What is the Placebo Effect?
The placebo effect is perhaps one of the most widely-cited psychological effects of the modern era. It is the tendency for people to respond beneficially to placebos, or inert substances, when they are led to believe that they are receiving real medications. To put it more simply, people actually experience relief from pain or improvement in medical conditions, just because they believe they have received a medication. In fact, this effect is so powerful that all modern studies of the efficacy of new medications are compared to control groups given placebos.
Placebo Effect Experiments
The reason that the placebo effect has received so much attention is that it points to the impact of mind upon body, or at least to the impact of expectation on the perception of an illness. The term “placebo” has been used since the early 18th century to describe “a commonplace medicine or method.” These were medicines administered more to make a patient happy than to provide actual medical benefits. Placebos were brought into the light of public awareness in 1955 with Henry Beecher’s paper, The Powerful Placebo.
Beecher’s paper made the medical community aware than placebo effects have a significant effect in medical trials. As a result of this paper, the entire design of medical trials for new medications and procedures was adjusted to account for these effects. Current medical trials have a minimum of three groups. One group is given the medication or procedure being tested. Another group is given placebos. This might be nothing more than a sugar pill, saline solution, or sterile water. In medical trials for surgeries or other procedures, the placebo group might receive a sham surgery or ineffectual procedure. A final group, the control group, is given neither medicine nor placebo. Experimenters look at the effects experienced by the placebo group relative to the results of the control group. Any difference between these groups is known as the placebo effect. Next, the difference in effect between the placebo and medication groups is used to assess the actual impact of the medication once the effect of belief has been factored out. If the effects of medication are significantly greater than those of placebo, then the medication is considered effective.
Following this design, medical experiments can control for the effects of placebo. As described above, the patients are considered “blind.” They don’t know whether they have received the placebo or the actual medication. However, this is only half of the equation. When we communicate with one another, we pass along subtle messages through body language, tone, and other non-verbal factors. This also applies to the subtle communication that passes between experimenter and participant in a medical study. So, to fully control for the placebo effect, medical trials follow a double-blind design. This means that neither the experimenter nor the participant know whether a participant is in the placebo group or the group which receives actual medication. This means that the experimenter cannot unconsciously influence the expectations of the participant. It is the final measure needed to control for the placebo effect and discover the true efficacy of a given medication.
Placebo Effect Examples
Historically, one of the most interesting examples of the placebo effect comes from a man named Emile Coue. He was a French pharmacist and psychologist who first began working as an apothecary in France in 1882. Coue found that his patients improved much more quickly when he praised the efficacy of the medication. In fact, his observations regarding patient outcomes in connection with belief are the first historical examples of the placebo effect. Coue came to the conclusion that the effect of belief was more powerful than that of the medication itself. He first studied hypnotherapy and began treating clients with this alone. Later, he devised a form of conscious autosuggestion that gained widespread acceptance in Europe and limited recognition in America. His work has even left a mark on popular culture. It was Coue who coined the phrase, “Every day, in every way, I’m getting better and better.” This was one of the foundational “suggestions” in his unique brand of treatment.
One simple example of the placebo effect is an instance in which a patient receives a placebo after being told that it is a new headache medication. Many patients experience significant pain relief after receiving the placebo. The same applies for nausea medication, drugs for fatigue and depression, and blood pressure medication. In each case, some participants show a response to the placebo. With depression, nausea, and pain, it can be assumed that the response is no more than psychological. The placebo can be thought to affect no more than our perception of our condition. However, in instances like changes in blood pressure, actual physiological changes are observed through the placebo effect. While these effects may only be psychosomatic, they still have the potential to shine a light on psychologically-based methods to effect real physical change.
Implications of the Placebo Effect
May researchers have asserted that the placebo effect is entirely psychological. Put another way, this means that it only effects our perceptions and has no real effect on physiology. Kaptchuk has said,
Placebos may make you feel better, but they will not cure you. They have been shown to be most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea.
However, recent studies have shown that this is not true. The placebo effect can measurably influence blood test results, heart rate, and blood pressure. The implications of this are profound. They point to psychological effects that can produce tangible physiological changes within the body. In fact, if these results are explored more fully and harnessed, they could literally change the face of medicine.
That’s not all. Over the last two decades, it has been found that the impact of the placebo effect is actually increasing. Our expectations are having more of an impact on medical and physiological conditions than they had in the decades before. On the one hand, this is amazing. It moves us further in the direction of mind-based solutions to organic dysfunction. On the other hand, it means that the line between effective medication and the effect of belief is getting blurrier by the day. The increased power of the placebo effect makes it more difficult all the time to judge whether a medicine is truly effective, or if it is simply the result of our expectations. A potentially related factor is that our experiments have also grown in scope. With larger, more expensive, and more elaborate trials, it is suggested that the belief of the participants is more fully engaged, thus making the placebo effect stronger. But, if this is the case, then perhaps the strength of our belief is the most significant factor in treatment outcomes.
However, as with all things, there is a downside. The downside of the placebo effect has a name. It has been called the “nocebo effect”. This can be seen in drug trials when participants have been made aware of the potential side effects of the medication. A significant percentage of participants experience these negative side effects, even when they have only received the placebo. This suggests that our expectation can negatively affect patient outcomes and physiological conditions, just as it can have a positive effect. When we believe that something will make us sick, it is likely to make us sick. And, when we believe that something will make us better, it is likely that it will make us better.
When we take the implications of the placebo effect to their logical conclusion, some really interesting things come to light. For the last hundred years or more, the dominant paradigm has been one of scientific materialism. An unspoken assumption in this paradigm is the presence and unerring truth of the objective world. Subjective factors were seen as errors, artifacts which must be factored out in order to get a clear view of the “true” effects of a drug or an experiment. However, it may be that this assumption has been unwarranted.
The placebo effect is a subjective influence. However, if the studies that indicate that it has a physiological effect are accurate, then this subjective effect has a profound influence on objective reality. The subjective factor is not an artifact. Quite to the contrary, it is a real effect which must be factored in to the equation. And, since subjective effects are personal, we cannot point to an external situation which exists independently of personal experience, expectation, and belief. To break it down a bit further, we cannot look only to those factors beyond the subjective for the real. In fact, the subjective is just as much a part of the real as any material effect, as anything that can be measured, quantified, and scientifically analyzed.
This may still be a bit abstract, so let’s take it a step further. We once thought that personal factors were just noise in experimental results. If the current studies on the placebo effect are accurate, then it means that they are so much more than that. It means that subjective, internal factors have a definitive influence upon external events. The division between the objective and subjective is blurred. We must come to accept that psychological events shape objective reality. What we believe makes things happen, at least within our body.
This is a contentious claim. Researchers adhering to the old paradigm are going all out to prove that the placebo effect is purely psychological, meaning, in their perspective, that they have no real impact on physiological and organic conditions. They just make us feel better, but don’t actually change anything. The only problem with this is that some experiments show otherwise. It has already been shown that blood pressure, heart rate, and blood test results can change as a result of the placebo effect. We’ve also seen tests in which a placebo like saccharin has been combined with an actual medication. Once the medication is removed and the patient receives only saccharin, the medical improvements persist. How much further can it go? What is the extent to which physical conditions can be influenced by our expectations?