In Latin, the term "placebo" literally means "it pleases" (lat. placere = to please, to be liked). Placebo is defined as a "suggestive drug" which is not efficient and harmless. Its efficiency exclusively depends on the strength of self-suggestion of each individual person. Its application has been used since 1785 when this term was first used in a medical dictionary as an – ordinary method or drug.
Since each treatment is accompanied by a placebo effect, the effects that are assigned to drugs vary among patients as well as doctors. A patient who has a positive opinion about doctors, nurses and hospitals is prone to have a more positive reply to placebo and on an active drug, in comparison to a patient who has a negative attitude and will more likely deny the beneficial effects of the same drug or will develop side-effects. A positive effect is more likely when both the patient and doctor believe that an intervention will be beneficial. The placebo effect is being observed during each treatment in medicine (e.g. pharmacotherapy, psychotherapy or in surgery) as well as in alternative medicine. The placebo effect is sometimes as strong as certain pharmacological effects of a medicinal substance (i.e. a drug).
There are two factors that have a crucial impact on the placebo effect. The first is, certainly, an optimistic attitude which is also referred to as suggestibility, faith, hope or optimism. The very belief that you are taking a medicinal substance brings improvement. The second is a spontaneous change, which can often be even more important. Namely, spontaneous improvements are often perceived without any treatment. If such a spontaneous improvement appears after applying the placebo (a non-effective substance), it is understandable that the merit for one's betterment will be attributed to the placebo, as inappropriate as it may seem.
Generally, doctors are not fond of giving the placebo intentionally and secretly (opposed to clinical trials) because such "cheating" will disrupt the mutual trust they have built with their patients. However, despite their aversion to prescribe placebo, doctors sometimes meet patients who are completely convinced that they will forestall or suppress some illnesses by taking certain substances, although there is no scientific data to prove this viewpoint. The reason lies in the fact that each drug has a placebo effect, i.e. good and bad effects which are independent from active chemical ingredients.
In order to distinguish real drug effect from placebo effect, researchers have been comparing drugs with placebo. In such studies, half of the subjects have been receiving the drug during the study and the other half have been receiving the placebo which is identical in form. In such studies, it is ideal if the subjects as well as the researchers do not know who has been receiving the real drug and who has been given the placebo (such studies are called "double blind"). Science has determined that each drug has two therapeutic effects: the first one thanks to an active ingredient and the second one because of one's belief that he/she will get better. The latter phenomenon, known as the placebo effect, appears among a third of the patients who receive therapy under the condition that they are sure in its effectiveness.
Clinical trials
Many theories, discussions and even comprehensive, serious, pharmaco-biological and clinical trials exist and are directed towards trying to solve the enigma surrounding placebo and its real clinical efficiency. One such recently published research shows how doctors may, one day, start prescribing placebo-pills to their patients suffering from chronic pain. Such pills will reduce the pain as efficiently as any "real" painkiller that can now be found on the market. A research team from the Northwestern University of Feinberg, Chicago has examined the brain anatomy and psychological characteristics of patients and has proven that it is possible to predict which patients with chronic pain will efficiently react to the false "sugar" pill that is placebo.
'Their brain is already prepared to positively respond to placebo', says the leader of the research, Vania Apkarian, Professor of Physiology at Northwestern. 'Its psychological and biological cerebral constitution is the cause of its suggestible state in which, if you claim that the pill will reduce their pain - their pain level will really be reduced. 'Such a patient isn't necessary to deceive', says Apkarian. There is a biological base supporting the placebo response.
Research has shown that all subjects sensitive to placebo have a similar brain centre structure: neural emotional centers are larger in the right side of the brain and their brains have a somewhat larger sensory cortex in comparison with subjects who haven't responded to placebo. Other than that, personality tests showed similar psychological traits: a high emotional self-awareness and an elevated sensibility to painful situations. The research was published in the journal Nature Communications.
Also, it is proven at a neurophysiological level that the use of placebo stimulates the frontal cortex as well as the core of the brain – the grey matter and the amygdala, activating dopaminergic pathways and, in a smaller measure, serotonergic pathways. This activation provokes feelings of relaxation and pleasure which corresponds to an improvement noticed by patients. However, the mechanism of impact of the placebo effect remains to be, in some of its parts, a mystery. What is intriguing in this process is what is seems to be a phenomenon in which abstract thinking effects some very basic and primitive processes which operate in a similar way among animals.
Peter Trimmer, a biologist from the University of Bristol, UK says that it all starter with research that showed that something similar to the placebo effect exists among many animal species. At first sight, this seems to be absurd. Why would an organism, if it can cure itself, wait the placebo's incentive to initiate it? An answer from an evolutionary perspective was offered by a new computer stimulation showing that the defense mechanism has a switch which is under the control of the mind. Trimmer says that there is a simple explanation for such a phenomenon – the process of starting an immune response is so exhausting that a strong and durable incentive might seriously deplete one's energy storages in the organism.
Among a number of recent studies, a research has been carried out among patients who suffer from Irritable bowel syndrome (IBS), a type of illness which terrorizes a person with alternating constipation and diarrhea. Scientists have told these patients that they will give them a placebo pill made out of an inactive substance which, according to studies, showed a significant improvement through a self-healing relationship between the body and the mind. The result was predictable- a large majority of the patients felt much better.
Also, in another study containing 84 cleaning ladies from 7 hotels researchers wanted to discover if placebo could be used for physical activities. In 4 hotels, the cleaning ladies were told (convinced) that their everyday work fulfills a healthy and active lifestyle. They haven't told anything to the cleaning ladies from the remaining 3 hotels. A month later, they have discovered that the women from the informed group lost, on average, a kilogram in weight, their blood pressure was reduced by almost 10% and were much healthier from the perspective of fat percentage, body mass index as well as the waist to hip ratio.
If you want a better television, you can buy a super mega HD plasma...or invest in placebo effect. A new TV is expensive, but self-deception is free! What is this about? Dutch scientists have carried out an interesting study. Subjects were shown the same video on the same television, but only half of them were told that they can expect a high-resolution image. To make the matter more convincing, they set up commercial materials and flyers around this group's television screen and have connected it to a very large cable. The second group was told that they would be watching a regular DVD video. Subjects have, predictably, fallen for the trick and have concluded that the image was better on the "HD" screen.
Scientists get all sorts of ideas, but Australian psychologists are especially flaky. Their study has researched the effect of alcohol/placebo on the emotion of sadness and it looked something like this. In the beginning, they divided the subjects in groups that will receive alcohol or placebo (apple juice). Then they have put them in a bad mood and served them their drinks. The result was interesting. The improvement in their moods was similar in both groups, but only the feeling of inebriation was comparable. A similar study was carried out among student at Princeton University, New Jersey.
However, the weirdest study was carried out at Baylor School of Medicine which was published in the New England Journal of Medicine in 2002 and which evaluated patients who have suffered from serious pain after knee surgery. The corresponding author, Dr. Bruce Moseley, who is an experiences surgeon, knew that the knee surgeries were helping his patients: 'All good surgeons know that there is no such thing as the placebo effect in surgery.' However, he tried to understand which part of the surgery helped his patients the most.
The patients who were participating in this study were divided into 3 groups. One group of patients had their damaged knee cartilage scraped off. The second group underwent a knee joint rinse so that any material that could cause inflammation was removed. The third group underwent "false" surgery, i.e. patients were given general anesthesia and Dr. Moseley gave them 3 standard cuts and behaved as if he was performing surgery. After the procedure, all 3 groups of patients were prescribed the same post-op care which included physical therapy.
The results were shocking. The condition among all patients improved. Dr. Moseley thought the results were both shocking and clear: 'Those patients weren't helped by my surgical skills at all. The whole benefit of the surgery of knee osteoarthritis was the placebo effect.'
The Placebo Effect and Everyday Life
The effects of placebo are usually linked to medicine, but they can be found anywhere around us. Did you know that pedestrian traffic lights are often used just so they could give us a sense of control? Or that the buttons used for closing the elevator door don't have any real function? Or that office buildings often have systems that emit a fake air conditioning noise and also fake heat regulators? Perception is the key to everything – psychologists, doctors, sports trainers (instructors) and various business people (managers), politicians or religious leaders know this and often use it. Sometimes even to our benefit (e.g. psychologists, doctors, sports trainers).
Today's unconventional (alternative) medicine, just like biomedicine, doesn't have any connections to the past (apart from a historical perspective) folk medicine, i.e. treatments done by different medicine men, healers, witches, etc. which is today thought of as backward. In today's terms, it greatly surpasses the ways that medicine men or witches prayed or danced in order to cheer up their gods and return one's health, send rain, etc. All medical systems as well as the parallel ones (alternative) have gone through their own developmental path and successfully supplement each other.
Today's, e.g. homeopathy, ayurveda, acupuncture, acupressure, phytotherapy, Chinese herbal medicine, bioenergetic therapy, reiki, chiropractic, osteopathic, manual medicine, various therapies that manipulate with the spine, bones or feet, aromatherapy, sound therapy, etc. are all systems for which different renowned and serious school and colleges exist in the world and where future experts – therapists are being educated.
Unfortunately, in many countries around the world, the law didn't precisely regulate how to run such a parallel, unconventional and alternative medical system so, because of that, many unqualified therapists-healers have taken advantage of such a chaotic regime and tried to make money thanks to the lack of knowledge and weakness of sick people. Such unprofessional therapists-healers are not at all or are not qualified enough to run such a business. These experts often identify their position of a therapist with some kind of messianic role (especially in the area of spiritual medicine and some forms of energetic medicine) so they turn it into a "comedy" which entirely lowers the value and dignity of their profession.
Such unqualified therapists take advantage of the fact which is pretty know today- thanks to placebo, i.e. placebo therapy 60-90% of illnesses can be improved among patients. Because of this, among others, many unprofessional spiritual medicine therapists, fake astrology experts, tarot card readers and others who unprofessionally take on other methods of esotericism find their place here. All of these different healers as well as some religious and spiritual groups offer one thing- salvation, enlightenment, new cognition, an increase in your physical and psychological performance, your spiritual growth and development. But is it all truly as they say?
Such unqualified (fake) therapists-healers often hang different medical images (charts, anatomy maps, chiropractic maps, maps that depict chakras, etc.) on the walls of their rooms (offices). This way, they are trying to impress you with their "knowledge" and their so-called professional titles so that you can become convinced in their qualifications.
But if you listen to them more carefully, you will see that, from the 639 muscles that the human body has, they are aware of just a portion of them (usually those are the biceps, triceps brachi, deltoid, pectoralis, abdominal muscles, gluteus, rectus femoris, soleus and sometimes the trapezius and adductor). They rarely know for any muscles outside of these groups.
Also, from the 370 acupuncture points on the human body that are known today, such fake experts will show you just as little as 10 acupuncture or acupressure points, usually those that have been known for a very long time. Even when they talk about chakras (although there are many explanations and theories from a scientific and spiritual viewpoint existing today), these so-called experts know how to explain only the basics about the 7 chakras and know very little about the basic flow of energy in the human body through chakras (the vortex of energy).
However, some of these unqualified therapists have something that one can envy them for and it is the way they convince people in the truthfulness of what they are saying, i.e. their healing "powers". Many of them have even convinced themselves that they are the right, i.e. true healers. And, what is most unbelievable, is the fact that there is even a bit of truth in what they are saying, i.e. in their therapeutic healing as well as their healing "powers".
Why is that so? The reason lies in the placebo effect which results from their efforts to convince people in their qualifications and the efficacy of their therapy.
According to some researchers, among 10 randomly chosen people, 4 of them will be totally under the influence of the placebo while 2 more will be partially influenced. In other words, among those 10 people, the placebo effect will, in a higher or lower measure, influence as many as 6 people. According to different research, that is a higher percentage of efficacy than doctors are able to achieve when introducing a new drug. In those cases, they are happy to achieve a 40% efficacy.
This is one of the reasons why today, according to the WHO (World Health Organization), classical medicine is ranked 4th according to its representation around the world. The first three places are held by other parallel medical systems.
The placebo effect is indispensable in aromatherapy. Namely, therapists will try to convince you in the healing properties of their therapy as well as the efficiency of various essential oils, perfumes, scented candles, flower arrangements, etc. that they use. Your head might start to ache thanks to all of the smells, your nose might become irritated or your skin might redden thanks to the oils, but they will say its all a normal occurrence. And you will, of course, believe them.
Similar goes for sound therapy. Namely, therapists will try to convince you that you will feel better if you listen to nature sounds, e.g. the sound of the sea (waves), wind or some birds, even the sound of a harp, violin, guitar, etc. You will feel better if you listen to Mozart, Tchaikovsky, Ravel or a similar composer. The real truth is that you would feel your best if the therapist would let you listen to your favourite music, such as blues, rock, country, etc.
Did you know that the color of a certain drug is not only used to diversify the type of pill, but that it also has a strong placebo effect? Pharmaceutical companies have been using these kinds of findings in color psychology for a long time and so: tranquilizers (pills) are usually blue, stomach medicine is green, strong painkillers and cardiovascular remedies are red, antidepressants and stimulants can be red, yellow or of a pastel color, whereas birth control pills are light blue or pink.
Patients suffering from depression have a better reaction to yellow pills, while patients that have a high blood pressure give advantage to white pills. For most people, red and black pills seem more efficient than those that are white, whereas brown color is thought to have a laxative effect. The shape of the pill as well as her price also play an important role in placebo effect. More expensive drugs are more efficient than a cheap one and a pill that tastes bitter has a better effect than a sweet-tasting one. Also, a pill that has the manufacturer's logo engraved in it will have a stronger placebo effect.
According to some medical-therapeutic theories, a person gets ill from 30% of illnesses that are of a physical or material character and today's medicine cures these types of illnesses pretty successfully. However, people also get ill from 70% of malignant illnesses which are of a spiritual and psychosomatic character and today's medicine is much less efficient in those cases. This is where the placebo effect and its power of suggestion come into play.
No matter the level of education of certain people, as it was previously mentioned, the placebo effect "works" at a higher or lower level among most people. It is sufficient to trust your doctor, the members of your family, your sports trainer, your friends or that you can be convinced by various therapists in the efficacy of their therapy. The placebo effect will come into play.
And if you think that you are not the type of person that can be tricked by placebo- don't be so sure of it because it greatly depends on a given moment or situation. You might be surprised because the placebo effect is much stronger than it is usually believed. An optimistic state of mind, i.e. a will to improve or being convinced that you will improve will gradually lead you to success.
A person who believes that he/she will get better and will succeed will do all the necessary work in order to, sooner or later, achieve that improvement or success. This effect is based on the fact which says that, if you have an expressed opinion that a certain situation or phenomenon will happen, the subject will do all the necessary actions that will cause all the pre-expected situations to happen.
This is often seen in the process of curing patients or when making some important business or life decisions. It can also find its purpose in sports and sport competitions. Your wish and belief in success will gradually lead you to it.
Placebo and the placebo effect, as well as its importance in everyday life, has a much larger role than it is given credit for.
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