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In research studies and in real life, placebos have a powerful healing effect on the body and mind
Dr. Elissa H. Patterson and EFDC member Dr. Hans Schroder published this article in The Conversation under a Creative Commons license.
Did you ever feel your own shoulders relax when you saw a friend receive a shoulder massage? For those of you who said “yes,” congratulations, your brain is using its power to create a “placebo effect.” For those who said “no,” you’re not alone, but thankfully, the brain is trainable.
Since the 1800s, the word placebo has been used to refer to a fake treatment, meaning one that does not contain any active, physical substance. You may have heard of placebos referred to as “sugar pills.”
Today, placebos play a crucial role in medical studies in which some participants are given the treatment containing the active ingredients of the medicine, and others are given a placebo. These types of studies help tell researchers which medicines are effective, and how effective they are. Surprisingly, however, in some areas of medicine, placebos themselves provide patients with clinical improvement.
As two psychologists interested in how psychological factors affect physical conditions and beliefs about mental health, we help our patients heal from various threats to well-being. Could the placebo effect tell us something new about the power of our minds and how our bodies heal?
Real-life placebo effects
Today, scientists define these so-called placebo effects as the positive outcomes that cannot be scientifically explained by the physical effects of the treatment. Research suggests that the placebo effect is caused by positive expectations, the provider-patient relationship and the rituals around receiving medical care.
Depression, pain, fatigue, allergies, irritable bowel syndrome, Parkinson’s disease and even osteoarthritis of the knee are just a few of the conditions that respond positively to placebos.
Despite their effectiveness, there is stigma and debate about using placebos in U.S. medicine. And in routine medical practice, they are rarely used on purpose. But based on new understanding of how non-pharmacological aspects of care work, safety and patient preferences, some experts have begun recommending increasing the use of placebos in medicine.
The U.S. Food and Drug Administration, the organization that regulates which medicines are allowed to go to the consumer market, requires that all new medicines be tested in randomized controlled trials that show they are better than placebo treatments. This is an important part of ensuring the public has access to high-quality medications.
But studies have shown that the placebo effect is so strong that many drugs don’t provide more relief than placebo treatments. In those instances, drug developers and researchers sometimes see placebo effects as a nuisance that masks the treatment benefits of the manufactured drug. That sets up an incentive for drug manufacturers to try to do away with placebos so that drugs pass the FDA tests.
Placebos are such a problem for the enterprise of drug development that a company has developed a coaching script to discourage patients who received placebos from reporting benefits.
Treating depression
Prior to the COVID-19 pandemic, about 1 in 12 U.S. adults had a diagnosis of depression. During the pandemic, those numbers rose to 1 in 3 adults. That sharp rise helps explain why US$26.25 billion worth of antidepressant medications were used across the globe in 2020.
But according to psychologist and placebo expert Irving Kirsch, who has studied placebo effects for decades, a large part of what makes antidepressants helpful in alleviating depression is the placebo effect – in other words, the belief that the medication will be beneficial.
Depression is not the only condition for which medical treatments are actually functioning at the level of placebo. Many well-meaning clinicians offer treatments that appear to work based on the fact that patients get better. But a recent study reported that only 1 in 10 medical treatments sampled met the standards of what is considered by some to be the gold standard of high quality evidence, according to a grading system by an international nonprofit organization. This means that many patients improve even though the treatments they receive have not actually been proved to be better than the placebo.