The Power of Nothing

Placebos: how’s that when you’ve a headache and a doctor gives a white tic tac saying it’s more effective than paracetamol, it works, but when it’s your mate giving you that dodgy looking minty medicine, it just doesn’t? :\

A placebo consists in any substance not known to have any medical effects (which means that doesn’t produce any meaningful chemical or biological change in the organism), but that it’s made to look like a proper drug. Sometimes, in fact,  the act itself of swallowing a pill produces an effect if the person believes the pill is a proper medicine. For this reason, scientists often give placebos to patients in order to see if an effect is due to the active drug or only from the action of taking a pill prescribed by a doctor.

First of all, there are reasons to believe that when a patient gets better under the effects of a placebo, bodily healing processes are involved, but what’s impressive is that the processes of healing MUST be completely self generating. Although in the past the healing effect of placebo was considered to be only a patient mystification, now placebo research studies have demonstrated that there are neurobiological mechanism at its root. Neuroimaging studies have shown that placebo administration activates endogenous antinociceptive pathways when it is given to reduce pain, but also induces release of dopamine in the striatum in parkinsonian patients if given to reduce motor impairment. (Pollo & Benedetti, 2009).

The outcome of such studies are likely to remove the negative connotation which has been linked to the concept of placebo, but also to raise a new awareness on the potential exploitation of the placebo effect to the patient’s advantage.

If the placebo effect is a self –healing process initiated by psychological signals including conditioning, verbal and visual clues (Meissner, 2011) it is likely to work also in additive or even synergistic ways with conventional drugs. Therefore the therapeutic environment with a physician speaking positively about treatments, providing encouragement, trust and creating a kind of ceremony can completely modify the effectiveness of a drug.

In a holistic vision of mind body-interactions, the placebo effect is a powerful therapeutic tool especially for such conditions where existing treatments are only partially effective.

There are a variety of reasons why a scientist gives patients a placebo treatment including the promotion of the patient’s wellbeing, For example a doctor facing a woman with a newly advanced tumour which cure cannot be found, gives her a placebo intervention in order not to dash her hopes. Interestingly enough patients are also administered placebos for what it can be defined as a convenience reasons. Surveys have in fact shown how doctors often happen to give their patients “fake-treatments”, so they will stop complaining. Furthermore placebos are also given to patients to determine whether their medical conditions are ‘real’ or only psychological. What this last point is not taking into account though is that the actual placebo effect could be the reason why the patient feels better. However I think that when used in such way administration of placebo is unethical as it includes deceiving the patient.

Surveys indicated that between 51 and 100 % and between 17 and 80 % of respectively physicians and nurses have at a certain point in their professional career used pure placebos intentionally. But it’s important to take into account how the data also indicate that the overall frequency is quite low, since pure placebos are usually applied only once or a few times to a small minority of patients.

Reference

Pollo & F Benedetti. The Placebo Response: Neurobiological and clinical issues of neurological relevance. Progress in Brain research 175: 283-94, 2009

K Meissner et al. The placebo effect: Advances from different methodological approaches. J Neurosci.31:16117-24, 2011

http://rstb.royalsocietypublishing.org/content/366/1572/1905.full#sec-1

http://books.google.co.uk/books?hl=en&lr=&id=ixHqjCrvaXQC&oi=fnd&pg=PA225&dq=placebo+in+psychology&ots=o07vuDqegd&sig=IL5m_28q915dhxsTp2pfPjSeEmg#v=onepage&q=placebo%20in%20psychology&f=false

 

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9 Responses to The Power of Nothing

  1. Placebo treatment groups are very good to use when a researcher is trying to show a treatment effect. The science behind how a placebo pill works is definitely baffling to me. There is no doubt that they have a valid use in testing the effects of different treatment methods, and opens up research opportunities into more holistic treatments, as a way of treating an illness. However, do you think the use of a placebo drug is ethical in regards to medical research?

    The world health organisation, under the declaration of helsinki state that all medical trial which use a placebo have to fully disclose the fact that the participant may, or may not receive a placebo drug. Researchers’ should also make sure that when balancing, treatment with research objectives, they should make sure that if a standardised treatment is available for the disease under investigation, that the standardised treatment is used instead of the placebo.

    Litchenberg and Nitzan (2003) identify the ethical justifications for using a placebo in clinical trials.
    (http://jme.bmj.com/content/30/6/551.full)
    These justifications for the use of a placebo include;
    -The intentions of the physician using the placebo must be benevolent i.e. in the best interests and well-being of the subject.
    – when the placebo isn’t proved effective it should be withdrawn immediately
    – A placebo should be given with the intentions of easing the patient’s suffering and not merely masking the symptoms
    – If the patient appears to be benefiting from the placebo, removing it without the use of a more effective treatment is unethical.

    As you have discussed, placebos can be an effective form of treatment, when used in an ethical way, to benefit the patient.

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  3. bprowlatt says:

    I think it is amazing that just thinking about being healed has healed people, if this placebo effect is true, it really does go deeper than cold hard facts and the medical system. The confines of our imagination is based on what we have experienced and our whole collective idea of the world is based on what we have experienced, meaning that a vast majority will never experience this effect because of their faith in the established medical system of today.

    After reading this blog i researched past cases and found that people have been cured of cancer and tumours have receded back to non life threatening sizes showing that the mind and imagination are powerful things.

    I think the imagination is something that we are not taking as seriously as we should be, I think your mind doesn’t just control things in a sense that you bring things out of the ether and out of your imagination and manifest them in the real world, but i think your mind actually has an effect how thing go in the real world. If you believe in things they have incredible power over you (both good or bad) and whose to say that’s not real, there is a directs correlation between positive energy and positive results in the physical form, everyone who reads this knows that happiness generates a better way of life and a better feeling of life.

    You may place the coincidence card on these cases, but they are to wide spread and happen to often to be ignored !

    Good Blog i enjoyed reading it, sorry about that rant

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  5. psucd2 says:

    Good blog. Placebos can be useful in helping people feel better for example the majority of alternative therapies are just basically placebos. A study into the effects of acupuncture on back pain found that in the group who actually received the acupuncture improved by 47.6% while the group who received the fake acupuncture improved by 44.2% (http://archinte.ama-assn.org/cgi/content/full/167/17/1892). Another study investigated wether a sham device or a fake pill had a better impact on arm pain. They found that the results were better in the sham device condition (http://www.bmj.com/content/332/7538/391.full) These studies show that the mind does have an impact healing and part of the effectiveness of medicine could be down to the whole procedure that goes along with it.

  6. leprice91 says:

    I really enjoyed reading your blog. The thought of a placebo healing people is amazing. It is true though when I was younger when I had a headache my mum would put sugar in my water and tell me it was a disposable tablet and it would work. Any way I’ll stop telling you my life story 🙂

    I believe the imagination is a big part of the healing concept as if we believe we won’t get any better we recognise the symptoms more so we are not proactive in trying to make ourselves better. I agree with bprowlatt when saying there is a correlation between positive energy and positive results in physical forms.

    Happiest is the key to a successful life 🙂

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  8. Afshin says:

    I love the cartoon that you used above! I also really enjoyed reading this post.

    The placebo effect really shows the power of the human mind and all the capacties that it is capable of and we we are only now beginning to understand. There are of course, the amazing studies that are discussed by the guys above about the placebo effect managing to cure cancer; many people may attribute this to the power of God, Miracles and Praying that make an individual get better not the placebo effect. However, what about on a smaller scale? Research has found that a caffeine placebo can trick the dopaminergic system into thinking that the body is receiving caffeine and elicits the effect that caffeine usually has such as higher alertness and faster reaction times (Kaasinen, Aalto, Nagren, Rinne, 2004). This really reflects the power of nothing, as you stated above.

    In my opinion, the placebo effect really does have the power to change the world and science. Its abilities to induce pain relieval, cure symptoms and elicit certain responses make it to be a very important contributor to science in control conditions. However, it is important to consider that society is becoming increasingly aware of scientific methods and individuals may be aware that placebos are being used; will this knowledge still have an impact on their treatment?
    Furthermore, the opposite to the positive effects of the placebo is the ‘nocebo’; this is the same inert drug that has no effect on the participant, however somehow elicits negative effects on the patient. This really reflects how placebo effects are truly down to individual differences and how much belief and motivation an individual has.
    The mind is truly powerful.

    🙂

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