What has been called “the placebo effect” is an example of the awesome power of the human mind that is usually misunderstood and greatly under-appreciated. The misunderstanding about its potential value may be due to the disruptive role it is usually felt to play in medical research. Many medical researchers consider it to be a huge nuisance since it makes their work more difficult and the results of the research more difficult to interpret. Medical researchers are very aware that a human research subject’s beliefs about the medications or treatments they receive have a dramatic effect on the outcome of the treatments. This can make it very hard to determine if their experimental interventions are having the desired effect or not. To get around this hurdle, researchers often randomize their subjects to receive either the active treatment or an identically appearing inert treatment. This allows them a means to control for the placebo effect. After the experiment, they subtract the effect of the “inert” placebo from the active treatment they are interested in. Even in successful studies, where the active treatment has a clear effect, the effect of the placebo can be much larger than the residual treatment effect that remains after the placebo effect has been subtracted for the total response.
If we just look at placebos in this way we get a very distorted view of what is actually going on in these research studies. It is important to ask how an inert substance (such as a “sugar pill”) can acquire such a powerful effect on the human body and its function? Rather than just being a nuisance to medical research, could the placebo effect be a window that lets us get an important vantage point into the power of the human mind? There actually is a fair amount of well done research on the placebo effect to help us answer this question. We can begin to answer it by examining how an experimental subject’s beliefs about a potential treatment modify its impact.
An excellent start in answering this question is provided by a study of the effect of drugs on the airway resistance of people with asthma published in Psychosomatic Medicine (Vol. 32, No. 5, 1970). The researchers treated their subjects with two different drugs, one that opened up the airways (called a bronchodilator), and compared it to the effect of a second drug that tend to tighten up the airways and make it harder to take deep breath (called a bronchoconstrictor). Two things are important to keep in mind here: we have no conscious control of the actions of the airways in our lungs, and researchers can very accurately measure any changes in an individual’s airway resistance.
In this study, subjects were randomized to receive either a bronchodilator or a bronchoconstrictor. Neither the subject nor the people doing the testing knew which was which. In addition, and here is the key, the subjects were also randomized as to what they were told about the action the treatments will have in their lungs. Half were told the treatment would open their airways and half were told their airways will tighten down due to the inhaled treatments. Of course, this means that half of the time the explanations were completely opposite of how these drugs normally act.
If the drugs worked through the placebo effect only, you would expect that the actions of the drugs would be totally due to what the subjects expected to happen. This was not the case. When measured objectively and precisely, the dilator did open the airways and the constrictor did tend to close them, no matter what the subject was told, just as expected. It gets very interesting when you compare what happened when the subject’s expectations were correct to what happened when they were mislead and their expectations were wrong. When a bronchodilator was given to a subject who thought it was a constrictor, the dilation effect was cut in about half. When a bronchoconstrictor was given while the subject was told it was a dilator, the constricting effect on the airway was also lessened by about half.
This study demonstrates our beliefs have a powerful effect on our body in ways we are usually unaware of. This is just one study of many that show these kinds of effects that result from our expectations and beliefs. Other placebo studies show clearly that the confidence a patient has in their treating clinician, the confidence they have in the treatment itself and many of the subtle characteristics of the drug or procedure involved all have potent impacts on their intended benefits. And all of these effects have been shown to be mediated by our perception of treatment circumstances through our attitudes and beliefs.
In my medical practice, I use these insights all the time with great benefit to my patients. This does not mean I deceive people by prescribing placebos which I know have no real activity. What it does mean is that I am very careful to encourage my staff to be helpful and supportive and professional at all times, because I know that the more confident my staff is, the more my treatments will be helpful. I also use the patient’s confidence in a treatment to help guide my choice between fairly equivalent interventions. Another way I use these insights is to be careful to communicate my confidence in another practitioner’s abilities when I refer a patient to them. (I am always confident in whomever I refer to, but I know I need to pass this assurance on to my patients). These are only a few of the ways I use these insights, but deceiving people is not part of any of them.
Are their messages here if you are not a physician or healer? I am sure there are. Know that our beliefs are powerful, but their action is beneath our conscious awareness and the exact mechanisms are as yet unclear. You should also keep in mind that all human healing can be either enhanced or inhibited by this effect. Perhaps the most important take-home message, though, is that our mind holds enormous but as yet under-appreciated under-utilized healing potential. The scientific study of the “placebo effect” offers us an objective window into the mysteries of the human mind.
Wishing the best health to all,