The Placebo Effect, Real or Imaginary?
The following information was presented to the Center For Inquiry Indiana, (CFI) at one of their recent monthly meetings, Scientific Medicine and Mental Health. This information may be copied and used by anyone free of charge. It is a compilation of accepted medical analysis of the placebo effect, with a few comments by me.
The placebo effect is widely misunderstood and frequently used to justify pseudo-medical treatments such as used in Complimentary Alternative Medicine, CAM. It is also the main ingredient of all religious Faith healings.
The average person knows little about the placebo effect and therefore is a prime victim of religious faith healers and bogus medical healers. Hopefully this presentation will educate those who are unaware of the misuse of the placebo effect. It is primarily used by charlatans to take money from gullible people and jeopardize their health and wellbeing.
Let’s start with two simple definitions: Placebo 1) A drug containing no active ingredients given to a patient participating in a medical trial in order to assess the performance of a new drug. 2) Something done or said simply to placate or reassure somebody. It has no actual effect on whatever is causing problems or anxiety.
CAM practitioners and faith healers never talk about the placebo effect because it is the only explanation for their claimed success in the moderation of pain and discomfort. Their first task is to convince their patients of the efficacy of their treatment, including medications, touching therapy of many sorts, incantations, and mysterious “medical” technologies. They must convince their patients that they are responsible for patients improved feelings when natural healing and the placebo effect are responsible. CAM practitioners and faith healers cannot treat the underlying disease and thereby jeopardize the patient’s long-term health. The treatment of a lethal disease may delayed or ignored. Licensed medical practitioners who habitually or intentionally prescribe useless or dangerous medication and treatment to their patients would loose their licenses would be in court defending multiple law suites for mal-practice. Unfortunately, faith healers and CAM practitioners are allowed to continue to cheat the public and to endanger gullible and needy people.
Placebo treatments by definition are inert; there is no real effect. No real change in pain level has been recorded in medical trials, but there is a change in the patients’ emotional response to the pain, meaning they believe they feel better. Canes, glasses, crutches, and important medications are often erroneously discarded by people who really need them. In medical trials designed to measure the perceived efficacy of placebo therapy, there was a 35% temporary positive response.
All new pharmaceutical drugs are tested against the placebo effect. If the drug offers no better than a 35% reduction of pain or reduction of a specific condition, the drug is considered inert and discarded.
A fascinating hierarchy of effectiveness exists concerning the efficacy of placebo treatment. A partial list follows.
1) Placebo surgery works better than injections.
2) Placebo injections work better than tablets.
3) Placebo capsules work better than tablets.
4) Big pills work better than small pills.
5) Two pills work better than one pill.
6) The more dosses per day the better.
7) The more expensive the treatment the better it works.
8) The color of a pill makes a difference, depending on pre-accepted claims.
9) Telling a patient “this will help”, “this has had spectacular results” works better than saying “this might work”.
10) A white coat on a caregiver makes effect more potent.
11) Distinguished looking caregivers with stethoscopes around their necks are more effective than a young, carelessly dressed caregiver.
12) The placebo effect does not work on an unconscious patient.
13) A confident acting caregiver is more effective than a non-confident caregiver.
What are the limits of the placebo effect?
1) Placebos cannot help unconscious patients or patients who don’t know they have received a placebo treatment.
2) Placebos can’t cure anything that can be objectively measured such as cancer, broken bones, high blood pressure, diabetes, etc.
3) Placebos have been known to occasionally and temporarily help relieve headaches, depression, itching, shortness of breath, indigestion, nausea, inflammation, osteoarthritis, some multiple sclerosis symptoms. These reliefs are debatable.
4) Some researchers suspect it may help relieve angina, herpes simplex, and ulcers. It might temporarily help control blood pressure, high cholesterol, high blood sugar, and help tolerate exercise. These claims are also debatable.
5) Placebo technique can release natural painkillers.
6) The “nocebo” effect is a potential effect that can induce adverse results in a patient such as “voodoo doll” or curse might worry or stress a patient and raise blood pressure, and the will to live. (Those patients recovering from heart operations who knew they were being prayed for by large numbers of people recorded more complications, possibly due to higher stress levels than patients not prayed for or who did not know they had been prayed for.)
The beginnings of understanding the placebo effect came in 1955 when H. K. Beecher did fifteen clinical trials. 35% out of 1,082 post operative patients claimed to have experienced some pain relief by placebo medication. In 1997 a massive review showed no evidence of real relief. All relief was due to spontaneous fluctuations of pain, regression of pain to a mean level, additional treatment, scaling bias, irrelevant response variables, politeness to researchers, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotations, etc. In 2001 Danish researchers did a massive meta-analysis of small trials and found similar results.
If you are not already convinced that the placebo effect is just imagined relief, the following results of placebo efficacy will help convince you.
During placebo testing, the directions given to patients were extremely important and directly related to a patient’s response to the placebo treatment. Patients who were told an IV contained a powerful pain relief needed 34% less medication than patients told nothing. In addition, patients who were highly motivated to get better, did better. That included gullible, less educated, and less skeptical patients. Interesting! Should skeptics choose the times when they should be less skeptical?
Explanations are simple, sensory experience such as pain and pleasure, can effect your body’s neurochemistry and release endorphins, catacholimines, cortisol, and adrenaline, all are potential pain killers that may indirectly reduce inflammation and assist healing.
What are other factors? Care, affection, and prayer often improve relief by taking patients’ minds off of their pain and discomfort.
In case there are those who might believe in a non-chemical relief of pain, such as a healing deity, the following experiments should convince you how the human body can be manipulated and fooled without supernatural help.
Patients warts were painted with inert paint. They were told when the paint wore off their warts would be gone. It worked but had nothing to do with a supernatural intervention. Asthmatics were told a non-functioning bronchodilator worked when it did not, but it gave them some relief anyway, actually 52% of their bronchial tubes looked improved. Fake ultrasound for treatment of wisdom tooth pain gave relief. Colitis patients claimed improvement after fake treatment.
A surgical procedure to prevent angina, Internal Mammary Ligation, reported a 90% success for 40 years until it was proven to be useless, and abandoned.
8 of 10 patients received fake knee surgery. All patients were satisfied with outcome. Real surgery did not improve outcomes compared to placebo surgery. Questions: Did patients really need surgery? Did patients recover on their own without surgery? Did placebo factor work?
Skeptics like you and I, demand to know how the placebo effect works. Here’s how. First of all, we are likely to see what we expect to see. Wine tastes better if it is more
Expensive and fast food tastes better if it has a McDonald’s wrapper. In addition, we humans are more likely to see what we want to see. Patients who have a strong need of relief are more likely to perceive relief. Conditioning teaches the body like Pavlov did in his dog experiments. Animals are subject to placebo effects such as Pavlov’s dogs that salivated at the sound of a placebo bell rather than actual food. Animals respond to attention and kindness like humans. Pet owners experience placebo effects from their pets when there is none. We are likely to misinterpret pet’s reaction to placebo medicine when there is nothing but natural healing.
Did you know real acupuncture and placebo acupuncture work identically? It’s true, the same biochemical effects are created with real acupuncture pin pricks as with phony toothpick pricks at different points on the body.
Why not use the placebo effect intentionally whenever possible? Being optimistic improve the placebo effect. Optimists recover more quickly, live longer, and have healthier immune systems. Optimism helps digestion and improves resting and recovery from stress. Biofeedback, meditation, and prayer help speed recovery from illness. Writing positive essays and journals is thought to improve recovery times by reducing flight or fight hormones. Improving your attitude on health concerns and reducing stress is thought to slow aging and improve healing. Dealing positively with loneliness is beneficial. Loneliness is as dangerous as smoking. Rich social lives helps people live longer and healthier.
The conclusions about placebo effects are not clinically important but do positively effect patient reported perceptions of pain, nausea, and wellbeing. Most reported positive real medical effects are thought to be the result of bias, natural healing, and illusion, with a few exceptions as listed above.
Confusing isn’t it? The placebo effect is a real effect that is not really real. Sounds like a silly conclusion, but now you know as much or more than your personal physician. The next time you are ill, put the placebo principals to good use, they won’t do any harm unless you are gullible enough to believe in faith healers and CAM practitioners.