What the Placebo Effect Tells Us About the Brain’s Power to Heal
In the 17th century, something amazing happened in Western medicine: Anton van Leeuwenhoek of Holland invented the microscope and discovered the biological nature of disease. Once a scientific basis for illness had been identified, the effectiveness of treatments could be observed and measured for the first time. Physicians had to go through their medicinal cabinets and figure out what — among their many tinctures, potions, elixirs, and balms — actually worked.
The vast majority of their “cures,” when tested for scientific efficacy, turned out to be ineffective or detrimental. Not surprisingly, those that were proven effective tended to have a history as folk remedies among indigenous cultures. The first proven active ingredient, cinchona bark, was known among Peruvian Indians to be effective against malarial fever and was eventually used to cure both King Charles II and Louis XIV.
But how were scientists to account for the positive effects previously demonstrated by treatments that were later proven to be useless? The phenomenon was named the “placebo effect,” Latin for “I will please,” and for centuries scientific medicine considered it a nuisance, something to eliminate or avoid. Only recently, due to a combination of innovative brain-imagining techniques and sophisticated double-blind studies, have scientists begun to respect the placebo effect for what it really is: the activation of the brain’s innate capacity to heal.
Dr. Herbert Benson of Harvard University estimates that placebos yield beneficial results for up to 90 percent of diseases. Clinical studies have shown that placebos are effective for up to 60 percent of subjects suffering from aliments such as pain, depression, and ulcers. In one study, doctors painted warts with dye and told patients they would disappear. The warts later vanished, despite the fact that the dye had no medicinal quality. A study by Dr. Arif Kahn showed that up to 75 percent of the benefits of antidepressants are due to the placebo effect. Placebos have been shown to get people drunk, prevent the common cold, relieve chronic fatigue, and even cause remission in cancer patients.
The placebo effect isn’t “all in the mind,” as some mistakenly claim. After patients with inflamed intestines were treated with a placebo, over half of them reported improvement, which was verified with a sigmoidoscope. Placebos can open the airways of asthmatics, and placebos said to contain pain relievers can cause the release of actual opioids, the body’s natural pain relievers. All of these are real, verifiable physiological changes in the body that are caused by the brain.
A placebo cannot stitch up a wound or end an infection. But all of the body’s reactions to illness are controlled by the brain — and by persuading the brain, a placebo can influence the body’s response. Fever, pain, and swelling are responses that have evolved as the body’s way of dealing with illness. Fever, for example, raises body temperature to kill off bacteria or viruses. Pain tells us where and when something is wrong. All of these natural reactions can be augmented or reduced by placebos.
Traditionally, the benefits of placebos rely on their unconscious application. Studies have shown that if even the doctor knows s/he is administering a placebo, the effect on the patient is greatly diminished. For this reason, most studies are now done as “double-blind,” where neither the doctor nor the patient is aware the treatment is a placebo. The placebo effect is the ultimate confidence game — the practitioner and the patient must both believe in it to make it work. If a patient is told a placebo is expensive or rare, it is more effective than one that is said to be common or easily affordable. Placebos given by authority figures such as doctors are more powerful than placebos dispensed by a machine.
The most effective placebos, however, rely on more than just the belief of the doctor and patient: compassion factors in, too. Positive effects can increase by 50 percent if the placebo is given in a caring environment — defined as “warmth, attention, and confidence.” The reverse can also be true. Even an active drug’s potency can be diminished by emotional states like anger, hostility, or resentment. Anesthetized patients have been shown to respond physically to comments made by doctors during surgery.
One study of patients suffering from irritable bowel syndrome found that 62 percent of test subjects responded to placebos when they were administered with a “warm, friendly manner … empathy … and communication of confidence,” wrote Dr. Ted J. Kaptchuk and colleagues in a study published in The BMJ. In contrast, only 44 percent responded to impersonally administered placebos. To be most effective, doctors need to provide reassuring, attentive and personalized care — whether or not there’s a placebo involved.
The placebo effect is actually a complex combination of psychology, physiology, and social relationships. It isn’t much of a leap to say that the effect sheds light on the entire human experience: what it means to live well and be healthy. There are measurable health benefits to maintaining a positive outlook and knowing people who care for you. It suggests that effective health care should involve a “whole life” approach.
Do human beings always have to trick themselves with placebos to tap into the healing powers of their own brains? Perhaps not. A recent study allowed individuals to view their own brain’s response to pain in real time, via an MRI machine. Subjects who were able to monitor their pain-response eventually became adept at consciously manipulating it — voluntarily administering their own body’s natural pain relievers. This preliminary research suggests that with the right tools and the proper mindset we can control at least some of the beneficial aspects previously relegated to placebo treatments.
The mechanisms of healing and communication between your brain and immune system are so complex that you’d be hard-pressed to do a better job than your brain does naturally. Just as it is better that our brains keep our hearts beating and our lungs breathing without our conscious attention, it is also to our benefit that our bodies heal themselves without our having to concentrate on it.
Yet, as the placebo effect demonstrates, there is much we can do to help our brains be effective healers. We don’t need a sugar pill to trick us into caring for one another, diminishing our stress, and using our brains more effectively. The more we learn about the mental factors involved in health and recovery, the more confidence we can have in our own ability to heal ourselves. And who wouldn’t prefer it that way?
This article was originally published in the Winter 2010 issue of Brain World Magazine.
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