“They can conquer who believe they can…” – Virgil (70 BC – 19 BC)
I started to write a long complicated post about placebos yesterday, because 1) I was worrying that this blog was in need of some Legitimate Content, 2) I am really interested in the placebo effect and 3) my brother Dave chose it when I gave him a choice between placebos, a juicy local murder mystery and a post about attention span. (I’m not entirely sure he paid attention long enough to get past the first choice…)
I wanted to show you the evidence that placebos are getting more effective all the time and that the drug companies are having a harder time finding new drugs that outperform them. This is a big problem for Big Pharma because they can only continue raking in the cash if they find new drugs. If nothing they develop does any better than a sugar pill, then either they’ve got to come up with more ways to convince us that we’re sick (and believe me, they work hard on that) or they’re going to get into the business of repackaging and selling us inactive substances (as arguably the homeopathic remedy and vitamin industry are doing already).
But then I realized that Steve Silberman already wrote about this in Wired Magazine in August 2009. Go read his article. It’s really good.
What I’d rather do is write a long, complicated post about why I think the placebo effect is so interesting.
In case you’ve been hiding under a log, a placebo is a substance – a pill, injection, cream or other treatment (it can even be surgery) without any “active ingredients.” When a person takes a placebo instead of a substance with active ingredients, and the placebo produces the desired effects, this is known as the placebo effect. The key thing here is that the person taking the placebo doesn’t know whether it is a real treatment or a placebo. Here are some interesting facts:
- The more you pay for a placebo, the better it works.
- If the placebo has a brand name on it, it works better than a generic.
Homeopathic medicine, which is very popular in Europe and becoming more popular in the US, is considered by many in the medical establishment to be a thinly disguised form of placebo treatment. The little granules a person swallows, they argue, cannot contain enough of anything to have an effect on a 150-pound human body. A recent study has revealed that over 50% of doctors in Germany regularly prescribe placebos to their patients. But some doctors feel it’s unethical to tell their patients to take something that they know is a sham.
Nurse to doctor: “You know that patient you prescribed a placebo to? He paid with Monopoly money.”
Last December, some researchers at the Beth Israel Deaconess Medical Center (that’s one of Harvard Medical School’s teaching hospitals) did a study that addressed this inherent deception involved in prescribing placebos. The assumption is that in order for a placebo to work, the patient has to believe it is a real medication. Could you get the same effect but be honest with your patients, telling them that you were only prescribing a sugar pill?
In their study, 80 patients suffering from irritable bowel syndrome were separated into 2 groups: They all met with a doctor, but the first group was given placebo pills that they were told were “made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in symptoms through mind-body self-healing processes” and the second group wasn’t given anything. Incredibly, sixty percent of the pill-popping patients reported improvement in their symptoms over the course of the trial, as opposed to 35% in the second group.
One of the women taking the placebo was reportedly disappointed when the trial was over, because her symptoms returned. She tried self-medicating with TicTacs but they didn’t have the same effect. (She should have used Jelly Bellies. They have documented medicinal properties. note to self: future post on documented medicinal properties of jelly bellies.)
It’s clear that what’s really at issue here is belief. These, and in fact all the studies involving placebos, are resounding evidence that what’s going on in your brain can and does affect what happens in the rest of your body. This shouldn’t really surprise us. The brain is a physical thing, after all. It’s connected to the rest of the body. The problem is that we don’t understand how. We can’t pick it apart, find the chemicals involved, reconstitute them in pill form, and bypass the brain and its nebulous belief systems altogether.
We don’t understand the physics of belief. And until we do, we won’t believe it. Now there’s a conundrum for you.
My own personal take on this is that a lot of us Westerners are still stubbornly stuck in the Cartesian duality of mind and body. We’ve been brought up to treat everything below our necks like we treat our cars. Every so often, you get a tune up. When something wears out, you get a new part. Keep it clean, in good form. Read the manual. We have expectations – if something is not functioning correctly, there must be a logical cause, and a logical, findable solution. A chemical. A gene. A missing vitamin. Too much salt. If something major goes wrong – well, you were given a lemon. Life’s unfair.
From the neck up, though, it’s more of a crapshoot. We give our hyperactive children stimulants to calm down and focus, without a clue as to why. The mentally ill go through drug after drug on a trial-and-error basis until one is found (if one is found) that works. No one has found a way to loosen the tenacious and debilitating grip of substance addiction. Our brains are the black box whose code we haven’t been able to crack.
It’s like there’s an unwritten rule between brain and body: never the twain shall meet. In the one, the logic of cause and effect is king. In the other, we keep trying, but it’s hit or miss at best.
Placebos hint that insisting on mind-body duality might just be a big fat mistake. The reductionist, mechanical, one-gene-at-a-time, one symptom-at-a-time, one-vitamin-at-a-time approach to medicine and our bodies might fix problems that pop up, but it often introduces other problems (aka “side effects”) in the process. And so far it hasn’t worked all that well when applied above the neck.
I have nothing against traditional medicine. I’m not one of those people who won’t immunize her kids or take them to the doctor. If I have a headache, I pop an Advil. But I also think my mental state affects my overall health. And in this respect I find the placebo effect really, really intriguing. It’s like a major clue from the black box of our brains. Thoughts can translate into physical processes. Belief begets embodiment. I think, therefore I heal.