The Placebo Effect: Psychological and Biological Phenomenon

We expect our doctors to have an explanation for our illnesses. In a few cases, there is no real answer. In these situations, the doctor’s last resort is to convince the patient to think that there a solution. The placebo effect is a profound phenomenon in which patients receive a sugar pill and display signs of improvement from their initial health condition. However, the sugar pill does not have any actual chemical effect on the body since it lacks real healing properties. Hence, the patient’s improvement is solely contributed to how much they believe the effectiveness of the pill.

The word “placebo” originated from the Latin phrase for “I shall please.” The sole purpose of the placebo is to satisfy the person rather than cure them of their illness. The use of placebo pills was first practiced in the late 18th century. Due to a lack of technology, doctors could not fully explain their patients’ sicknesses. Instead, they prescribed fake medical treatment, claiming that it would alleviate all of their problems (Mestel). Given enough time, the patients would return in full health and would be satisfied with their “results.” This practice continued for centuries and still exists today. The purpose of the placebo effect remains the same: to cure illnesses through the manipulation of the mind.

There is no real statistic or instructional process that accurately represents how a placebo pill would work on everyone. The success rate and the effects of the medicine differ from person to person, depending on how severe each case is. However, there is a vague estimate on the placebo outcome, which is explained by Ph.D. Faith Brynie, author of The Placebo Effect: How it Works. She states, “the placebo cure rate [could] range from a low of 15 percent to a high of 72 percent. The longer the period of treatment, and the larger the number of physician visits, the greater the placebo effect (Brynie).” Researchers try to understand the brain better to figure out how to achieve better placebo results for all patients. Many factors come into play; however, it all comes down to perception and relatively up to the person’s desire to heal (Brynie).

A prime example of when a placebo is used successfully is presented in Norman Cousins’ book, “Anatomy of an Illness as Perceived by the Patient.” He wrote about his internal struggle with a severe joint condition and how he overcame it by living in a more optimistic point of view. This condition is called ankylosing spondylitis, where it diminishes the collagen production and motor function of his spine. After his meeting with his doctor, William Hitzig, Cousins was told he would die within a few months. Soon after, Cousins was taken to the hospital to receive intensive care. For a few days, he felt as if his health was diminishing the longer he stayed in his room. Cousins could not eat the processed food they served, could not sleep, and could not remain emotionally stable due to his surroundings (Cousins 27-32). He convinced Dr. Hitzig to check him out of the hospital and decided to stay at a hotel to take care of his disease by himself. His doctor suggested taking part in activities that promote positive emotions such as watching a funny video a day and taking vitamin C. Following through his order, Cousins’ health drastically improved and he was able to move freely again within a few months. Shocked by the results, his views on health changed positively. He decided to write a story about his treatment to inspire readers that they are in control of their future (Cousins 38-48). Instead of the standard placebo pill, vitamin C and laughter were used to treat Cousins’ ankylosing spondylitis. Different methods and forms of placebo are used as remedies for all types of patients. For Cousins, he needed a more familiar form of medicine, such as laughing away the pain. In the end, no matter how the placebo is used, the individual should benefit from that treatment.

There are situations where instead of benefitting from the placebo pills, those pills could bring harm to the individuals. It could be as easy as being informed about a tablet having adverse side effects, which increases the chances of those symptoms of the illness to happen. This diagnosis is still considered a placebo in which the more appropriate and specific term for it would be called the nocebo effect. There are examples of which patients suffered from nausea, dizziness, or even pain in the body. One specific case would be with a 26-year-old man who attempted to overdose in what he thought was antidepressants. The man known as Mr. A, he experienced severe hypotension to the point where he collapsed. After reporting himself to the emergency room, his vitals were examined. His reports continued to come out as low pressure until a physician revealed what he took was placebo tablets. In a couple of minutes, Mr. A’s blood pressure returned to normal. Later on, he was examined again. It was confirmed that he was depressed, along with a history of depression and the usage of medication to treat it. Subsequently, he found an advertisement for clinical research on antidepressants and decided to try it out. He claimed he did not have an issue, and it aided with his emotions well. Weighing in the factors of Mr. A’s case, the nocebo effect was present due to his views on medication and his past of depression (Reeves). Placebo and nocebo are counterparts to each other, and the actual difference is that one could benefit the patient, and the other one could result in side effects.

Usually, placebo tablets are made out of either sugar, saline, or starch, meaning that there should not be any active medication to affect the individual’s health in any way. When researchers conduct a blind study, sugar pills are used to evaluate how strong the patient’s reaction to it. They do not inform the volunteers that they are on placebo because it does not create a bias that could affect the results of the research (“The Placebo Effect”). How the procedure is conducted starts with having two groups that are unaware of which pill they are taking. It is the researchers’ job to figure out if there are any significant differences between the groups and if that test drug has any successful outcomes. However, in other cases, the body is still able to respond to placebo even when they are told up-front by their doctor. Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School, calls open-label placebos. He conducted a study on people with irritable bowel syndrome, letting half of the group know that they were receiving a sugar pill while the other half remained uninformed. By the end of his research, he found that the open-label placebo group’s symptoms improved more drastically. Kaptchuk believes that “the open-label placebo might be valuable, instead of putting people on drugs immediately that people would be put on placebo.” His end goal is to prevent patients from becoming too dependent on pain medication to the point of addiction (Marshall).

Aside from pills, harmless injections and sham surgery are considered the stronger alternatives in the world of the placebo. The injection that doctors use contains saline, which is completely safe for individuals. The effect of the physical needle going through the skin could convince individuals enough to believe that they are completely cured. As for sham surgeries, people would go through the process of surgery where they would not eat, shower, be under local anesthesia until they are in the operating room, and the doctors would not perform the procedure. In a 2014 review of 53 trials on sham surgeries, researchers found that they work almost just as well as actual surgeries. Sham surgeries work the same as sugar pills and saline injections. However, it is a more complicated process to go through, making it more believable; thus, the placebo effect would be more effective for the patient.

The placebo effect is a psychological and biological phenomenon. For example, a patient with back pain would expect the placebo pills the doctor prescribe them would work. That expectation triggers the brain to release chemicals such as endorphins to ease the pain. Genetics also play a role where it could manipulate how well the placebo works on person to person. Those with more active receptors are more likely to experience the placebo (Altman). In the University of Michigan, the Professor in the Departments of Psychiatry, Jon-Kar Zubieta, and his team decided to conduct a study of 14 males in their twenties who are given a salt solution that claims to feel less pain. The team took before and after positron emission tomography (PET) scans to be able to read the level of endorphins produced by the opioid system (Motluk). The opioid is located in the brain. It is comprised of receptors that release pain and euphoria in the body. After receiving the placebo, the results were half of the group experience pain, while as the other half, they did not feel anything at all. Zubieta’s conclusion from this study was that the placebo effect enhanced the opioid’s control of the chemicals (Motluk).

There is a misconception that the placebo method may seem unnecessary, and doctors should prescribe their patients’ real medicine that does have active and beneficial ingredients, however, the placebo is a vital part of understanding mental and physical health. The placebo effect has provided many benefits for a large community with mental disorders and illnesses such as depression, nausea, or pain management for patients who struggle to find any solution to those problems. The placebo effect could be an alternative to medicine, for there are very few negative side effects when taking them. Placebos can also enhance the consumer’s medication, where their body produces more chemicals to heal faster as well. However, despite how many success stories there are, the work of the placebo is a mental process. Ultimately, it is still up to the individual whether to believe that the method of treatment will work for them.