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Tuesday, June 28, 2022

The Power of the Placebo Effect

Alice Banfield looks at the science behind, the objections to, and the prospects of placebo-based treatments.

The placebo effect is a phenomenon which clearly illustrates that having belief in the effectiveness of a treatment can be enough to cause significant improvements in health. The human mind can cause people to believe that fake medication gives real results, and the effects on health can sometimes be as significant as those seen with genuine treatments. Simply the thought that you are receiving medical help can have a large impact on your perception of the symptoms which you are experiencing.

Placebos are often used in clinical trials alongside the medication being tested, to be analysed in comparison to the real drug. This allows the power of new medicines to be investigated more thoroughly. Drugs are quite frequently shown to be no more effective than a placebo, and so they do not get past the trial stage.

Placebos are also used as a treatment in themselves. Often, sugar pills are administered to sick patients, who are told that it is a drug which will aid their recovery. Although the medication contains no active ingredient, appreciable effects are frequently seen. These chemically inert medications have been seen to help people with a fairly wide range of conditions such as back pain, insomnia, irritable bowel syndrome, fatigue and nausea.

It has been shown that even just the colour of the tablet can alter the effect which the placebo has on the body. Researchers at BMJ have shown that red, yellow and orange pills are associated with a stimulant effect, while blue and green pills relate to a tranquilizing effect. Larger pills also seem to produce a stronger effect than smaller ones, while branded placebo pills are seen to be more effective than unbranded ones. Preconceived expectations and biases held by people before taking medication can affect the outcome drastically. Fake surgeries have also been carried out, and a 2014 review of these surgery placebos showed that improvements were experienced around 75% of the time.

There is some ambiguity surrounding the science behind the placebo effect, but it appears to be linked with the idea of conditioning. This idea of conditioning was shown by Ivan Pavlov in the 1890s, who conditioned dogs to relate his presence with being given food. His arrival would then consistently cause the dogs to salivate, even when no food was being given. Many signals, for example a buzzer, were also shown to trigger automatic responses. This shows that a cue can be directly linked with a physiological response, and because our brains associate taking a pill with relief, brain chemicals will be produced, and will start the pain relief process as soon as the medication is taken.

Brain-imaging studies also show that placebos cause quite significant changes in neurobiological signalling pathways. Reward pathways are activated in the brain when you expect that an effect will be felt. This can then stimulate the release of endorphins, which act in a similar way to opiates such as morphine. When these bind to opioid receptors, pain relief can be experienced. It has also been proved that placebos cause dopamine to be released, which is another neurotransmitter which can help to decrease pain sensitivity.

Many doctors today prescribe placebo drugs to their patients, which many people argue is an unethical approach which can easily be classed as deception. It can also be seen as immoral to give people ineffective remedies in clinical trials when there are chemically active medications available. There may be serious consequences if the patient in need of treatment does not receive authentic medication to begin with; there is even a risk of experiencing a ‘nocebo’ effect, meaning that negative side effects are felt in response to the drug. Additionally, some people are more genetically disposed to placebos, while others are less likely to react to them. However, if there is still a likelihood that the placebo will have a positive effect, then surely the doctor is carrying out his duty of trying to help the patient, which cannot be considered unethical.

Placebos can be incredibly useful in certain scenarios, and sometimes they can be used when other drugs cannot. For instance, opioid pain relief cannot always be given to burn victims due to associated respiratory depression. In a case like this, there is no real debate about morality. A saline injection can be given rather than a painkiller, and often this is a good option to make the patient feel more comfortable.

Today, lots of researchers are looking into ways in which we can improve and extend the uses of placebo medication. Further research is definitely required, but it seems that a more extensive use of placebos in medicine could be beneficial. Serious side effects from taking medicines would not be experienced to the same extent, it would be more cost effective, and people would not become dependent on the drugs. However, the issue of ethics may slow down this process.

The placebo effect clearly shows that the mind has a very powerful influence on the body, to the extent that it can mimic the effects of genuine medical treatments. Further investigation into this field could greatly advance our knowledge of both the brain and the success of various medicines. A more extensive understanding of the effect could lead to some very interesting discoveries; however, the issue of morality lingers over all those looking into the phenomenon and the use of placebos.

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