“A placebo is anything that seems to be a “real” medical treatment — but it doesn’t.”
What is Placebo?
“A placebo is anything that seems to be a “real” medical treatment — but it doesn’t. It might be a pill, a shot, or some other type of “fake” treatment. All placebos have one thing in common is that they do not contain an active substance meant to affect health.
Normally, the person getting a placebo doesn’t know for sure that the treatment isn’t real.
The placebo is often in the form of a “sugar pill,” but it may also be an injection, a liquid, or even a procedure. This is intended to act like a true cure, but it does not affect the disease directly.
How Are Placebos Used?
During studies, researchers use placebos to help them understand what effect a new drug or some other treatment could have on a particular condition.
For example, a new drug may be given to some people in a study to lower the cholesterol. Others will get placebo. None of the study’s people would know if they got the real medication or placebo.
Researchers then compare medication and placebo effects on study participants. This way, they will assess the new drug ‘s efficacy and test for side effects.
Advantages of Using a Placebo
The major advantage of using a placebo when evaluating a new drug is that it weakens or eliminates the effect that expectations can have on the outcome.
If researchers expect a certain result, they may unknowingly give clues to participants about how they should behave. This can affect the results of the study.
To minimize this, researchers sometimes conduct what is known as a double-blind study. In this type of study, neither the study participants nor the researchers know who is getting the placebo and who is getting the real treatment.
By minimizing the risk of these subtle biases influencing the study, researchers are better able to look at the effects of the drug and the placebo.
A pain relief is one of the most observed and powerful placebo effects. According to some estimates, approximately 30% to 60% of people will feel that their pain has diminished after taking a placebo pill.
For example, imagine that a participant has volunteered for a study to determine the effectiveness of a new headache drug.
She notices that her headache dissipates soon after taking the medication, and feels much better. She later discovers, however, that she was in the placebo category, and that the medication she was given was simply a sugar pill.
How Placebos Are Used in Medical Research
In medical research, a placebo may be given to some individuals in a study, while others are being tested for the new treatment.
The purpose of doing this is to determine whether the new treatment is effective. If participants taking the actual drug show considerable improvement over those taking the placebo, the study can help support the claim for the effectiveness of the drug.
While a placebo has no effect on illness, it can have a real effect on how some people feel. The potency of this effect depends on a variety of factors. Some things that can influence the placebo effect include:
- The nature of the sickness
- How strongly the patient believes the treatment will work
- The type of the response the patient expects to see
- The type of the positive messages a doctor conveys about the treatment’s effectiveness
- Genes may also manipulate how people respond to placebo treatments
Some people are genetically inclined to respond more to placebos. One study found that people with a gene variant that codes for the higher levels of the brain chemical dopamine are more prone to the placebo effect than those with the low-dopamine version.
People with the high-dopamine version of this gene also be inclined to have higher levels of pain perception and reward-seeking.
When testing new medications or therapies, scientists want to know if the new treatment works and if it’s better than what already exists.
Throughout their research, they learn the sort of side effects the new treatment might produce, which patients may benefit the most, and if the potential benefits outweigh the risks.
By comparing the effects of the treatment to a placebo, researchers hope to be able to determine if the effects of the medicine are due to the treatment itself or caused by some other variable.
What Is the Placebo Effect?
The placebo effect is defined as a phenomenon in which some people experience a benefit after an inactive “look-alike” substance or treatment is administered.
There’s no established medical benefit of this drug or placebo. The placebo is sometimes in the form of a pill (sugar pill) but can also be an injection (saline solution).
How do people undergo actual improvements arising from fake therapies? The patient’s beliefs will play a large part in the placebo effect.
The more a person expects treatment to work, the greater the likelihood that they will exhibit a placebo response.
In most cases, the person does not know that the treatment they are receiving is actually a placebo. Instead, they believe that they are the recipient of the real treatment.
The placebo is designed to seem exactly like the real treatment, whether it is a pill, injection, or consumable liquid, yet the substance has no actual effect on the condition it purports to treat.
It is important to note that a “placebo” and the “placebo effect” are the different things. The term placebo refers to the inactive substance itself, while the term placebo effect refers to any effects of taking a medicine that cannot be attributed to the treatment itself.
How does the placebo effect work?
In the past, some researchers have asked if there’s compelling evidence that the placebo effect is a real influence.
But there are studies that show that the placebo effect is true in some circumstances. For example, in response to a placebo, scientists have documented brain activity.
Since several experiments have shown a placebo effect, we know for certain that mind and body are connected in one way.
Some scientific evidence suggests that the placebo effect on pain may be due in part to endorphin releases in the brain. Endorphins are the ultimate killers of pain in the body. But it appears there’s more to it than this.
The expectation effect
Many believe the placebo effect is due to the patient believing in the substance, treatment, or doctor. The thoughts and emotions of the patient often induce physical changes in the brain or body at short notice.
The patient wants to feel better, and for some time he or she is feeling better.
But even if a person feels better after taking a placebo, this does not mean that the illness or symptoms of the individual were not real. The person can feel less nervous, for example, so the hormones of stress decrease.
For Example, taking a placebo can change their perception – a person may reinterpret a sharp pain as uncomfortable tingling.
The conditioning effect
One group had a real pain medicine in one study that looked at the placebo effect in pain relief, and the other did not. Both groups were given a placebo in the following days which looked like the real pain medicine.
Anyone who had administered the true pain medication could handle more discomfort than someone who had not previously provided pain medicines.
This helped to separate the power of the researcher telling them they would have an effect from the learned experience of having the effect in the past.
This type of learned response after the personal experience is called the conditioning effect. It seems to be part of what we call the placebo effect.
The nocebo effect
The nocebo effect, in which a person after a placebo has more symptoms or side effects, is still being studied. Researchers believe a substance in the body that sends signals through the nerves can explain this in part.
For example, when a person is concerned the substance is activated and the person feels more pain than a person who is not anxious.
The nocebo effect can be seen in the brain: brain-imaging studies have shown that pain is more intense when a person expects more pain than when they don’t. This is linked to changes in certain brain regions on the imaging studies.
The mind-body connection
Even though we may not know all the ways it could work, the idea that the mind can affect the body has been around for thousands of years and is well proven for some situations.
Most ancient civilizations relied on the relations between mind and body to manage the illness. Shamans or men in medicine would not have regarded their efforts as placebos.
But their healing powers may have worked partly through the patient’s strong belief that the shaman’s treatments would restore health.
Or it could be that a sick person was going to get better anyway, but recovery was thought to be because of the treatment – which might have really done nothing for the illness.
Because placebos frequently have an effect, even if the effect doesn’t last long, some people think that the placebo produced a cure.
But placebos do not cure. And in studies where doctors are looking at whether a tumor shrinks, placebos have very little, if any, effect.
Even, placebos can obviously help to alleviate other symptoms in certain people, such as discomfort, anxiety, and sleeping problems. In earlier times, doctors sometimes administered placebos out of frustration or desperation, because nothing else was available or seemed to work.
A 2008 study found that almost half of the doctors polled said that they used a placebo when they felt that it might help the patient feel better.
Some scientists believe that the effects of many alternative and complementary therapies can simply be a placebo effect. If the patient believes in the treatment and wants it to work, it may, at least for a while, appear to do so.
If the placebo worked on a disease that would not usually get better on its own, and it lasted, it would be considered a true cure, not a placebo effect.
Other things that can add to or be confused with the placebo effect
Certain other factors can affect study outcomes, and may be confused with the placebo effect. These are effects that can cause a study to report that a placebo (or even a treatment that doesn’t actually work) had some effect when it really didn’t.
Timing of unrelated events
Along with the placebo or nocebo effect, incidental events (unrelated effects that might have happened without the placebo) might also be linked to the placebo because of their timing.
For example, a headache or rash that happens soon after taking a placebo could be caused by something else entirely, but the person might think the placebo caused it. The same can be said for good outcomes: if a person happened to start feeling better after taking a placebo, it might be thought to be due to the placebo.
Healing or changes in symptoms
A health problem that improves on its own (many do) can sometimes add to what’s thought of as the placebo effect. Even in serious conditions such as cancer, some types appear to get better and worse on their own, although they continue to spread and worsen over time. This is part of the effect of timing, noted above.
A person who was taking a placebo when symptoms started improving on their own is very likely to believe that the placebo had some effect. And a self-limited illness that goes away completely on its own at such a time might have the placebo-taker convinced it was a miracle drug.
Timing can have another effect when symptoms cycle through getting better and worse on their own.
The patient is more likely to sign up for or be accepted into a study when their symptoms are very bad. But in cyclic illnesses, the worst symptoms are usually followed by a period when they start getting better – no matter what’s done.
This can make the test method seem like it works, or it can look like the placebo effect if the person ends up in the placebo group.
An advantage of having a control group that’s very much like the test group is that both groups should have about the same numbers of people who’ll get better with or without treatment, so they balance each other out.
Patient selection and sign-up
Patients who already have some faith in a particular method are more likely to sign up for a study about that method. For example, people who have faith in their medical doctors’ methods are more likely to sign up for a study on medical treatment.
People who believe that acupuncture works are likely to volunteer for a study of acupuncture. Those who don’t believe a method works probably won’t sign up to test it.
This means that the group who volunteers for the study already has some expectation effect before the study starts.
Many who sign up are likely to report at least a brief improvement in symptoms with the treatment (or even with a placebo, if one is used) because they expect to be helped by the treatment.
Lack of blinding can affect reporting of these kinds of coincidental timing effects and belief in what caused them.
For example, people who know they’re getting placebos will know that their headache is not caused by the medicine, and they probably won’t report it.
Those who know or believe that they are getting the real medicine are more likely to believe that the medicine is causing the headache, and are more likely to report it.
Blinding and having groups that are very much alike help to balance these incidental timing effects.
Limits of the placebo effect
A 2010 study carefully evaluated over 200 trials that included a placebo group along with a group named “no treatment.” The reviewers found that placebo treatments have no major effects on disease but appear to improve patient-reported outcomes in some settings – particularly pain and nausea.
The placebo effects on pain varied quite widely, from nearly none to substantial relief. These variations in placebo effect were partially explained by differences in how experiments were performed, and what was said to patients.
The reviewers noted that it is hard to tell if patient-reported results were actually due to placebo effects or whether patient responses were simply biased.
In the end, placebos don’t cure. We can also make people feel better but they can make them feel bad as well.
And placebo effects (along with other factors that may affect outcomes of the study) often result in clinical trials that are not carefully designed with falsely positive outcomes. This is one of many reasons why good study design, like having control groups that are set up to be very similar to the test groups, are so important in human studies.”