The Placebo Effect

placebo.gifThe Placebo Effect is the influence of a treatment that has no medical value but seems to have a beneficial effect. (Kind of like apologizing to your wife for something you didn’t do.)

Inject a close-to-celestial-discharge patient with salt water and give him a sugar pill, and for some reason, he’ s back up and running in no time. This is especially true for subjectively assessed disorders such as migranes, back pain, and depression, which are all just in your head anyway. The placebo effect may account for a large part of the therapeutic value we subscribe to medications which is good news for those medications that don’t really work that well, since at least you think they do.

(There’s a sneaking suspicion that that erectile dysfunction ad that tells you to seek a doctor if you have an erection lasting more than four hours is an attempt at giving you a big setup.) 

The placebo effect for pain medications has been at least partially explained by brain chemistry. When the brain experiences pain, it releases endorphins—chemicals that naturally act like morphine to relieve pain and make you really, really happy. Brain imaging studies have shown that when a person takes a placebo, it triggers the release of endorphins. Neurologically, it’s as if he had taken the illegal drug, but without the trouble of having to do shady deals through his car window.

There is also the less understood but equally powerful nocebo effect. Often, people who are told that they are going to experience negative side effects from a drug do, even if there is no medical reason for it. In one study, people were given a sugar pill and told that it induced vomiting. Later, 80% of them started throwing up, which is why it’s such great fun to be a janitor at nocebo testing clinics.

Similarly, in another study, women who believed they were going to die of a heart attack were found to be four times more likely to die of a hart attack than women with the exact same medical profile who did not think that they were at risk. Thinking sick may make actually make you sick which makes it quite possible that Richard Simmons will live forever.

In some areas of medical treatment, the placebo effect actually seems to be getting bigger. In studies of aintidepressants, the response rate to placebos has been increasing by 7% every ten years. In 1980, 30% of depressed people given a placebo improved without any other treatment; in 2000, it was 44%. This may be due to widespread advertising and heightened expectations for drugs. In general, the public has more faith in psychiatric medications than it did twenty year ago, which give placebos more power.

Additional Facts:
  • The color of the pills may also have an effect on some patients. In one Italian study, blue placebos made excellent sleeping pills for women and had the opposite effect on men. (Perhaps because it looked like Viagra and perhaps just because they were Italian.)
  • Painful injections may have more therapeutic value than ones that hurt less so remember to ask the physician for a really painful one.