Thread: Why Does the Placebo Effect Work/

It is a puzzle for me why placebos can apparently cure illnesses, even those thought to be incurable. Is it a human interaction event, where empathy, love and compassion tap into the patient's brain and improve their outlook, so that the immune response finds a cure? Is it a natural regression of the disease that would have occurred anyway? Why are there so few scientific papers on placebo cures?

The placebo effect refers to the phenomenon in which some people experience some type of benefit after the administration of a placebo. A placebo is a substance with no known medical effects, such as sterile water, saline solution or a sugar pill. In short, a placebo is a fake treatment that in some cases can produce a very real response. The expectations of the patient play an important role in the placebo effect; the more a person expects the treatment to work, the more likely they are to exhibit a placebo response

Placebo Effect - What Is the Placebo Effect?

It is a puzzle for me why placebos can apparently cure illnesses, even those thought to be incurable.

It doesn't cure illnesses - which makes it quite dangerous.

The classic example of this was done with a double blinded study of asthma patients. A significant minority of the patients who'd been given the placebo said that they felt that their condition was under control and they felt a lot better. When their lung function was tested - it was found that their condition had deteriorated. They were at serious risk of a life-threatening attack.

The "real response" or "some type of benefit" that patients often report for all kinds of tests like this are amelioration of perceived symptoms. So if the problem is something like feeling nauseous because of a medication, or many pain problems, then the placebo effect may be medically useful.

For conditions which are life-threatening when untreated, such as asthma, or hypertension, or diabetes, and for many of the autoimmune diseases, the false "feeling better" when using a placebo can worsen the condition because they are not primarily about how symptoms feel, they're about how a patient's metabolism functions.

There is a psychosomatic component to most symptoms of injury or illness.
It is precisely this psychosomatic component which placebos address, or remove.
If the main symptom is pain, then the placebo does little harm while alleviating the suffering of the injured.

Originally Posted by adelady

It is a puzzle for me why placebos can apparently cure illnesses, even those thought to be incurable.

It doesn't cure illnesses - which makes it quite dangerous.

The classic example of this was done with a double blinded study of asthma patients. A significant minority of the patients who'd been given the placebo said that they felt that their condition was under control and they felt a lot better. When their lung function was tested - it was found that their condition had deteriorated. They were at serious risk of a life-threatening attack.

The "real response" or "some type of benefit" that patients often report for all kinds of tests like this are amelioration of perceived symptoms. So if the problem is something like feeling nauseous because of a medication, or many pain problems, then the placebo effect may be medically useful.

For conditions which are life-threatening when untreated, such as asthma, or hypertension, or diabetes, and for many of the autoimmune diseases, the false "feeling better" when using a placebo can worsen the condition because they are not primarily about how symptoms feel, they're about how a patient's metabolism functions.

Thank you for the reply. I would expect that there is a human interaction and an expectation generated. The patients, apparently up to a third, feel better. So we can call this a "feel better" effect as you have stated. However, I remember hearing on the radio about soldiers crying in pain on the battlefield and doctors administering saline injections, in desperation because of lack of morphine, with the patient seemingly feeling far less pain as a consequence. I wonder if the brain of those people is affected by certiain hormones or if there is a big psychosomatic effect as sculptor has stated which has not been thoroughly accepted or even investigated.

Although you have stated the results for asthmatics and diabetics, and I accept that there is just a "feel good" effect generated, what about cancer patients where I have heard of amazing recoveries?

Originally Posted by jimmythesaint

Although you have stated the results for asthmatics and diabetics, and I accept that there is just a "feel good" effect generated, what about cancer patients where I have heard of amazing recoveries?

Which cancer patients?

The mind exercises a powerful influence over the body. From the beginning of time, the sorcerer, the interpreter of dreams, the fortune-teller, the charlatan, the quack, the wild medicine-man, the educated physician, the mesmerist,and the hypnotist have made use of the client's imagination to help them in their work. They have all recognized the potency and availability of that force.
Mark Twain - Christian Science

Leading to Diazepam/Valium taken for anxiety, but studies have shown that it only works when the patient knows they are taking it.
All in the imagination...true of false?

all?
or
nothing?

gee:
That's a tad rad dad.

what about cancer patients where I have heard of amazing recoveries?

From what? No one has ever survived a diagnosis of mesothelioma that I've heard of. But there are plenty of cancers where there is a chance, infinitesimal in most cases but a chance nevertheless, for a patient to survive through spontaneous remission. There are others, like prostate cancer, where many old men die with prostate cancer rather than from prostate cancer.

Most of the "amazing" recovery from cancer cases that get shouted from the rooftops are ones where

a) the patient didn't understand the doctor's description of their condition in the first place. The doctor said 'this is serious and needs treatment'. The patient heard 'this is a death sentence'. Not really. But patients and/or their families are quite often confused about what doctors have told them about what stage their tumour is at.

b) the greatest majority of "amazing recovery" stories come from people who had surgery but didn't go ahead with some or all of the chemotherapy or radiotherapy followup recommended by the oncologist.

What they didn't realise was that these therapies are often used to increase an existing chance of survival. Statistics show that patients who only have surgery have a higher rate of relapse than those who have the recommended chemo or radiotherapy as well. But there are always some patients where the surgery itself was enough - it's just that neither doctors nor patients have any reliable way to predict which patients will survive just as well with surgery alone.

c) and then there are those who were misdiagnosed in the first place. The radiographer misinterpreted a scan and described a condition as being much more serious than it really was - or half a dozen other forms of misinterpretation or, possibly, poor communication between doctors, specialists, and patients.

The placebo effect has several methods of working.

For example : one method is simply to distract people away from the perception of pain. Another is to leave the pain as it was, but to have the people report lower levels of pain because they think they should have lower pain, even though they feel it just as badly. There may also be innate mechanisms that get activated, such as a release of endorphins.

But Adelady is correct is suggesting it is not a cure.

By the way, on those remissions of cancer, there is a weird way they may happen. When the body has a massive infection, causing fever, cancers often shrink as the body slowly recovers. It appears that the immune system fully activated attacks cancers as well as the infection. These remissions are sometimes called spontaneous, even though they are not.

Originally Posted by adelady

The "real response" or "some type of benefit" that patients often report for all kinds of tests like this are amelioration of perceived symptoms. So if the problem is something like feeling nauseous because of a medication, or many pain problems, then the placebo effect may be medically useful.

By extension common pain relievers like aspirin are enhanced by placebo effect.

If so, their effectiveness depends partially on a shared belief within society, that they work great. And that calls for... propaganda! If it's partially placebo, proper marketing will make it more effective.

On the other hand, a new product incorrectly said to cause nausea, may be self-fullfilling when people imagine nausea and report that to others. This is a product image issue that needs careful management.

Placebo effect is one of the many subjective tricks that the human mind can use to keep us functional or get our needs met. They can all collectively be considered "hypnotic' effects in that they exist within the individual and do not represent change outside the person. These are often very important, even lifesaving, tricks. They can range from the "hysterical strength" that allows a small woman to lift an automobile off her child, to the dissociation that allows an abused child to "not remember" that the person who raped her the night before is sitting across the breakfast table from her.

I agree with both Sealeaf, Pong and Sculptor in the placebo effect being a condition of the human mind whereby the power of belief and conviction are enough to promote systemic responses in the body that respond to that mindset condition and supplement or detract from the overall health of the person.

The effect appears to be prominent when viewed in the same context as say a blind faith. The extreme 'psychosomatic' examples I would state are those bizarre ritual cases of 'Pointing the Bone' and 'Voodoo Deaths' where people in a state of normal health are struck with apathy upon the ritual being undertaken which frequently leads to a very rapid death. The fear associated with the belief in these rituals may be associated with brain activity (in the Amygdala) producing symptoms of stress throughout the body. Yes these victims become apathetic often refusing water and food, but the deterioration in health is so rapid and profound and in some cases even when treatment is administered (eg. Kinjinka case), the deterioration continues at a profound rate. Obviously there is a spectrum to consider here between those that would not be hostage to this negative placebo effect and those that would. The power of conviction in the mind would have a role to play in determining the position on this spectrum.

I note that in wiki "The generally recognized sequence of events, as enumerated by Esther M. Sternberg, MD, in 2002, stands as follows: various chemicals and electrical impulses are released that are transmitted by nerve fibers. Simultaneously, hormones are excreted from the brain, adrenaland pituitary glands in response to stress on the system. Cardiac arrhythmias are often the result of an overabundance of these hormones on the system."

Sealeaf also added a few more examples to throw into the mix which I agree with.

In the same way that I would view these extreme cases as 'Negative Health" responses, I would also assume therefore that the power of the mind could contribute to 'Positive Health' responses. While many cases of documented miracle health reversals are a pile of hogwash, I certainly would not rule out ALL cases. Given the minds ability to regulate the health of the body, a bit of placebo could in my opinion go a long way in assisting self-regulation back to a state of health.

Obviously when illnesses take control in the body, the symptoms are so overt (far gone) they are readily diagnosed and frequently so advanced that the natural recuperative powers of the body are challenged and thereby need to be supplemented by medicinal aids and treatments, but to those people that can be assisted by the placebo effect, I say good for them.

In Pong's example, he states the power of marketing and a brand name as a potential source for the placebo effect. In marketing circles the agencies would agree as they are fully aware that marketing is designed to alter human behaviour and purchasing patterns through brand effect on the mind. Once again this is an example of the power of belief or conviction to change the mindset. Obviously once the mindset is changed, physiological responses will follow.

Yes in general I would agree with Adelady that diagnosed ailments are generally not able to be affected by the placebo effect. It may however draw those cases out.......However in some less severe cases, the recuperative powers of the body supplemented with the mindset may have a small to significant role to play in health. It is just too subjective to make a definitive call in this matter in my opinion it would be wise to keep the bridges open. :-))

You give me more credit than I deserve. I'd thought placebo effect unsubstantiated speculation before this thread.

So those quack remedies do have this small effect going for them, at least. Wow.

Hey one could make some money here. Point some research to make the headline "Aspirin less effective than you imagine - say experts", that would simply expose the subtle placebo aspect of using the drug. But hold on, call the lawyers at Bayer and ask if they'd like to, um, purchase controlling rights to your research.

The placebo effect has come under attack recently, and some research says it only appears in when improvement is self-reported, not empirically measured.

Placebo interventions for all cli... [Cochrane Database Syst Rev. 2010] - PubMed - NCBI

I think the role of the mind/brain in illness is really a separate question, and there are a lot of effects that don't necessarily require invoking some magical or supernatural process. Hearing a baby cry will stimulate milk let down in a new mother's breast and the physiological reasons are understood. Stress hormones like cortisol have well known long term negative effects on metabolism and immunity. They are specific and measurable.
In addition there are social or behavioral aspects. Is a patient with a positive, cheerful attitude more likely to be compliant with his doctor's intstructions, more likely to have a better diet, more likely to sleep well, more likely to seek help for complications, less likely to take risks that endanger his health in other ways, more likely to have friends or relatives to look after him or notice potential problems? The possible variables are many and probably difficult to control.

Originally Posted by Pong

So those quack remedies do have this small effect going for them, at least. Wow.Hey one could make some money here.

An early marketer - Roll up, roll up and experience the healing powers of snake oil from Dr William S. Haubrich. Each free sample gives you the chance to receive 10 years subscription at affordable rates and also entitles you to be notified of other important research findings from our mobile laboratoty. Congratulations, but don't cause a stampede in your eagerness. Stand here for instalment payment options while Candice, a healed bulimic and paraplegic, demonstrates the power of this curative remedy while she dances in her tight bodice to keep you entertained . :-))

Well..

Does placebo work the same in everybody? Or does it have no effect on some people? And how do you make it have more effect on someone?

Say you have an illness with no cure, no research is been done on your illness because it is rare. How does a doctor make the placebo effect work the best it can?

Originally Posted by Zwolver

Well..

Does placebo work the same in everybody? Or does it have no effect on some people? And how do you make it have more effect on someone?

Say you have an illness with no cure, no research is been done on your illness because it is rare. How does a doctor make the placebo effect work the best it can?

Refer to the local witch doctor, hypnotist, priest or marketing agency. Any 'trusted' source that can create or assist with mindset belief and conviction. :-))

I will ask my Diablo 3 character..

And just in time for this discussion, a new research paper on placebo effect.

Still more oversold placebo research from our old friend Ted Kaptchuk – Respectful Insolence

In regards to pain specifically, there is far more to pain than the simple conscious sensation we associate with it. On top of this sensation, pain illicits a very strong emotional response, as well as a strong motivational response (if you lesion certain parts of the frontal lobe, the drive to get away/stop the cause of the pain can be eliminated), and a strong autonomic response as well. There is further a good deal of feedback from the higher functioning parts of the brain back down into the lower, which play a role in modulating the neurons that relay the signals up from the spine to the brain, diminishing the pain signal itself - this is where distraction and likely the placebo effect have some of their effect. I'm sure there are higher level areas that intercommunicate which also modulate pain, as well our subjective experiences as a whole, where the placebo effect takes place as well.

Originally Posted by adelady

what about cancer patients where I have heard of amazing recoveries?

From what? No one has ever survived a diagnosis of mesothelioma that I've heard of. But there are plenty of cancers where there is a chance, infinitesimal in most cases but a chance nevertheless, for a patient to survive through spontaneous remission. There are others, like prostate cancer, where many old men die with prostate cancer rather than from prostate cancer.

Most of the "amazing" recovery from cancer cases that get shouted from the rooftops are ones where

a) the patient didn't understand the doctor's description of their condition in the first place. The doctor said 'this is serious and needs treatment'. The patient heard 'this is a death sentence'. Not really. But patients and/or their families are quite often confused about what doctors have told them about what stage their tumour is at.

b) the greatest majority of "amazing recovery" stories come from people who had surgery but didn't go ahead with some or all of the chemotherapy or radiotherapy followup recommended by the oncologist.

What they didn't realise was that these therapies are often used to increase an existing chance of survival. Statistics show that patients who only have surgery have a higher rate of relapse than those who have the recommended chemo or radiotherapy as well. But there are always some patients where the surgery itself was enough - it's just that neither doctors nor patients have any reliable way to predict which patients will survive just as well with surgery alone.

c) and then there are those who were misdiagnosed in the first place. The radiographer misinterpreted a scan and described a condition as being much more serious than it really was - or half a dozen other forms of misinterpretation or, possibly, poor communication between doctors, specialists, and patients.

I think this is a central point to the thread and provides an excellent opportunity for a consensus to be reached. In terms of pain relief, the placebo effect seems to operate on a "feel better" principle possibly putting into play higher level structures in the brain . However, in cases of more serious conditions such as asthma or cancerous conditions, there are other factors which could also come into play at the same time, such as the immune system reactivating itself (e.g. from a condition which requires a pathogen to be fought off) and, consequentially, the cancer also goes into remission (from T cell action?). Advertising effects for aspirin might raise levels of expectation and also eventual effect.

That clears it up for me - a placebo has minimum effects but mindset and the resulting hormones could be important in the perceived effects of a person feeling better. Superb answers from everyone. Thanks guys.