Medicinal Magic of the Placebo Effect

Scientists have discovered that a placebo, or sugar pill, is stronger and more useful than they previously believed.

For the past several years, doctors in the United States have noticed that the placebo response in patience has been growing bigger over time.

The evidence started stacking up during trials that were designed to test a drug’s effectiveness.

Fewer and fewer new pain drugs, however, were getting through double-blind placebo control trials. (Those are trials in which neither doctors nor patients know who is on the active drug and who is taking the placebo.) In 1996, an average of 27 percent of patients reported pain reduction from the new drug when compared to placebo. In 2013, that figure dropped to only nine percent.

Jeffrey Mogil, the McGill University pain researcher who co-discovered the trend, explained to Vox that placebos are growing in strength not just in pain medication trials, but in antidepressants and anti-psychotic studies as well.

“The placebo effect is the most interesting phenomenon in all of science,” Mogil said to Vox. “It’s at the precise interface of biology and psychology.”

This research is bringing new understanding to why alternative treatments — like acupuncture — help some people. It could also potentially allow us to one day prescribe smaller doses of pain drugs to help address the opioid crisis.

Ted Kaptchuk at Harvard, regarded as one of the world’s leading experts on placebo, told Vox that the study of the placebo effect is about “finding out what is it that’s usually not paid attention to in medicine — the intangible that we often forget when we rely on good drugs and procedures.”

He sees the placebo effect as a loose family of different phenomena. There is some evidence that placebos actually release endorphins in the brain.

So what contributes to the placebo effect?

Time. In the natural course of an illness, symptoms can get better all on their own.
Confirmation bias. Patients will focus on signs that they’re getting better and ignore signs that they’re getting worse.
Expectations and learning. We learn how to respond to pain and medicine from our environments. For example, when we take a placebo drug, we often feel better and create a good memory of taking that placebo that we often revisit, according to scientists.
Pharmacological conditioning. Our brains learn to associate taking a pill with relief, so it starts to produce chemicals to kick-start that release. If a patient takes a pill they think is a painkiller, your brain will activate the system.
Social cues. When study participants see other patients getting relief from the placebo, they have a greater placebo response.
Finally, it is not just about the pills. It is about the environment a pill is taken in. If the person giving you the pill and the rituals and encounters associated with them are good, then the placebo is more likely to work.

Though placebos do not treat or tweak the underlying causes of the symptoms, some doctors wonder if they can be integrated into treatments. Vox said that the doctors they spoke to are optimistic that discoveries in this field can be used in clinical settings. For example, doctors can be reminded that there is evidence they can relieve pain simply by being warm and caring to their patients.