Introduction

• Placebo effects are fascinating things which often produce very divided and divisive views. But let’s start simply: what is a placebo? A placebo is best described as a ‘harmless’ remedy that has positive effects on an ailment that cannot be attributed directly to the remedy itself.
• When most people think of a placebo one of two things often comes to mind; (1) a parent kissing a child’s knee after they have fallen and hurt themselves (2) a patient being given a sugar pill instead of a ‘real’ treatment for an ailment and the patient’s condition improving. However, it’s important to highlight that placebos can come in many different forms, including but not exclusive to: injections, surgery and counselling.
• The aim of this piece is to examine placebos in more detail, starting with the scientific evidence which really brought the spotlight upon the power of placebos, then digging deeper into how placebos work and the different competing theories out there. Next, I’ll explain how you can apply the scientific theory in your own life, and cover the importance of knowing where to draw the line, not throwing conventional medicine completely out of the window. I’ll end with sharing what I see as the key principles you should follow to actually implement placebos into your own life.

The Scientific Evidence

• The power of placebos really gained traction with the publication of a study by Harry K Beecher in the Journal of the American Medical Association called ‘The Powerful Placebo‘ in 1955. Beecher highlighted that across more than a dozen clinical trials involving ~1,000 individuals, 35% of patients being treated for an illness with a placebo (usually a sugar pill) instead of actual medication actually felt better and showed measurable signs of improvement.
• If Beechers’ study in 1955 was the first to give placebos a big name, then the study issued by Moseley et al in 2002 in the New England Journal of Medicine really blew open the door. The study related to knee surgery where surgeons found that simply making an incision so it looked like patients had an operation was enough to convince people that their knee felt better. This happened with equal frequency, meaning having your knee opened and nothing actually happening was as good as the surgery itself. 
• There are many other studies which show the effectiveness and power of the placebo effect, but these two really struck me. At this point I want to briefly touch on the nocebo effect, as no discussion is complete without considering the opposing view. The nocebo effect occurs when a patient believes a non-harmful treatment or action will cause harm and so it does. Voodoo curses and black magic are examples of this, Erik Vance the author of ‘Suggestible You‘ talks about when a curse was put on him and almost convinced him it was going to kill his unborn child.

How does the Placebo effect work?

• Now I’ve shared the evidence to ‘prove’ that placebos work I’m going to dig down into the theories/explanations for why and how they work. Unfortunately, there isn’t a single explanation which everyone buys into, but (from what I’ve seen) there are two completing theories.
  • Theory 1: To do with neurotransmitters – The first possible explanation is that the issuing of a placebo triggers a release of neurotransmitters (e.g. endorphins and dopamine), your body’s natural painkillers, therefore when we take the placebo our endorphins increase and our pain is reduced. Evidence to support this comes from PET scans, with researchers seeing the areas of the brain containing the body’s pain receptors becoming activated by both painkilling drugs and placebos. This explanation would align with research that shows placebos seem to work with the treatment of Parkinson’s not Alzheimer’s. Whilst the exact cause of Alzheimer’s is not known, it is known that the massive disturbance in dopamine regulation in the brain causes many of the symptoms related to Alzheimer’s disease. Therefore, because the neurotransmitters are so effected in Alzheimer’s, placebos are unable to have the same effect for the patient.
  • Theory 2: Just a little tender loving care (TLC) – The other major explanation or hypothesis to explain why placebos work is much less tangible than the first. Dr Lissa Rankin, author of Mind Over Medicine, argues that that placebos simply work for patients because they are receiving care and attention. If true this would mean that health care providers don’t just facilitate the placebo process, they are actually the placebo themselves. Rankin argues that this works because of the relaxation of the ‘danger state’ which being ill or in pain puts the human body in. Once relaxed – achieved because we believe we will be healed by the doctors – the body’s natural repair mechanism is able to kick in and start the healing process itself. 
• Both theories have good rationale and compelling arguments. Personally, I hope that the first theory is correct because the second scares me somewhat. If we only heal once we believe the right person or treatment is available, then knowing too much or being a natural pessimist (like I am) is terrible. I don’t take paracetamol because I don’t believe it works, if I now know that treatments provided by doctors also only work if you believe them next time I’m ill or in pain I might never be healed!
• Despite my concerns for my personal safety, this really does highlight an important point about placebos: you can’t simply hope they’ll work, you must truly believe that they’ll work for them to work. This suggests you shouldn’t overthink medical treatments. Just like with Santa Claus, it’s better to stay uninquisitive, naive and believe than to ask too many questions or wait up for your parents to enter your room and suddenly flick on the lights.

Applying this to your own life

• Whilst the scientific arena is the most discussed place for placebos, and rightly so given that’s the arena that will ultimately prove which of the above hypothesis are correct, placebos absolutely can, and I believe should, be employed by individuals in everyday life. 
• There is an almost limitless number of ways you can apply placebos in your everyday lives, I won’t bore you by listing hundreds here, but instead I want to share 3 examples to help get you in the right frame of mind and the creative juices flowing to design them yourself.
  • Weight Loss – If you are actively trying to lose weight and someone tells you look thinner, you are more likely to shed weight. The person telling you that you look thinner has no empirical evidence to know if you actually have lost weight but mentally it works as a placebo by lifting your mood, making you feel good that your effort is paying off and steeling you to continue harder to lose more. 
  • Productivity – Amending your physical environment to ‘get in the zone’ and complete a difficult task can be a considerable placebo. Although changing rooms makes no difference physically to your capabilities you can ‘psych’ yourself up and end up producing higher quality work in that period. They key to this working is that the first few times you use this you are sure you’ll do great work, I’ll explain why at the end of this section.
  • Improve your Mood – Choose a memory you love and which causes you to smile every time to think about it. Now tell a colleague at work about this experience. Every time you are feeling frustrated and angry at work ask your colleague to remind you about that experience, you’ll be surprised how quickly you can change your mood with absolutely no change in the underlying circumstances that caused your initial bad mood.
• Now, not all placebo’s will work. Even the above three examples not all will work every time for every person.
• The point that placebo pessimists wheel out at this stage is ‘won’t I know I’m tricking myself’? In some cases, yes, but often that doesn’t even matter. There is evidence to show that if patients are told they are being given a placebo many felt better anyway. This doesn’t necessarily mean we are all experts at deceiving ourselves, often the key is that it is coming from a doctor or an authoritative figure, and this rings true in all the case studies. 
• It is because of this that I don’t think all 3 of the examples have equal weight. The middle placebo effect, ‘productivity’, is based on the ability to deceive yourself, hence why I highlight the importance of ensuring the first few times you create the physical environment you are already feeling great. You need those first few times to go well otherwise you won’t be convinced that getting into that environment will increase your productivity. In the weight loss example, someone else (preferably someone you trust, an authoritative figure), is telling you what you are doing is working. Even if it isn’t working your brain is telling you that it is.
• In summary, placebos are far more effective when an authoritative figure is re-enforcing them for you.

Know where to draw the line

• So far in this piece I have promoted the use of placebos and their effectiveness, however it would be amiss of me not to spend some time on the opposite side of the fence.
• Placebos should not be seen as a one size fits all approach to reliving pain. For example, if you have a sucking puncture wound then someone, even a doctor, giving you a sugar pill and saying it will save your life isn’t going to quite cut it. Therefore, do apply common sense when trying to deploy the use of placebos, focus on areas where a well understood and documented ‘cure’, like surgery to stop a sucking puncture wound, isn’t available.
• There is also evidence that placebos don’t work on accelerating healing wounds, while this study was only on a small sample size it does re-enforce placebos don’t always work.
• However, don’t be afraid to use a placebo in addition to traditional methods. For example, if you have a throat infection absolutely take the antibiotics to shift it, but if someone can convince you that applying a ‘throat gel’ will help improve the effectiveness of the antibiotics then crack on.
• Research suggests that the order in which you run the two together is also important. If you have to take a harmful drug, such as steroids, to tackle an even more harmful disease then take the placebo first and then the ‘real’ treatment. You can then reduce or potentially remove the ‘real’ treatment while maintaining the effects through the placebo.

Conclusion

• The placebo effect is real and I believe can be harnessed by people in certain situations. There are two key things to consider though: (1) It’s all about belief, you can’t simply hope that the placebo will work, it won’t (2) For more serious pains/diseases think about using a placebo to complement ‘real’ treatment, not alone.
• Throughout this blog I have touched on examples and tricks you can use to help ensure a placebo works, these I believe can be broken down into the following 4 things that Dr. Ted Kaptchuk, director of the Harvard Medical School placebo program, has listed in the ‘what you  can do’ section of his article ‘putting the placebo effect to work‘:
  1. ‘Make sure you’re getting the support you need from your doctor‘. You need to ensure your doctor or a healthcare professional is supporting you, without that the placebo is highly unlikely to work.
  2. ‘Recognize that it might be “in your head,” but that there’s nothing wrong with that’. Your brain is a very powerful machine and very difficult to understand, sometimes you just need to go with it, if something is working don’t be overly concerned about why.
  3. ‘Find treatments you can believe in’. As highlighted a few times already it’s all about belief with placebos.
  4. ‘Keep your healthy scepticism’. Unfortunately, there are people out there exploiting people so always keep an eye open and don’t put yourself at greater danger or in more pain by getting involved with dangerous ‘placebos’.
• Stick to these 4 key principles and go test how you can enhance the power of placebos in your own life, the potential benefits are massive. Digging down into this topic has been really interesting for me, making this a really enjoyable post to research and write, I hope you find it useful!

 

Photo Credit