Can a placebo alleviate symptoms?
Pharmaceutical researchers test new drugs by comparing them to a placebo, a pill that looks like the drug but has no effect. The objective is to determine if the drug is more effective than the placebo. Interestingly, people who take the placebo often experience positive effects. If these effects are equal to those taking the actual drug, the drug is considered unsuccessful.
Self-Healing
In 2009, researchers conducted a small but insightful clinical trial that uncovered the first component of the placebo effect.“Placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes.”
After three weeks, 30 percent of group A patients reported adequate relief, compared to 60 percent of group B.The disease alleviation rate in group A revealed the first key factor of the placebo effect: Time heals. Or let’s use a more accurate term highlighted in the note received by group B: Our bodies have “self-healing” abilities.
Most people ignore it, and the legacy media have not emphasized it enough. However, it is one of the essential components of healing from a disease and is the core concept of natural therapeutics.
Self-healing is nothing mysterious. In IBS patients, gut function may be affected by stress, inflammatory mediators, or specific diets.
Even with no action, the gut, microbiome, and immunity can slowly heal on their own over time.
Our bodies have an incredible self-healing function that operates continuously, protecting us from harmful substances, viruses, and cancer.
Natural healing is the foundation of the placebo effect, an innate ability that we all possess.
Positive Belief
The efficacy doubling in group B is intriguing since patients in this group received a placebo along with a reassuring note about self-healing.Reassurance leads to positive belief, the second component of the placebo effect.
The author of the IBS study, Dr. Ted Jack Kaptchuk, a professor of medicine at Harvard Medical School and director of the Program in Placebo Studies and the Therapeutic Encounter, conducted another study.
The two pills looked identical and were put in an envelope and labeled differently. These envelopes were then assigned to three groups. Group A received a placebo labeled as Maxalt, group B received Maxalt labeled as a placebo, and group C received Maxalt labeled as Maxalt.
After two and a half hours, patients in groups A, B, and C reported reductions in their pain scores of 30 percent, 38 percent, and 62 percent, respectively.
The most intriguing finding was that patients treated with a placebo labeled as Maxalt experienced similar effects as the group who received actual Maxalt but believed it was a placebo.
The positive belief associated with the drug suggested that it would be effective. Every well-known drug is linked to certain brand-related beliefs.
The same thing can happen with a placebo.
The Message Matters
The message conveyed to a patient by his or her doctor regarding the expected treatment outcome can significantly affect the patient’s healing process.The doctor informed half of the participants that they had been given an antihistamine cream to treat their rash. The other half were told that the cream was a histamine agonist and would worsen the rash.
The group that was told the cream would exacerbate the rash experienced irritation within 10 minutes after application. Those who were told the cream would make the rash better saw improvement (5.1 mm versus 4.7 mm).
The study results suggest that the message has an impact on the treatment outcome.
Compassion With Authority
In a previous study, Dr. Kaptchuk’s team recruited 262 patients with IBS and randomly assigned them to three groups.The first group of patients did not receive any treatment. The second group received a placebo, with minimal doctor-patient interaction. The third group received the same placebo as the second group, but their doctors listened to them attentively and patiently.
In the first group that received no treatment, 28 percent of the participants experienced adequate relief from their symptoms, which can be attributed to the natural healing of the disease. In the placebo group for which minimal interaction was provided, 42 percent of the participants experienced adequate relief. However, in the group in which participants were engaged and received interactive treatment from their doctors, 62 percent reported adequate relief from their symptoms.
Simply put, engaged interaction between doctors and their patients before treatment can produce the most effective results, even with a placebo.
Furthermore, a doctor’s compassion combined with authority can tremendously influence a patient’s healing outcome.
During Ms. Crum’s skin prick test study, a group of patients were treated by a physician who made a personal connection with them. Instead of just asking for basic information, the physician asked about their personal experiences such as, “Where were you born?” and “What was it like growing up in Ohio?” The physician’s badge indicated that she was a “Fellow at the Stanford Allergy Center,” and the procedure was conducted in a spotless room with great precision.
By demonstrating compassion and competence, the doctor raised the patient’s expectations through positive feedback about the cream’s effectiveness. This belief substantially improved the patient’s healing (5.1 mm versus 4.3 mm).
In another scenario, the doctor was detached and not at all warm. She stared at the computer screen and asked, “Date of birth, birth location. ... Next question.” Her badge read “student doctor,” and her desk was messy. She fumbled when she put the blood pressure cuff on the patient.
In this scenario, the patient showed no reaction to the skin test. (5.1 mm versus 5.0 mm).
Not Merely Psychological
It’s often assumed that the placebo response is not mediated through physical or chemical mechanisms but is purely psychological. Despite this prevailing belief, an older and relatively small experiment has the potential to challenge this notion.A key pathological change in Parkinson’s disease is the lack of dopamine in the brain. This experiment used radioactive ligand isotopes to tag dopamine in the brain, which provided a precise readout of the level of dopamine.
The study provided evidence that Parkinson’s disease patients who received a placebo had a substantial release of endogenous dopamine in their brains. The placebo effect was as powerful as the drug treatment, and it was mediated by activating the brain region known as the nigrostriatal pathway, a major dopamine pathway.
Harnessing the Power of Placebos
The placebo effect remains a fascinating and often underestimated phenomenon in modern medicine. What began as a simple test control has unraveled into a complex interplay of psychological, neurological, and physiological factors.Revealing these unfamiliar components of the “placebo effect” gives us a fresh opportunity to decipher the true meaning of good therapeutics, including the power of our self-healing abilities, thoughts, beliefs, and social interactions on our overall well-being.
The health care system of the future should reconsider the connection between the mind and body, and explore new holistic approaches to health care that utilize the body’s natural healing abilities.
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