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Placebo Effect: Everything you need to know!

Mr White was a cancer patient dying from lymphoma in 1957. His tumors were the size of oranges and had infiltrated several organs. His doctors had almost given up when he heard of a new anticancer drug - Krebiozen. Within 3 days of receiving his first injection he was seemingly back from the dead and was discharged after 10 days of treatment. None of the other patients on the drug showed any improvement.

What was even more interesting was that after Mr Wright read reports criticising the drug, he relapsed. The doctors decided to lie to him and gave him an injection which had no drug but told him that it was an improved version of Krebiozen. He soon walked out symptom free!

2 months later after reading news that claimed Krebiozen was a useless drug - Mr. White died within the next few days. This curious case is one of the many reported findings of the “Placebo effect” due to which inactive medicines lead to recovery or improvements of symptoms.

“There are men on whom the mere sight of medicine is operative,” - Michel de Montaigne (French philosopher) in 1572.

What is placebo effect?

When there are observable improvements even clinical improvements in a patient’s condition, not due to any treatment but merely because of the belief that the treatment will work, it is called the placebo effect. This is a fascinating phenomenon which has had intrigued scientists, researchers and doctors for several decades. This effect beautifully illustrates the complex and intricate relationship between the mind and body- between psychological and biological factors and how belief can be a very strong motivator.

“Placebo effects on conditions like allergic reactions are pretty incredible. It’s not just, ‘oh, I feel better now’. You can actually see a reduction in the person’s inflammation.” - Dr Ben Colagiuri

What causes the placebo effect?

Researchers have been investigating this effect for a long time and there are several theories on how and why it occurs, however we’re still far away from completely understanding it. It is said to involve complex neurobiological reactions which include a plethora of processes starting from increasing the feel-good neurochemicals like dopamine and endorphins, to more activity in brain regions associated with emotions, self-awareness and moods. "The placebo effect is a way for your brain to tell the body what it needs to feel better," says Ted Kaptchuk, a leading expert in this area.

However, research has shown that it’s not only about the neurobiology of the effect. The societal, environmental and ritual factors surrounding the consumption of the placebo drug all influence how the brain and body reacts to the fake drug. When you are being given a lot of attention and care, if you perceive yourself to be getting the best care - all these seem to contribute to the placebo effect. There are several psychological phenomenon which offer an explanation of the causes and process of the placebo response:

Classical Conditioning: The concept of classical conditioning, first demonstrated in Pavlov's famous experiment with dogs, plays a significant role in the placebo effect. In Pavlov's study, the ringing of a bell, initially neutral, became associated with food, eventually triggering salivation in the dogs even in the absence of food. (Watch this hilarious scene from the TV show ‘Office’.) This principle applies to the placebo effect as well. For instance, if a particular pill has previously been effective in alleviating pain, a placebo that closely resembles this pill may also lead to a reduction in pain, solely due to the pre-established association with relief. Likewise, the very setting of a hospital or a doctor's office, typically linked with healing and care, can contribute to a patient's perception and response to treatment, further illustrating the impact of classical conditioning in medical contexts.

Expectations: What we believe that we will experience has an impact on what we actually experience. This study has found that expectations significantly influence the placebo effect. Patients who are extremely positive and believe wholeheartedly that the treatment will work are more likely to experience the effect. If you expect the cough syrup to relieve your cough, you might feel like coughing less after you take it. There’s several cues which can generate expectations of improvement:

  • Verbal - Doctors tell you that the treatment is highly effective

  • Actions - You will feel better if you actually do an action to get better, like taking a pill or going to the doctor or getting an injection

  • Social - The demeanour and communication of the healthcare provider, including body language, tone of voice, and expressions of empathy, can make you feel a lot better about the treatment you receive. If you perceive yourself to be taken care of, you are more likely to feel better.

A study published in The Lancet Neurology showed that patients who weren’t shown that they are getting an injection of morphine needed TWICE as much of the drug as those who could see the nurse administrating it. Awareness of being given a treatments greatly impacts the perception of it working, especially considering how pain is a highly individualised subjective experience.

Stronger pain relief experienced by patients who saw the morphine being injected | The Lancet Neurology
Stronger pain relief experienced by patients who saw the morphine being injected | The Lancet Neurology

Human connection, environment and rituals:

A 2010 study with IBS (Irritable Bowel syndrome) patients showed that a practitioner's warmth and empathy significantly influenced treatment outcomes. The study divided participants into three groups. The first group received fake acupuncture from a practitioner who said things like “I can understand how difficult IBS must be for you.” Group two had a fake acupuncturist who didn’t really talk and group three was just put on a treatment waiting list.

Augmented condition participants were given extra attention and reported more positive outcomes than the other 2 groups.
Augmented condition participants were given extra attention and reported more positive outcomes than the other 2 groups.

The results showed that the warm acupuncturist produced the best relief symptoms. This clearly indicated that empathy, warmth, duration of interaction and creating positive expectations actually affect clinical outcomes.

“The placebo effect is a surrogate marker for everything that surrounds a pill. And that includes rituals, symbols, doctor-patient encounters.” - Ted Kaptchuk, Professor at Harvard Medical School and top researcher on placebo effect

Placebo’s aren’t the cure to everything!

The power of placebos seems to be the most effective over symptoms that exist at the very hazy line between physical and psychological conditions. A systemic review looked into 202 drug trials with placebo groups in them and found that they are most impactful for conditions of nausea, asthma, pain and phobias with inconsistent results for smoking, dementia, obesity, insomnia anxiety outcomes.

Placebos seem to manipulate our experience of the symptom not the actual underlying cause. In a 2011 study it was found that the self-reported relief from taking either the active drug, placebo drug and fake injection was the same and all were equally effective. However, an objective assessment of their lung function found that only the drug group had better parameters. Placebo’s only help the symptoms that can be controlled by our minds. There are limits to what our brains can be conditioned to do.

Placebo effect
Image Copyright: Chris Madden

Placebo effect around us

The placebo effect is not just limited to medical treatments. It extends to various aspects of everyday life, influencing our perceptions and experiences in often surprising ways**.**

The glass shape makes the wine taste better: The impact of glass shape on wine taste is a fascinating demonstration of the placebo effect beyond healthcare. Renowned wine glass maker Riedel promoted the idea that their uniquely shaped glasses could enhance the flavor of wines. Numerous taste tests in the U.S. and Europe supported this claim, suggesting that wines, irrespective of their cost, tasted better in Riedel glasses. However, this perception was challenged by double-blind tests, where tasters were unaware of the glass shape; the results showed no discernible difference in taste. This illustrates how expectations can dramatically alter our sensory experiences.

Placebo Effect in Fashion and Brand Perception: Much like in wine tasting, the placebo effect significantly influences the fashion industry and brand perception. Designer clothes and accessories are often perceived as being of higher quality or more fashionable, not solely because of their material or design but due to the brand name and associated prestige. This perception persists even if comparable or identical items are presented without the brand label, indicating that the brand itself acts as a placebo, enhancing the perceived value and appeal of the product.

Placebo and Pricing: Research has consistently demonstrated a strong correlation between a product's price and its perceived quality, challenging the common belief that purchasing decisions are solely based on the product's inherent value. Contrary to what consumers often claim, their purchasing behavior reveals a deep-seated assumption: the higher the price, the better the quality. This belief is particularly strong for certain types of products and in specific contexts.

A 2008 study by Dan Ariely and his team revealed that expensive placebos work better than cheap ones. The study involved giving mild electric shocks - standard protocol for measuring pain thresholds. There were 2 groups and both received the same placebo pill however, one group had an information brochure which had the price of the pill at $2.50 v/s the other pill was at 10 cents. The results showed that 85% of those receiving the “expensive” pill reported pain relief whereas only 61% of the “cheap pill” group reported relief. These findings clearly illustrate how the perceived value, influenced by price, can affect the efficacy of a product—even when there is no actual difference in the product itself.

Wrapping up

“One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, powders of hickory ashes than of all other medicines put together,” “It was certainly a pious fraud.” - Jefferson wrote in 1807.

The placebo effect is a captivating testament to the intricate interplay between mind and body, unveiling the profound impact of belief on our physiological well-being. Mr. White's remarkable case and countless others underscore the potency of psychological factors in influencing clinical outcomes. While researchers delve into the neurobiological mechanisms, classical conditioning, and the power of expectations, it becomes evident that the placebo effect's influence isn't confined to medicine alone; it permeates various facets of our lives, from the perceived taste of wine in special glasses to the influence of pricing on our perception of product quality.

As we continue unraveling the mysteries of this fascinating phenomenon, one thing remains clear – the mind possesses a profound ability to shape our experiences and, in some instances, contribute to the very healing it seeks.

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