Think about many thousands of Americans buying a particularly expensive prescription medicine over the Internet from a foreign source to save considerable money. Later it is discovered that the drug was a fake, some harmless material. An investigation of how the fake drug has harmed people discovered that a significant fraction of users have had their symptoms completely eliminated by taking the fake drug. They thought the drug was real. And it worked just fine. Scientists have called this phenomenon the placebo effect, getting a beneficial result that seems unfounded.
Every time a company goes through the very complex government process of getting a new drug approved part of the testing is to include some people who get the real drug and some control subject who get a harmless and fake substitute, but the physicians do not know which is which. Virtually all the time some of the people getting the fake drug do just as well as those getting the real one. Once again, the placebo effect has surfaced. Of course, the data must show a lot more positive results from the real drug than from the fake one, and of course no serious problems with the real one.
Researchers at the University of Connecticut examined 19 clinical trials of antidepressants and concluded that an amazing 75 percent of the drugs’ effectiveness was caused by the expectation of improvement, rather than any changes in brain chemistry. An earlier study of depressed patients treated with drugs, psychotherapy, or a combination of them found that 50 percent of the drug effect was a result of – you guessed it – the placebo effect.
A number of studies of dummy pills found that they had the ability to speed up pulse rate, increase blood pressure, and improve reaction speeds when participants were told they had taken a stimulant. If people were told that the fake pills they had taken was a sleep-producing drug, they had the opposite physiological effect.
In another study, warts were painted with a brightly colored, harmless dye. The doctors promised the patients that the warts would be gone when the color disappeared. And that’s what happened. Another study of asthmatics had doctors telling patients they were inhaling a bronchiodilator, which was not true, but nevertheless there was dilation of their airways. When patients suffering pain after wisdom tooth extraction were given a fake ultrasound treatment, that both they and the therapist thought was real, they got just as much relief as from the legitimate treatment.
When colitis patients were treated with a fake treatment, 52 percent of them reported feeling better and, even more impressive, 50 percent of the inflamed intestines actually looked better when examined with a sigmoidoscope. Depressed patients who were just placed on a waiting list for treatment did not do as well as those given fake medicine. When people with pain were given a fake drug their relief from pain came about an hour after taking the dummy medicine, just as happens when a real drug is taken.
Long ago surgeons used a procedure involving small incisions in the chest and then tying knots in two arteries to increase blood flow to the heart as treatment for angina. It helped 90 percent of patients. But then it was found that a fake surgery, where the arteries were not tied off, proved just as successful. A 26-year-old woman was suffering panic attacks. During a severe one she went to the emergency room because she feared dying from a heart attack. The doctor prescribed dummy pills and her attacks subsided. She was told about the “trick” weeks later. In another case people caught fewer colds after they were told they had received huge doses of vitamin C, but they actually received powdered sugar and when the fake treatment was stopped the number of colds caught went back up.
The American Council on Exercise (ACE) commissioned a study to see if athletes actually get an extra boost in the form of “super-oxygenated” water. The study at the University of Wisconsin, La Crosse tested thirty-two healthy volunteers that represented both competitive and recreational runners who ran a minimum of 7.3 miles per week. They were told they were in a study to measure the effects of super-oxygenated water (SOW) on exercise performance and they watched a video about the purported performance enhancing effects of SOW. Half the subjects drank 16 ounces of bottled water or 16 ounces of what they thought was SOW (but was, in fact, tap water). Those taking the fake SOW ran 83 seconds faster on average (actually 84 percent ran faster) even though heart rate and blood lactate levels were virtually the same between the two groups.
Pretty hard not to believe in the placebo effect. Here’s what some experts have said: “Expectation is a powerful thing. The more you believe you’re going to benefit from a treatment, the more likely it is that you will experience a benefit.” This was said by Robert DeLap, M.D., head of one of the Food and Drug Administration’s Offices of Drug Evaluation. Michael Jospe, a professor at the California School of Professional Psychology said: “The placebo effect is part of the human potential to react positively to a healer. You can reduce a patient’s distress by doing something which might not be medically effective.” “Over the years, placebo studies have shown that subjects who believe that they are receiving beneficial treatment often experience a variety of positive outcomes. There clearly is a strong connection between the mind and body as it relates to physical performance,” said Dr. Cedric Bryant, ACE chief exercise physiologist.
New research making use of the most sophisticated technology like PET scanners and MRIs that reveal what is going on inside peoples’ heads has produced amazing results. This kind of examination has revealed that even though we can oversimplify and say that the placebo effect is in peoples’ heads, it turns out that dummy treatments believed real by patients actually produce changes in brain chemistry. A brain-imaging study found that depressed patients who responded to fake medication showed changes in cerebral blood flow that were similar to what was seen in patients who responded to anti-depressant medication. Self-medication takes on a whole new significance. Dr. Michael Selzer, neurology professor at the University of Pennsylvania School of Medicine sums it up this way: “There have always been people who have said that we could make ourselves better by positive thinking. After pooh-poohing this for years, here are studies that show that our thoughts may actually interact with the brain in a physical way.”
Before getting to the implications of all this for ordinary people, not that a study of Danish general practitioners found that 48 percent had prescribed a placebo at least ten times in the past year. The most commonly used placebos were antibiotics for viral infections (an all too common practice by American physicians) and vitamins for fatigue. A study of doctors in Israel found that 60 percent used placebos, usually to fend off requests for unjustified medications or to calm a patient. The use of placebos by physicians is controversial. But perhaps all the commercials you see for new and expensive prescription medicines have a hidden agenda – to make you believe that they will work, so that after you get your doctor to prescribe them they actually will work!
Here are some things you should contemplate – think of them as placebo lessons for the wise. First, no matter what kind of medical treatment you receive, it is in your self-interest to truly believe that it will work. Don’t ask your doctor whether he believes in placebos or prescribes them. Second, understand that all kinds of alternative medicine and therapy may only work if you truly believe that they will work for you. This is why so many sham or unproven or unorthodox medical solutions dismissed by the medical establishment – from meditation and yoga to vitamins and homeopathic products – actually are embraced by people. They work wonders because these people have “faith” in them. Of course, there really are a lot of completely nutty and sham products being sold to vulnerable people. And yes that brings us to religion, where the same positive placebo effect can also work wonders, even though it may be seen as the healing power of faith and God’ work.
The power of positive thinking is real. Things that work when science says they should not are like getting a bargain or a miracle. Some may denigrate the placebo effect as being self-delusion, self-deception, subjective, conditioning, or merely the power of suggestion. Just remember that it is in your self-interest to believe that some medicine, therapy, treatment or healthy activity can help you. Maybe believing that eating certain foods will make you healthier may actually do just that – if you believe in them. Financially, of course, it is better to spend as little as possible on some unconventional solution to believe in.
Power to the people has new meaning, something that we can give ourselves – placebo power is in the mind of the believer. One last point must be made. Not all of us have significant placebo power. This is probably a talent or skill that can be improved through experience. Sometimes only the real thing will work and is absolutely necessary. The placebo effect is no reason to reject or refuse what is believed by health professionals to be necessary and effective. Better to see the placebo effect as an insurance strategy, something extra that costs little, except your faith.
[Joel S. Hirschhorn’s new book is Delusional Democracy – Fixing the Republic Without Overthrowing the Government.]