The idea that a placebo is just a little white sugar pill is so pervasive in our society that it prevents us from learning anything new about placebos. Unfortunately, “little white sugar pill” is also usually the depth of our knowledge on the subject. Even doctors, who can prescribe them as a diagnostic tool, often know very little about the nature of placebos and their effects.
Research scientists who conduct formal experiments on humans know about placebos and their effects as a required part of their scientific experiments. In order to figure out the effect of a drug or medical procedure on a human being, researchers have to use placebo control groups. If placebo groups/controls are not used, the subject’s previous experience (conditioning, bias, expectations and emotions) can distort the careful measurement of the drug or procedure being tested.
As such, placebo effects are well documented in research experiments. However, there recently has been research on the placebo effect itself, not just the part it plays as a control group in an experiment. So, as the placebo effect is researched and dissected, it turns out to be composed of common, well understood parts of our psychological makeup as human beings (that is, conditioning, bias, expectations and emotions).
Research on placebos and their effects highlight the following new information:
1. There are two processes going on, the placebo and the placebo effect. The placebo itself is a zero. It has no effect. Patient-generated placebo effects, however, appear to be significant. As an example of the two processes, the little white sugar pill itself has no medical effect, but a research subject may report significant improvement.
2. Placebo effects are not caused by the object (e.g. the pill) or the procedure (e.g. an injection). Researchers propose that the use or non-use of a placebo object or procedure does nothing and changes nothing. The researchers propose a new definition: “The placebo response is the reduction in a symptom as a result of factors related to a patient’s perception of the therapeutic intervention” (Vase et al. 2002). In other words, the patient causes the placebo effect, not the object or the procedure or the theatrics (like sticking you with pins/acupuncture) of the health practitioner.
Surgery, for example, is a very theatrical procedure and patients have reported significant improvement from surgeries that were used for years and found to be completely worthless (internal mammary artery ligation to relieve angina pectoris, for example). Various cultures use of bloodletting over the last 3,000 years is another obvious example of patients reporting significant improvement as a result of useless and even dangerous placebo surgery.
3. Much of what is considered to be placebo improvement may actually be patient report of improvement, without any actual physical improvement. In a study done on asthma patients whose lungs were X-rayed before the administration of an asthma drug or a placebo, the placebo group reported improvement, but X-rays and ventilation measurement showed no change in lung function. This is a very common situation in all of medicine (called obliging/biased reporting or experimental subordination) because patients tend to want to please their doctors or researchers by saying what is expected of them.
4. The patient’s inaccurate perception of a successful treatment in the therapeutic environment is also influenced by:
» The natural course of the disease (the condition goes away on its own)
» Concomitant treatments (other simultaneous treatments)
» The Hawthorne effect: Subjects may change their usual behavior just because they are participating in a study or seeing a doctor, and this can lead to overestimating the effects of treatment.
» Regression to the mean: Human performance tends to average out over time, so initial peak performance and positive results may be misleading. The athlete who breaks a personal record on one day will tend to return to their normal, average performance. The medical treatment that achieves stunning results on the first trial will probably not be as effective on repeated tests. This is why anecdotal reports of patient improvement (“… But it works … it really works … but it works for me”) are useless to determine if a procedure actually works and why placebo control groups are used in scientific studies: to filter out these misleading and illusory initial results.
This human tendency toward biased reports of improvement when trying new treatments explains why odd practices like bloodletting and other placebo-based alternative medical treatments (like homeopathy) continue to mislead patients into thinking that they “work.”
5. The placebo effect is not “the power of positive thinking” or belief, hope, mind over matter or the mind healing the body (“Does Thinking Make It So,” reference below). Energy medicine practitioners and others hawking health improvement scams from power bands to the wonders of crystals and pyramids present this as a kind of a wishful thinking, psychokinetic power of the mind, “… If you focus the power of your mind through the crystals, you will connect to the forces of Nature and be healed …” ($39.95 for one crystal, please).
Bio-feedback is a well-researched effect that allows us a very small degree of control over some autonomic nervous system functions (fight or flight/epinephrine release, relaxation, pulse rate, blood pressure). Some examples familiar to us all are yoga stretching and breathing exercises for relaxation, athletes getting ready for maximum effort and soldiers getting ready for combat who can use their previous experience and conditioning to relax or their uncertainty and fear to prepare their bodies for maximum effort. However, extrapolating this minor ability into the wish-fulfillment ideology of a 4-year-old (where thinking you’re a prince or princess does make it so) is, well … childish.
Thinking positive thoughts cannot make your muscles stronger, kill the flu virus or heal AIDS. No belief, hope, wish or other “mind healing the body” philosophy has ever been able to produce the grandiose promises of placebo based, health improvement scams. If the mind could heal the body, that effect could be measured and there is no scientific evidence of any such psychokinetic effect.
So, if the reason to have a placebo control group is to filter out biased, conditioned and emotional reporting then, by definition, placebo effects are a series of mistakes patients make by inaccurately reporting the effects of medical procedures and drugs in a therapeutic setting. All of these factors affect “… the patient’s perception of the therapeutic intervention” and explain the mechanism of the placebo effect. After all these well-understood parts of what we call the placebo effect are filtered out, what’s left? Apparently, not much, hence the title of another article below (“Placebo are you there?”).
Just as placebos and their effects are being better understood as a series of mistakes and patient reporting errors (that are natural to make due to our conditioning, biases, expectations and emotions), alternative medicine is advertising that they intentionally use and harness, “the power of the placebo” as a legitimate, healing therapy. Except … placebos have no power. Alternative practitioners seem to be a step behind. If the placebo is a zero and not caused by the “placebo object” (needles, pills, potions, power bands, etc) or the theatrics of the “healer” and the procedure, then why pay these people?
I thought I had scrapped the bottom of the human gullibility, placebo barrel, but I recently discovered another layer: the ultimate do nothing, placebo scam, “Braco the Gazer”!
This guy is great. No religion, no philosophy, no teaching, no words, no message and no claims of healing: demonstrating once and for all that the placebo effect is all you! Apparently it’s not necessary to stick pins in you, give you water and tell you it’s curative, manipulate your spine or invisible Reikian energy or claim the powers of the almighty. All you have to do is stare … and people will say you have saved them, cured them and (the important part) will give you money.
If you needed anything to convince you that a placebo does nothing and is not produced by the healer’s theatrics, the pill, potion or procedure, Braco is the perfect placebo. You, your cognitive mistakes, biases, expectations, conditioning and your emotions produce your own personal placebo effect. The good news is you don’t have to pay anyone for it. Go to a real doctor or a licensed therapist: You still produce your own placebo effect (for free) and the M.D. or therapist actually helps you.
» Vase L et al. (2002) “A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia,” Pain 99: 443-452
— Victor Dominocielo, M.A., a California-credentialed teacher for 38 years, is the human biology and health teacher at a local school. He earned his master of arts degree in education from UCSB. The opinions expressed are his own.