Why Placebos Work
Mind over matter?
They say, “whatever you put your mind to, you can achieve.”
But I’d never quite taken it literally.
And for decades, the phenomenon of the placebo has been a mystery to scientists and healthcare workers. I mean, why should a made-up/false treatment plan work on a patient?
Let’s uncover what I found.
What is a placebo?
"The placebo effect is more than positive thinking — believing a treatment or procedure will work. It's about creating a stronger connection between the brain and body and how they work together." Prof. Kaptchuk
In 1799, an overly confident physician E. Perkins devised ‘unusual’ rods that would supposedly cure inflammatory conditions (such as rheumatism) using electromagnetism.
He fraudulently used steel and brass instead.
(Un)fortunately, his patients were none the wiser. Some claimed its effectiveness, leading to one of the earliest records of placebo use.
Placebo, derived from a Latin word meaning “I shall be acceptable or pleasing”, is a substance used for treatment but with no actual therapeutic value. It started as a way to pacify patients.
The opposite of this (causing harm instead) is the nocebo effect.
But over time, placebos have become more commonplace.
For example, an estimated 50% of physicians in the US have been said to prescribe placebos for patients (thankfully, with no harm to them).
In some cases, even the patient knows.
So why would something like this work?
Are patients only trying to please their doctors by reporting relief? Is it simply mind over matter?
In a study by Kaptchuk et al, he realised there was no measurable relief of symptoms. Only that which the patient subjectively reported.
“Our results challenge the conventional wisdom that placebo effects require intentional ignorance.” — Prof. Kaptchuk
What happens in the brain?
Thanks to functional brain scans, certain parts of the brain have been identified during a placebo effect. One of these is the Peri-Aqueductal Gray, a brain region involved in behavioural responses to stimuli or stress.
The prefrontal cortex lit up when placebos worked, meaning judgement can come into play. When we see a confident doctor or perhaps, get the feeling of getting injected, the non-sceptical brain thinks— aha, this will definitely work!
But on a more microscopic level, there’s a release of opioids (euphoria-induced substances) naturally produced by the body itself, in just the sheer anticipation of relief.
In summary, placebos don’t cure diseases.
That’s the general consensus.
But they can affect symptoms that are majorly modulated by the brain, such as pain (as in the pain pathway system) or insomnia.
Apart from helping to sieve malingerers (people who fake illnesses), this phenomenon is very useful in drug trials. The rationale is that it’ll reveal if the drug truly is effective. However, this is gradually being phased out due to ethical concerns, as new drugs would rather be compared with older ones.
A supportive patient-physician relationship enhances the placebo effect.
If there’s one thing this has proven, it’s that it’s not just about the specific treatment. Its context matters just as much.
🔌 Recommendation of the month!
As the year wraps us, write a letter to your future self! I did last year and I can’t wait to get it at the end of this year, seeing as I have no clue what I wrote!