The Placebo Effect

I’ve always been fascinated with the placebo effect. For those that may not be familiar, this effect occurs when a fake treatment or inactive substance is given to a patient and there is an improvement in the patient’s condition. In fact, the most rigorous clinical trials are called “double-blind, placebo controlled.” These studies have some people getting an inactive treatment, or placebo, and others getting an active treatment where neither the patients nor the practitioners know who is getting which treatment. After the data is collected it can be determined how good the active treatment is compared with the inactive treatment. It is interesting that while really good pharmaceutical drugs will be successful in a much greater proportion of patients than the placebo, in virtually every clinical trial there will be patients who notably improve after receiving just a sugar pill, a salt water injection or even a fake surgery.

I remember as a kid that simply driving to the doctor’s office made me feel better. While logically being in a car when sick should have only made me feel worse, the knowledge that I was going to see a doctor made me feel better- even before I stepped into the doctor’s office.

The placebo effect is the topic of last week’s episode, Real Doctors, Fake Medicine of the Only Human podcast. Host Mary Harris interviews Dr. David Kallmes who studied the effectiveness of vertebroplasty, a surgery to repair spinal fractures. His findings, published in the New England Journal of Medicine, found that about 40 percent of both those patients that received the real surgery and those that received a sham surgery experienced immediate pain relief from the procedure.

So while it kind of makes sense that people may experience relief from a sham surgery simply because patients trust their surgeons and whole heartedly believe them, there is also evidence that patients experience an improvement in their symptoms even when a physician tells them that what they are being given is a fake treatment. Mary Harris interviewed Ted Kaptchuk, director of the Center for Placebo Studies at Harvard Medical School, to discuss this phenomenon.

Ted Kaptchuk’s research shows that patients experience relief from their symptoms even when they are told that the treatment is fake. In one study, 27 percent of patients had adequate relief with fake treatment that they were informed by physicians was fake. That’s almost a third of patients!

The research by the Center for Placebo Studies suggests there is a neurobiological effect, a physical effect within the body, which causes patients to experience relief from their symptoms. As Ted Kaptchuk described in more depth in a Science Friday podcast, he hypothesizes simply going to a doctor’s office and having a positive interaction with the physician or the act of taking a pill and then chasing it with water may activate some sort of subconscious response from our bodies that alleviates symptoms. He believes the placebo effect resides in endorphins, the body’s own painkillers and possibly has a genetic connection.

Ted Kaptchuk closes with “what I think I’m doing is quantifying and making the art of medicine a science.” No matter what your position is on the placebo effect, everyone can agree that a supportive, trusting relationship with a medical provider is going to have a positive effect on health outcomes.