These ideas on the placebo effect have been scratching around in my head for over 10 years now, but due to its nebulous nature, I never really thought of it as something I would actually try to put down on paper. But after some recent heated discussion in our office, I decided I want to throw out a different perspective as an opinion piece.
There has been quite a bit of debate about the placebo effect lately. The fact is that it is so consistent, and I believe, important, that in some sense, it may be the first and last thing that matters. I have already faced the wrath of some of my scientist cohorts at 4 Organics for expressing these ideas, but somewhere in here is an important truth I felt should be expressed. Hopefully I can make myself clear.
A big part of my job is reading scientific papers and studies on human physiology, biology, biochemistry, psychology, and pharmacology. I read more of them than I care to admit. One thing that is remarkably constant is the presence of the placebo effect, defined as a health effect measured from an inert intervention other than a biologically active treatment. Control groups are given an inert intervention, but some portion of the control group invariably experiences the same or similar effects as the test group given the active intervention. Not occasionally, not quite a bit, but a lot. What contributes to placebo is very complex, to be sure, and has a lot to do with what is being observed and measured, how it is set up, and how much subjectivity is involved.
Basically, it is a term applied to a collection of yet-to-be-determined processes (rather than a single factor) that may be involved in bringing successful resolution to a health issue.
But my thesis derives from the very fact that it does exist, not the specifics of how and why. Something within us (or at very least, some of us) is able to muster necessary resources to literally achieve remarkable results in terms of self-healing. Figuring out why it works for some and not others is certainly a big piece of the puzzle, but I am convinced it is safe to say that mental attitude and belief plays a key role. I am also sure the placebo effect is not a single event, as if your mind simply says heal and your body instantly responds. I suggest simply that your mind can play a large role in activating this remarkable, innate complex of physiological events that result in healing and which we currently term the placebo effect.
No matter what scientists are testing, we see proof that the human body can engender a response that is supposed to be attributable to a specific external stimulus (i.e. a medical process, technique, drug, supplement, etc.,) but without said stimulus. What this ultimately means, regardless of your field, persuasion, or philosophy, is that any single intervention you test can never be deemed to be 100% responsible for a specific effect. Even if statistics show an intervention is effective for a certain percentage of recipients, there will always be people who can experience the same result without the external stimulus. An external factor can be enhanced on a sliding scale (from nothing to everything) by internal factors (including belief or expectancy.)
The process is a continuum of factors, unique to each individual, but that can ultimately be seen at work throughout the species.
This really muddies waters for scientists, and it is still more than just an issue of contention -- it is downright exasperating for most. But I have another perspective, and this is just my opinion, because by definition, the science is still murky. Whatever is going on with the "placebo effect," it is clearly a natural part of human biology. Built into all of us is the ability to influence our body in order to achieve healing or repair. If it was an unconscious process like breathing, we would all do it automatically (like a lizard regenerating a tail.) It's definitely more complicated, and we are yet to uncover the underlying mechanisms. Whatever the actual process, though, it can be activated by people somehow, and from my reading and experience I have reasonably concluded that one's state of mind is absolutely a part of the activation process.
I have read studies of people with multiple personality disorders who would switch from one personality that was deathly allergic to a specific food to another personality that could eat it safely. Even if it was somehow psychological, it says a great deal about the power of the mind in these situations. Or another case of a man who was diagnosed with a terminal illness, cured by a new treatment he was told would work, then later when told the treatment was debunked, subsequently died of a relapse soon after (reported in the NY Times.) These are documented cases. They serve to show us the capacity for biological control and self-healing that is in all of us, and somehow the mind is involved.
As far as research goes, a recent study published in Science Translational Medicine on placebo versus drug impacts on migraines suggests there is real evidence that believing a medicine will work can have a strong effect on its actual activity. Another study which compared asthma patients receiving "placebo" acupuncture with patients receiving an actual albuterol inhaler, found effects from the "faked" acupuncture could make patients feel less short of breath even though tests revealed that their lung function had not changed. Before you jump up and say something like the language of the study may have very well influenced the results, I say that it does not actually matter for my premise to have validity.
Let me say categorically that I am not advocating the primary use of placebo-based medicines or interventions. Relying on this approach alone to address a serious issue could actually be very dangerous, not to mention a bit batty given how seemingly random it currently seems to activate. Moreover, I am not trying to uncover the science behind the placebo (as I said, the effect is most likely a complex of many influencing factors,) so much as suggest a way to apply it on a practical level. If the health issue to be addressed is serious then obviously all appropriate medical solutions should be applied, but I am talking about adding one more elusive ingredient to the mix.
If a person has the ability to harness an in-built natural talent, but is only currently able to activate it through the representative or ritualistic-type action of taking a pill, or using a mental technique, then what does it really matter, as long as it works? Doing whatever we can to assist the body in its restorative endeavors is nothing but a good thing. I would argue that there is no real downside to this unless it is used as a substitute for something else.
Every time I read another study and see how many people in the control group had the same results as the test group, I can't help thinking, if only we could understand and harness that ability. Maybe we do not know exactly how the body engages its amazing healing abilities yet, but if we know techniques that can activate it by proxy, then I say we should, at very least, embrace that. Start there. Whatever lets us switch it on is a good thing.
So what am I saying about the placebo effect here?
No matter what the placebo stimulus turns out to be, as long as it is physiologically harmless (i.e. a sugar pill, colored water, chants, or whatever,) and it allows us to activate the placebo function, then it is a good thing to add to your regimen. It comes down to belief for me (and also to some extent the power of ritual, but that's another discussion.) If a person has a strong enough belief that something is going to work for them, whether that is enough to do the job is not the point, so much as the fact that it very well may be, and doing your best to activate it is just smart.
It's not a just woo-woo positive thinking -- there is real scientific evidence showing the body has the ability to achieve a complex physiological health effect entirely on its own with no external influence. There is absolutely a relationship between the mind and body. Spontaneous remission of a cancer is not magic. There are real physiological processes going on, even if they are too complex and thus poorly understood. Neuroimaging research tells us that "mental functions and processes ... exert a significant influence on brain activity."
Now, I have read all the arguments against the application of the placebo effect, and I hear it often said that there is no good medical decision that is based on deception. I agree that this process should never require a doctor to lie to his/her patient. I am also not suggesting we apply the placebo process on an industry-wide professional level and do away with modern medicine. I am talking about a very personal, individual action that may help a great deal (and if done properly, will not hurt, at very least.). You do not need to cross into woo-woo land to gain advantages here. And it's much more than just positive thinking.
I have also heard it said that there is no compelling evidence that the mind can create healing simply through will or belief. I find this statement to be almost incredulous. There are plenty of documented cases of people healing themselves without any external intervention. It seems crazy to deny this. It definitely happens, so there is ultimately science behind it. People have exhibited the ability to completely heal themselves of problems that medicine would argue requires external intervention.
Again it comes down to language. Simply by willpower alone? That is meaningless. Willpower is absolutely part of the process, not all the process. Plenty of research exists to prove that a positive and optimistic disposition influences physiology. In fact, optimism is so powerful, a recent study among first-year law students found a direct relationship between optimism and how well immune cells respond to invading bacteria or virii (cell-mediated immunity.) I actually found plenty more evidence to support this.
As always, it comes down to the language you use to frame the question. In fact, it doesn't even matter if a study is biased because of the way it sets up -- creating what is called expectancy. My perspective is that you can cut across all the complexity and all the rhetoric and get to a single kernel that matters: using any technique, whether meditation, affirmation, reinforcement, repetition, or even imaginative belief building (you could call it self-deception, but that too is loaded) is just a tool to be employed to help the body rise to its full potential and thereby solve the problem. We may not understand the science yet, but we are beginning to understand ways to employ this powerful process even in the absence of full knowledge. Thousands of years of human biological and intellectual evolution have shown us that you do not actually need to understand the science behind an event to activate it and reap its benefits.
So think of the placebo effect as another tool in your box. It can be called many things, of course, but today this fascinating ability to self-repair is the placebo. Whatever treatment you choose to employ in your effort to self-heal, don't be afraid to add the "placebo effect" to the mix. By weaving a state of positive belief and open accommodation, (and, yes, expectancy too,) we can maximize our in-built ability to help solve health problems. Don't be tricked by materialist reductionists who argue that strictly speaking the mind is not necessary to your ability to heal. I say wholeheartedly give power to this function. Charge everything you do with the belief that it will help activate your healing. Given time, I feel certain we will learn just how fundamental an "effect" the placebo really is. But in the meantime, just don't underestimate or de-value the power of belief.
Just from a personal note, there are six doctors in my family, and to them I have said, don't be afraid to help patients feel positive toward their healing, whatever the process. I hear the rationale that it is not the doctor's role or place, but I disagree (to an extent.) I think that while we do not understand the placebo process, it is reasonable to do everything to help it activate. You do not have to lie to be a positive influence; in fact, if you can help "encourage" someone to call up this ability, then what can be the downside? In the end, it's simply a slight perspective shift to bring all a patient's resources to bear upon a problem.
No doubt this will be somewhat contentious, so add your opinion in the comments below.
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References:
Altered Placebo and Drug Labeling Changes the Outcome of Episodic Migraine Attacks; Slavenka Kam-Hansen, Moshe Jakubowski, John M. Kelley, Irving Kirsch, David C. Hoaglin, Ted J. Kaptchuk, Rami Burstein; Sci Transl Med, 8 January 2014.
Mind does really matter: Evidence from neuroimaging studies of emotional self-regulation, psychotherapy, and placebo effect; Mario Beauregard; Progress in Neurobiology, Volume 81, Issue 4, March 2007.
Expectation and Dopamine Release: Mechanism of the Placebo Effect in Parkinson's Disease; Raúl de la Fuente-Fernández et al; Science, 10 August 2001
The opinions expressed in this article are of the author. Content and other information presented on the site are not meant to be medical advice or any substitute for professional advice, counseling, diagnosis, or treatment. Never delay or disregard professional medical or mental health advice from your physician or other qualified health provider.
