The Power of the Placebo

The human physiology is not an exact science. If it were, people would respond more uniformly to various health and medical treatments. As it is, a patient’s response to different forms of intervention can vary greatly and researchers are trying to understand the different factors that influence one’s response. One area that researchers are looking at is a phenomenon known as the placebo effect.

The placebo effect, technically referred to as nonspecific effects, is a complex topic that has to do with how one’s expectations of a treatment (substance or procedure) may impact how the body responds. Researchers may never come to a consensus on how the placebo effect works, but they all recognize that patients often improve after treatments that contain no active component or identified mechanism of action that would lead to a physiological improvement.

One of the first studies that clearly demonstrated the power of the placebo was conducted on a number of weight trainers (G. Ariel and W. Saville, 1972). All the subjects had been involved with heavy weight training for 2 or more years. The subjects were told that those who showed the greatest improvement during the 16-week preliminary training period would be selected for the second phase of the study and given an anabolic steroid. In reality, the researchers randomly selected subjects for the second phase and the subjects were given an inactive, harmless substance that looked like a steroid. Even though the weight trainers were given a fake treatment, strength gains during the placebo period were substantially greater than during the preliminary phase. The mind is very powerful!

Obviously, there is a mind-body connection in terms of health and physical performance. But exactly how effective is the placebo effect? That is a question that may never be answered completely, but a review of the literature indicates that the placebo effect may account for 33% to 70% of treatment effectiveness (A. Roberts, 1995). There may also be a mind-body connection involving the relationship between the therapist/caregiver and the patient. When prescribing a particular form of treatment, the level of optimism, conviction, and persuasive abilities demonstrated by the therapist significantly influences how the patient will respond (J.D. Frank and J.B. Frank, 1991). In other words, patients appear to respond more favorably to treatment when the caregiver conveys an optimistic outlook regarding the prescribed treatment.

Up to this point, the placebo effect would appear to be nothing more than the power of suggestion, but there are many reasons for the placebo effect. One explanation for why people appear to respond to certain treatments is known as “spontaneous remission.” Certain diseases or conditions are likely to “get better” whether treatment occurs or not. Headaches, the common cold, and most back pain will improve with or without treatment. If during recovery from the condition, the patient takes some substance, they may incorrectly associate the improvement with the “treatment.” This natural history of the disease or condition may be a major source of success for all practitioners.

Another reason for improvement following treatment is known as “regression to the mean” and has to do with when the patient seeks medical help. Typically, people seek treatment when symptoms are at their worse. At this point, with the severity of the symptoms at their worse, the patient can only improve. If the patient uses a particular treatment during this time when they are naturally progressing back to normal – or becoming asymptomatic – they may attribute the improvement to the treatment.

So what can we learn from this placebo phenomenon? First, try to be an informed consumer and do your homework regarding any form of treatment you are considering. Do more than just read the information provided by the practitioner. An informed consumer is less likely to make a decision that may be detrimental to their health. There are many ineffective treatments (no identified mechanism of action) on the market today, but because of the placebo effect, they may still have some benefit. The more you know about the treatment and how it works, the more confidence you will have in its effectiveness. The danger in using some “treatments” is that the treatment may be hazardous to your health. Some so-called treatments have a directly negative impact on your health while others have an indirect influence. By using an ineffective treatment, it may delay your efforts to seek out effective treatment, and this delay may allow your condition to worsen.

Another thing we can learn from the placebo effect is the importance of selecting your health care providers wisely. Find someone you feel comfortable with and can communicate with easily. This is extremely important since their “bedside manner” may influence how you respond to treatment. Remember; whether the treatment is traditional or “alternative,” your recovery will in part be influenced by the placebo effect.

Doug Booster