Can a sugar-filled pill have a real biological effect? Is that a dummy pill of happiness we just gulped down?
Here’s the fascinating story of placebo — the journey of an empty pill that kept us happy for over two thousand years.
And it’s a long story.
What Is A Placebo
A placebo is a pill with no pharmacological effect that is given merely to satisfy a patient who assumes it to be a medicine.
It is a fake medication with no therapeutic effect of its ingredients on the persons taking it. In Latin, placebo means, ‘I shall please!’
A placebo is a dummy pill – that is, a pill with zero medicinal effect.
Placebos have been used for centuries by the physicians as well as the quacks to help patients with many diseases, though via deception. It’s deception because a placebo doesn’t have any medicinal properties. But new research is proving otherwise — that a placebo can indeed have a valid effect on us.
Read on to find out if your mind is capable of healing your body. Find out if plain sugar pills as effective as prescription drugs.
A (Disgusting) History of Placebo
A placebo is actually an empty pill of happiness, and you’ll soon know why.
Placebos are substances given for relieving the symptoms of an ailment, but they come with no proven medicinal effect.
But modern-day researchers are proving these pills, far from being fake or sham, have an effect. In fact, 30 to 40 percent of the people given a placebo have shown an improvement in their symptoms. So, is it time to revise the whole story of the placebo?
However, placebos are not entirely the domain of pills or drugs – they come in many forms. A placebo can be pharmacologic (as a tablet), physical (as a manipulation), or psychological (as a conversation).
History has evidence that placebos can come as magic, religious rites, exorcism rituals, phlebotomy or bloodletting, emetics, purgatives, lotions, oils, suppositories, urine, menstrual blood, many kinds of ‘shite’ (feces of human and animal origin were recorded treatment methods), and the easily dispensed physical and psychic torture.
Incidentally, bloodletting was the longest-lasting sham-treatment of our times; and according to some medical historians, it was this that killed George Washington.Menstrual fluids, feces, urine, and bleeding-out were historically used as sham-treatments. Click To Tweet
Some of these unscientific, archaic, placebo treatments still reign today in some segments of the population in every country of this world. A commonplace placebo used even today by some in the villages and suburbs of India is making the person who faints – hold your nose – smell a dung-smeared shoe.
Historically, until the mid-20th century, almost all the medicines given by the doctors in the Western system were placebos. But it didn’t end there: the placebos have a place in the modern medicine as well, albeit, in a much different – and scientific – way.
Placebos are routinely used in drug trial studies to find out whether the pharmacological effects of a drug are real. A new drug is given to a ‘test’ group, while a placebo to the ‘control’ group, and then the results are compared.
This double blind, randomized, placebo-controlled trial is held as The Gold Standard for proving effectiveness of a potential new drug. It is “double blind” because both the patients and the researchers are blinded as to which pill – real or dummy – the patient was receiving.
Placebo Effect: A Faith Reflex
The placebo effect or placebo response is a fascinating yet puzzling phenomenon. It has challenged the investigators for over 60 years.
The placebo effect can be described as an effect produced by a placebo. It can be an actual or imagined relief of the symptoms of a medical condition.
A book that sprang out of a November 2000 conference on placebo defined the placebo effect as:
The positive physiological or psychological changes associated with the use of inert medications, sham procedures, or therapeutic symbols within a healthcare encounter.
Essentially, a placebo effect is a psychosomatic effect – an unconscious, automatic response of the mind-body combine.
The area of placebo effect that has been extensively researched is one of placebo induced pain relief, called placebo analgesia – the study of the neurobiological mechanisms of pain reduction by sham treatment.
Hippocrates, Father of Medicine, was apparently a placebo dispenser. The benefits that his patients derived were mostly the result of the ‘patient-doctor relationship’ – the placebo effect.
All the ‘healers’ among the Babylonians, Greeks, Egyptians, Romans, and Chinese, worked their charms by the same placebo effect.
The Indian medicine system was an evolved one in those times; and even though they correctly used turmeric paste for wound antisepsis and ant-heads for closing surgical lacerations, prescriptions of fasting, abstinence, and animal dung served the purpose of the times.
Since then, for over 2,000 years, it was primarily the faith of the patients towards their doctors that treated them – until the middle of the 20th century.
As Walter Brown writes,
The history of medical treatment is largely a chronicle of placebos.
Every concoction handed by the doctor had an invisible order written into it, ‘This will heal you!’ Faith was the only actively beneficial ingredient in those medicinal mixtures.
Even though medicine has evolved enormously over the last two millennia, however, the placebo effect remains a pervasive phenomenon even today.
A Danish study of 772 randomly selected general practitioners revealed that 86% of them admitted to using a placebo for their patients at least once, and 48% said they used it over 10 times, over the last year.
A typically used placebo intervention was dispensing antibiotics for viral infections. The most reported reason given by the clinicians was that they gave it to avoid confrontation with the patients.The warmhearted doctors have been the placebos themselves – since the beginning of medicine! Click To Tweet
On the other side, not surprisingly, when the patients have been conditioned to believe that their doctors will undoubtedly treat them of their aliment, they got better relief with placebos.
Even the good behavior of the doctors has been found to be influencing better therapy response.
In a study, the placebo response increased from 44% to 62% when the doctor treated their patients with “warmth, attention, and confidence.”
These prove one thing: The doctor himself is a placebo.
However, even when placebos can have noticeable effects, it’s not too much. Two Dutch doctors, Asbjørn Hróbjartsson and Peter C. Gøtzsche, carried out a systematic review of 130 clinical trials in which patients were randomly assigned to either placebo or no treatment. They found “little evidence that placebos, in general, have powerful clinical effects.”
Placebo Researchers: Sham Warriors
The area of placebo effect that has been extensively researched is the one of placebo induced pain relief, called placebo analgesia — the study of the neurobiological mechanisms of pain reduction by sham therapy.
It is now known that placebos reduce pain by causing release of body’s natural endorphins, and changing the threshold of pain perception. Researchers have also shown that individuals high in optimism show a greater placebo analgesic response.
Perhaps the first investigation into the mechanism of the placebo effect was carried out by L. Lasagna and colleagues at the Massachusetts General Hospital in Boston, in 1953. They did a two-part study on a total of 162 patients who had undergone surgeries, called ‘The effectiveness of oral analgesics and the problem of placebo “reactors” and “non-reactors”‘, and concluded that out of the 69 patients who received placebo injections for pain reduction, 11% showed ‘consistent’ response, while 55% showed ‘some’ response.
Henry K. Beecher, an anesthesiologist and a colleague of Lasagna, in 1955 authored the classic paper called ‘The Powerful Placebo’ which examined 15 existing clinical reports with placebo responses. These studies had data from 1,082 patients in whom, Beecher suggested, placebo showed significant effectiveness in approximately 35%.35% people show effects on taking placebos. 75% of Antidepressant benefits is placebo-effect. Click To Tweet
Two of the foremost placebo researchers in the world today are Ted Kaptchuk and Fabrizio Benedetti.
Ted Kaptchuk, a professor of medicine at Harvard Medical School, holds the position of the Director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS). In two fMRI-aided brain studies that they published in the Journal of Neuroscience in 2006 and 2008, Ted Kaptchuk and his team showed that placebo treatments alter the areas of the brain that regulate pain reception.
Additionally, they said, the placebo pills are also capable of causing negative side effects – “nocebo effects.”
Nocebo (Latin) stands for “I shall harm”.
Fabrizio Benedetti is professor of physiology and neuroscience at the University of Turin Medical School, Italy. Widely regarded for his research into the placebo and nocebo effects, he is said to run “the foremost laboratory for the study of placebo effects in the world.”
Benedetti is convinced by his studies that “therapeutic rituals move a lot of molecules in the patients’ brain, and these molecules are the very same as those activated by the drugs we give in routine clinical practice.” That is, ritualistic practices and medicinal drugs have similar effects on our brains at the molecular levels.
However, some studies also point out the ineffectiveness of placebos in certain conditions. This Dec 2014 saw a paper published in The Journal of Pain that meta-analysed data from 340 participants, in which Gashirai Mbizvo and his research team conclude that in cases of Complex Regional Pain Syndrome (CRPS), placebo analgesia does not last beyond the initial 15-30 minutes.
Truly Fake: Honest Placebos
The thing of note is this: Whether they are given to the consenting people with full, partial, or even false information, or just without any knowledge of the pills’ ineffectiveness, they fall within the category of placebo as long as the contents are known to be safe and inert.
The scientists call these non-deceptive placebos.Research shows a placebo acts, even when you know they are just useless. Click To Tweet
In a 2010 study called Placebos Without Deception at the Harvard Medical School, Kaptchuk and others gathered patients with Irritable Bowel Syndrome (IBS). While one group received no treatment, another group of patients was told they will be given inactive drugs.
To make it clear to all, these inactive drugs were placed in bottles labelled “Placebo Pills.”
When the results came, it was found that the patients who knew they were taking placebos reported twice as much relief as the other group. The placebo had healing effects comparable to some of the best real IBS drugs.
“Our results challenge ‘the conventional wisdom’ that placebo effects require ‘intentional ignorance,'” they wrote.
Thus, the concept of open-label placebos or ‘honest placebos’ was born. However, the FDA doesn’t legitimize prescription placebos.
A July 2020 paper in Nature found non-deceptive placebos are viable emotion regulation tools, and they take some time to reduce negative emotions. Moreover, at least for emotional distress, non-deceptive placebos lead to genuine psycho-biological effects and are more than response bias.
In their research, a team led by Darwin A. Guevarra of Michigan State University carried out two experiments.
- In experiment 1, participants who were educated about placebo effects and then received a non-deceptive placebo nasal spray reported less emotional distress when viewing emotional images.
- In experiment 2, participants who received the same non-deceptive placebo intervention showed reduced activity in a neural marker of emotional distress when viewing emotional images.
Dr Guevarra says,
I hope these findings bring us closer to using non-deceptive placebos
as mainstream interventions. They have the potential to regulate daily emotional life and help manage distress that accompanies many physical and psychiatric conditions.
Big Fight: Placebo vs. Prozac
What is Prozac?
Briefly, Prozac is perhaps the most famous antidepressant ever. It has been prescribed to over 50 million people worldwide.
But hardly anyone remembers that in 1989, Prozac made scandalous news as one man, Joseph Wesbecker, killed 8 people, and wounded 12, before killing himself under the effect of the drug.
Since then, the FDA now requires all antidepressants to carry a black box warning stating that antidepressants may increase the risk of suicide in people younger than 25.
Does Prozac treat depression better than any placebo?
That question may sound as rhetorical, but placebos have been shown to almost as effective as antidepressants. It may come as a surprise to you that brain images reveal placebo-treated patients have the same changes in their brains as in those treated with prescription drugs.
A 1998 meta-study of 2318 patients showed that 75% effectiveness of the antidepressants is due to the placebo and other non-specific effects. That is, placebos can be 75% as effective as antidepressants.
Martin Seligman in a widely cited chapter titled Positive Psychology, Positive Prevention, and Positive Therapy, quoted the above study and wrote:
In the depression literature, a typical example, around 50% of patients will respond well to placebo drugs or therapies. Effective speciﬁc drugs or therapies usually add another 15% to this, and 75% of the effects of antidepressant drugs can be accounted for by their placebo nature.
A 2002 meta-analysis of the FDA database by Antonuccio and Burns, in a paper titled ‘Antidepressants: A Triumph of Marketing Over Science’ concluded that many of the widely prescribed antidepressants have clinically negligible advantage over placebo.
A 2009 article in NEJM (New England Journal of Medicine) that reviewed Herzberg’s Happy Pills in America, Tone’s The Age of Anxiety, and Shorter’s Before Prozac, suggested that the antidepressant class SSRIs, which include Prozac, has no advantage over the largely discarded tranquilizers Librium and Valium.
It proposed that the pharmaceutical industry has replaced these, as well as the superior TCA and MAOI class of drugs, with the SSRIs simply because the latter are on-patent and thus more profitable.Placebo means, ‘I shall please!’ And Nocebo stands for 'I shall harm!' Click To Tweet
If placebo means ‘I shall please,’ then, isn’t happiness a placebo effect after all?
Yes. And No.
- Yes: Happiness could be the effect, of which placebo may be the cause.
- No: Placebos can have ‘nocebo’ effect – which gives unhappiness.
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Author Bio: Written and reviewed by Sandip Roy – medical doctor, psychology writer, happiness researcher. Founder of Happiness India Project, and chief editor of its blog. He writes popular-science articles on positive psychology and related medical topics.
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