Does the placebo effect work? The placebo effect works for things that are directly affected by the brain, but not for actual illnesses. Nobody understands exactly the mechanism behind the placebo effect, but there are some pretty good theories.
The word “placebo” comes from Latin, and its origins give a clue to what it does. In Latin place means “to please” and placebo means “I shall please”. It was first used in the medical sense in 1785 for “a medicine given more to please than to benefit the patient”. So, the idea of the placebo effect has been around for at least 250 years, but I’m sure it has existed for long before that. Anybody with children knows about the placebo effect. You give your crying kids an M&M while telling them it’s medicine and their pain just goes away. But how can something that is not medicine make pain go away?
Whenever a new drug comes onto the market, it must first be tested against a placebo. All of the people taking part in the experiment are divided into groups and given either the real drug or a sugar pill. Nobody, not even the doctors, know which patient is getting which pill. The subjects are followed throughout the trials to see how they improve and at the end, the people who took the real drug and the people who took the sugar pill are compared. If the people who took the sugar pill improve just as much as the people who took the real drug, then the drug fails the test. The problem is an awful lot of drugs fail this test. And, it turns out, the majority of drugs that do fail the placebo test are those that work on higher brain function in the brain, such as antidepressants, antianxiety drugs, and even migraine pills. This gives us a clue as to what the placebos are doing.
Experiments show that a placebo can lift someone’s mood or cut their pain just as effectively as a real drug. The reason why is part expectation and part our body’s own chemical ability to ease its own suffering. Our body has the necessary ability to feel pain. It is usually a warning that something bad is happening or is about to happen and we should do something about it. However, our bodies also have the ability to switch this pain off. We have all heard stories of soldiers who have been shot several times and still carried another soldier off a battlefield. We have heard stories of mother’s lifting cars, even though it tears muscles and tendons. Our bodies can suppress the pain, although it is only temporary. The pain will return once the other action has been completed. Our brains do this through the production of endorphins, which are natural painkillers. When someone takes a placebo, believing it to be a painkiller, the brain will produce endorphins, which will create pain relief and a feeling of happiness. The same happens with depression and anxiety. If you take a pill and believe it is an antidepressant, your brain will produce endorphins that will lift your mood.
The second part of this is expectation. If I give you an M&M it won’t help relieve your pain. If I give you an M&M and tell you it is a painkiller, it might help relieve your pain. If I dress as a doctor, take you into my office, listen to you talk about your pain, then give you M&Ms that have “painkiller” painted where the M&M was, and tell you these are some very strong experimental painkillers, they will relieve your pain. Expectation is a big part of the placebo effect. We know what effect should come from those drugs and we expect that effect to happen. This makes our brain produce endorphins.
The fact that placebos only work on ailments that are connected to the part of the brain that deals with expectations, interpreting social cues, anticipating rewards, shows how they are working. You have to know you are getting a placebo for it to work. If I crush up valium in your ice cream without telling you, you will have a totally different reaction than if I crush up M&Ms in your ice cream without telling you. The trick of a placebo is that you have to know about it. A placebo can help with your pain, but it will never shrink a tumor or fix a cataract in the eye. There are limits to what our brains can do. And this is what I learned today.
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Sources
https://www.etymonline.com/word/placebo
https://www.wired.com/2009/08/ff-placebo-effect
https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect
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