February 14, 2018 // Perspective

The placebo effect

Dr. David Kaminskas

The Catholic Doctor Is In

Thomas Jefferson once said: “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, powder of hickory ashes, than of all other medicines put together. It was certainly a pious fraud.” He did not know it at the time, but he was describing the placebo effect. The term “placebo” is of Latin origin and means “I shall please.” The placebo effect is an amazing phenomenon.

Anybody that quotes results of a scientific study to me knows that if it is not offered, I will immediately ask them if it was a double-blind, placebo-controlled study. If it was not, I will likely not take the study results very seriously. Medical studies that are trying to prove that a new medicine is effective must prove they are statistically better than a placebo (if the medicine is in pill form, then the placebo is usually a sugar pill). Study after study show that there is almost always a positive effect with placebo that can be upward of 40 percent improvement. Therefore, to obtain approval from the FDA and get on the market as a successful new medicine, you have to be able to beat placebo. Be aware that makers of vitamins and supplements, which reap billions of dollars of profits each year, are not regulated by the FDA and need not prove anything scientifically.

Is the placebo effect just the result of positive thinking? Absolutely not. It is so much more, especially if you are in a controlled trial. The doctor-patient relationship and the patient encounters play a role. The suggestion by the doctor or nurse that this pill is going to make you feel better is very important. The treatment ritual of seeing the doctor and getting various tests can somehow ultimately result in benefit.

The placebo effect can go the other way too. In a placebo-controlled trial you don’t know if you are getting the medicine or just a sugar pill. The investigators have to tell all the participants about the potential side effects of the new medicine. They may be told, for example that this medicine can cause nausea, headache and diarrhea. But, only half the patients are actually getting the medicine. Inevitably, a significant percentage of people on placebos get side effects based on the suggestion that they may. I have seen studies where the placebo had more reported side effects then the study medicine!

Sometimes new pain relief medicines have a difficult time beating placebos. Pain relief occurs through a complex neurobiological reaction. The opioid drugs, typified by morphine, work by binding to specific brain receptors. You might think that pain relief, then, should be tied to how much morphine one actually receives. Not necessarily. A brilliantly designed study in post-surgery patients put half the patients on a morphine drip that was titrated to control their pain. They did not know when or how much morphine they were getting. The other group of patients had the nurses come into the room as needed to control their pain. They would announce their arrival, show some empathy, and make sure the patients watched them push the morphine solution through the IV. This latter group used only half of the amount of morphine that the infusion pump group did, and yet had superior pain relief. The placebo effect is not only tied to expectations but also the human caring involved.

Changes in body chemistry have scientifically been measured with the use of placebos. One study showed that naturally occurring endorphins that we all generate in our brains increase and bind to neuroreceptors to relieve pain when a placebo-saline injection is given. This proved that it is more than a suggestion but an actual biochemical reaction that occurs in the brain to help relieve pain with placebo use. Using placebos to treat patients is deemed to be unethical in this age of informed consent. More research is needed in this area to learn how to harness the positive effects of placebo.

I learned in the early years of my practice that it is of utmost importance to give my patients hope. There must be optimism by the physician that a certain treatment plan will work. Not false hope, mind you, but hope that certain goals of treatment may be accomplished. The goal may be to live longer, to feel better, to relieve pain or maybe attend a special family event.

I am fully confident that when you visit the sick, hold their hand and tell them you care, you are helping to relieve their pain and suffering. When you do nothing more than sit in a room with a friend who is struggling with a physical or mental illness, and thereby show compassion, you are helping them heal.

Now, imagine being with a loved one and praying for them, or better yet, praying with them. How can this not be more powerful that any placebo effect could ever be?