that the reports were false and injected him with a “new double strength super-refined version” (actually just water) and his tumors melted again. Two months later, he read definitive reports that Krebiozen was fake. His tumors appeared again and he died two days later.
This just goes to show the power of placebos. However, once Mr. Wright learned that Krebiozen was a placebo, his symptoms appeared immediately. This is not the case for everyone.
“Honest placebos”, or “open label placebos” (placebos that the patient knows is a placebo) were mostly ignored until 2009 when and Harvard professor named Ted Kaptchuk decided to test honest placebos. He conducted a study in which he gathered a group of people with irritable bowel syndrome and half were given a sugar pill labeled “Placebo” and the other half got nothing. After taking the medicine twice daily for weeks many people in the placebo group showed symptom relief or even symptom disappearance.
This is because the placebo effect often works even when the patient consciously knows they are taking a placebo because the ritual of treatment tricks their subconscious. Although, honest placebos don’t always work as reliably, often, or effectively and normal placebos.
When a patient takes a placebo, the regions of their brain known to respond and process pain and anxiety show decreased activity. This is accompanied by increased activity in areas associated with emotional regulation. The pain ratings given by subjects also aligned with the MRI scans showing the levels of activity in areas associated with pain.
Even after centuries of research, we still know very little about placebos. We don’t know who is susceptible to them or what in what of kind of environment they work best in (metaphorical environment). One of the greatest mysteries surrounding the placebo is what kind of environment doctors could create maximize the placebo’s effectiveness. Some factors include price, temperament and behavior of the physician. This environment would also affect everyone differently, further complicating things.
Another key factor is what type of treatment the placebo takes the shape of. Placebos can take many forms, such as fake surgeries, pills, injections, lotions and creams, IVs filled with water, and even non-medicinal things like placebo alcohol that actually succeeds in making people drunk. The type of treatment can affect the results. For example, Americans respond better to injections, while Europeans respond better to pills. Scientists have also discovered placebo effectiveness varies from county to country. For example, placebo effectiveness is rising in the U.S. while Germany is the least responsive to placebos.
Of these examples of placebo treatments, one of the most surprising is probably sham surgeries. For example in 2004, a radiologist in Minnesota, named Dr. David Kallmes noticed something bizarre. For years, he had been performing an operation called a vertebroplasty, in which broken backs are healed through the injection of a medical cement. The procedure was often successful, relieving severe pain and allowing people to walk and exercise without difficulty. However, the operation would occasionally go wrong (for example, if cement was injected into the wrong vertebra) but patients would still appear to get better. This puzzled him and he decided to conduct an experiment. He conducted a trial of 131 patients in which half of them received a real vertebroplasty and have of them would get a fake one. Both groups experienced the same amount of pain relief and the same amount of improvement in functions such as walking, exercising and climbing stairs.
However, with all its benefits, the placebo effect has an evil twin:the dreaded…NOCEBO EFFECT (cue dramatic musical score). The nocebo effect operates on the same power of belief as the placebo effect but causes negative effects. For example, if a doctor gives a patient medicine for a headache but says it might cause nausea, the patient is likely to feel nauseous because they believe they will. Another example is when patients were given saline as chemotherapy actually threw up and lost their hair.
The term “nocebo” was coined in 1961 by Walter Kennedy. In latin it means “I shall harm” and it makes good on that promise. It is just as powerful as the placebo effect and is often accidentally triggered by doctors listing possible side effects. However, if the doctors don’t list the possible side effects they could be sued for malpractice. Another common example of the nocebo effect is people who believe they are more susceptible to a disease actually are because of that belief. Sometimes, the patients follows their subconscious expectations to the letter, such as a man who was told he had five years to live, lived those years in good health, and died exactly five years later.
One example of how powerful the nocebo effect can be seen a study in Japan in which thirteen people allergic to poison ivy were rubbed on one arm with a harmless leaf and told it was poison ivy and rubbed on the other arm with poison ivy and told it was harmless. All thirteen reacted to the harmless leaf and only two reacted to the poison ivy.
The placebo effect is still too unreliable and misunderstood to be commonly used in medicine (one of the reasons the American Medical Association is wary of placebos). When a patient buys a medicine, many people believe that it is unethical to give them a placebo when they believe they are buying a real drug. However, if the patient is told they are taking a placebo, it could lessen or negate the effects. One solution is a pill bottle that is part placebo, part real medicine (the patient knows that some pills are placebos, they just don’t know which). In order for doctors to legally prescribe a placebo, the patient has to sign a consent form.
The placebo effect, while often misunderstood and mysterious, is a stunning scientific phenomenon. Years of research will be necessary, but, with the right environment, it could become the cornerstone of modern medicine.