Permission to heal: the power of placebo

A double-blind placebo trial: the words send a shiver of orgasmic excitation down the spine of the drug researcher. It’s heralded as the ‘gold standard’ of drug trials, and it’s designed to uncover the true effectiveness of a chemical compound compared to just the imagined benefits that a patient may believe are happening with a dummy drug. And the ‘double-blind’ part ensures that neither group of similarly matched patients knows whether they are getting the drug or its phony replica.

The architects of this apparently foolproof trial clearly recognized the power of the mind to conjure up all kinds of effects. And so it has proved over the years, with a drug regularly outperforming the effects of the placebo by just 3 percent or so. 

Even this negligible benefit is often achieved only through some crafty data massaging. In fact, the results of around 70 percent of all ‘successful’ drug trials are faked, according to Marcia Angell, a former editor of the New England Journal of Medicine.

So effective is the placebo that it works across most conditions almost all the time—but can it be dismissed as just so much wishful thinking and imagining? A recent study has shed new light on the placebo phenomenon and, more significantly, what we are and the innate powers we possess, even if they are usually not recognized or acknowledged. 

The study discovered that parts of the brain physically change when someone is given a placebo to relieve pain. No chemical is making these changes, but it’s happening because a person thinks they have been given a drug. 

These changes have been monitored by brain scans, with 20 different areas being measured while more than 600 people were given a placebo that they thought was a pain reliever. Those who reported the greatest pain relief also had the biggest changes to the parts of their brain that control pain, including the thalamus and the basal ganglia.

The study, carried out by researchers from Dartmouth College, is one of the first to demonstrate the physical changes that our thoughts can create—once they have been given ‘permission’ from a placebo.1

Other placebo treatments have also had trackable physical effects. Several studies have had patients report major improvements after undergoing a sham orthopedic procedure, such as knee surgery for arthritis, spinal cement injections for vertebral fractures and gastric balloon operations. 

Placebo surgery is rarely performed because it’s considered to be unethical to deprive someone of a necessary surgery, but on the few occasions when it has been included in a trial, patients have often reported the same benefits as those who actually had surgery.

It can even improve a condition when the patient knows they’re taking a placebo. One experiment carried out by Ted Kaptchuk from Harvard Medical School—who has devoted his life to understanding the phenomenon—involved giving patients with chronic lower back pain a pill bottle with the word “Placebo” plastered across it.

Each of the 97 participants was told to take either the placebo or a painkiller twice a day for three weeks. Astonishingly, those knowingly taking the placebo reported a 30 percent reduction in pain, while those on the actual painkiller had just a 9 percent decrease.

Kaptchuk believes the placebo worked in his experiment because it was wrapped up in all the usual medical procedures that would be used if an actual drug were prescribed, involving “the rituals and symbols of our healthcare system.”2

But this opens up a bigger question. If physical changes are visible in the brain after a placebo, or people report a greater reduction in pain even when they know they’ve been given a placebo, then what does all this say about prescription medication? Suppose everything—the drug and the sugar pill—is placebo?

Perhaps our innate abilities to heal just need permission, whether it’s from a drug or a placebo. We’ve lost that belief in our own abilities and instead have handed over that power to experts and outside agencies, and it’s any pill—pharmaceutical or placebo—that gives it back to us.

 

References

1 

Nat Commun, 2021; 12: 1391

2

Pain, 2016; 157: 2766–72