Placebo has had an elusive and ambiguous existence in the history of medicine. The word was originally used to mean an inert dummy treatment given to placate (hence ‘placebo’) the patient (Wolf, 1959); and it has come to mean the effect of a supposedly ‘ineffective’ treatment that is apparently therapeutic (Shapiro & Shapiro, 1997).
This condescending view of placebo by medical researchers has meant that placebo effects have in the past century been consigned to the wastebin of ‘artefacts’ that interfere with ‘proper’ medical (i.e. drug) research. But there has been increasing interest in what understanding placebo could offer about the process of healing. Harrington has described three stages in the life of an artefact: “first it is ignored, then it is controlled for its presumed contaminating effects; and finally it is studied as an important phenomenon in its own right” (1997, p. 2).
Research
Beecher was the first researcher to attempt quantification of the placebo effect (1955); his metastudy of 15 clinical trials providing the oft-quoted figure of 35% as the average placebo effect. This means, that, in a study with a control group who receive a sham treatment (e.g. sugar pills), the likelihood of a positive response to the sham is roughly 35%. In actuality, this figure varies greatly, and of course critics have argued that the impression of the magnitude of the placebo effect is false (e.g. Kiene & Kiene, 2001).
These academic arguments seem to miss the point, which I think is: why do some people get better without the real medicine? How can we better understand this healing process, and how can we harness it for the benefit of mankind?
Claridge (1970) has described the placebo effect as the ‘total drug effect’ minus the specific pharmacological action of the drug. He says the overall effect of the drug treatment also depends on a multitude of other factors; such as the colour and brand name of the drug, the personality and confidence of the prescriber, the psychological state and suggestibility of the patient, and the physical environment.
The therapeutic relationship
Hawkins (2001) suggests therapists should study placebo research to improve patient outcomes through the therapeutic relationship. Brody (1997) and others have shown that a therapeutic relationship which allows the patient time to express themselves and feel valued improves healing. For the practitioner, three significant components contributing to improved placebo responses are: “providing an understandable and satisfying explanation of the illness; demonstrating care and concern; and holding out an enhanced promise of mastery or control over the symptoms” (Brody, 1997, p. 79).
Importance of meaning
How you interpret your world determines how your body functions. The physiological effects of meaning have been studied since the discovery of human opiate-receptors (Pert & Snyder, 1973). Says Brody, “A positive placebo response is most likely to occur in a patient when the meaning attached to that illness experience by the patient is altered in a positive direction” (1997, p. 79).
The conditioned response
Ader and Cohen discovered in 1975 that depressed immunity in rats could be conditioned. Since then, conditioned effect on immunity has been shown in humans (Buske-Kirschbaum, Kirschbaum, Stierle, Jabaij, & Hellhammer, 1994).
This means that the state of our immunity, and how we respond to treatments, can be affected by our previous experience with those treatments and situations. Ader (1997) asserts that placebo is essentially a conditioned response from “the individual’s experiential history with drugs, and perhaps, other medical procedures” (p. 139).
Towards a better understanding of placebo and healing
The medical study of the placebo effect has been piecemeal. This is because the current medical system does not have a coherent theory of healing – it focuses more on disease and its control through chemical or mechanical means. Thus, the medical model leaves out the role of the patient and the self-healing function of the body and mind.
It has thus been left to traditional, complementary and alternative medicine (TCAM) to formulate theories of whole personhood and the natural healing processes. TCAM practitioners claim to harness a patient’s innate healing processes through methods that engage the patient in more integrative ways. Natural health clinics could become research centres in placebo as a key towards an Integrative MindBody explanation for healing and health.
Gerald Lopez is an Ayurveda and Yoga Therapy consultant at Global Health Clinics. He is undergoing a Postgraduate Diploma course in MindBody Healthcare at Auckland University of Technology.
References
Ader, R. (1997). The role of conditioning in pharmacotherapy. In A. Harrington (Ed.), The placebo effect: an interdisciplinary exploration. Cambridge, MA: Harvard University Press.
Ader, R., Cohen, N. (1975). Behaviorally conditioned immunosuppression [Research Support, U.S. Gov’t, Non-P.H.S.]. Psychosomatic Medicine, 37(4), 333-340.
Beecher, H. K. (1955). The powerful placebo. Journal of the American Medical Association, 159(17), 1602-1606.
Brody, H. (1997). The doctor as therapeutic agent: a placebo effect reserach agenda. In A. Harrington (Ed.), The placebo effect: an interdisciplinary exploration. Cambridge, MA: Harvard University Press.
Buske-Kirschbaum, A., Kirschbaum, C., Stierle, H., Jabaij, L., Hellhammer, D. (1994). Conditioned manipulation of natural killer (NK) cells in humans using a discriminative learning protocol. Biological Psychology, 38(2-3), 143-155.
Claridge, G. (1970). Drugs and human behaviour (1795972). New York, NY: Praeger.
Harrington, A. (1997). The placebo effect : an interdisciplinary exploration. Cambridge, MA: Harvard University Press.
Hawkins, J. (2001). How can we optimize non-specific effects? In D. Peters (Ed.), Understanding the placebo effect in complementary medicine: theory, practice and research (pp. 69-88). Edinburgh, United Kingdom: Churchill Livingstone. doi:10.1016/b978-0-443-06031-1.50008-3
Kienle, G. S., Kiene, H. (2001). A critical reanalysis of the concept, magnitude and existence of placebo effects. In D. Peters (Ed.), Understanding the placebo effect in complementary medicine: theory, practice and research (pp. 31-50). Edinburgh, United Kingdom: Churchill Livingstone. doi:10.1016/b978-0-443-06031-1.50006-x
Pert, C. B., Snyder, S. H. (1973). Opiate receptor: demonstration in nervous tissue. Science, 179(4077), 1011-1014.
Shapiro, A. K., Shapiro, E. (1997). The placebo: is it much ado about nothing? In A. Harrington (Ed.), The placebo effect: an interdisciplinary exploration (pp. 260). Cambridge, MA: Harvard University Press.
Wolf, S. (1959). The pharmacology of placebos. Pharmacological Reviews, 11, 689-704.