At times, individuals have such profound faith in their doctors and prescribed medications that they experience immediate relief upon taking a pill. From a scientific perspective, it takes at least 15 minutes for a drug to take effect. Those who feel instantaneous improvement are experiencing the placebo effect.
This article explores what placebo is, how the placebo effect works, the brain mechanisms involved, and its application in medicine.
What is Placebo?
A placebo is a substance without medicinal properties, a ‘dummy’ treatment that resembles a tablet or an injection. It is made from harmless ingredients such as starch, glucose, or saline solution. Placebos can also take the form of special massages, diets, or exercises.
The term “placebo” originates from Latin, meaning “I shall please.” It was historically used in funeral chants. Later, Americans assigned it a second meaning—”flatterer.” By the 18th century, physicians had begun using the term “placebo” to describe dummy medicines.
What is the Placebo Effect
The placebo effect refers to the phenomenon in which a patient experiences an improvement in their condition after taking a placebo (a treatment with no therapeutic properties). In the 18th century, many diseases had no effective treatment, so doctors administered dummy drugs to provide some relief.
American physician Henry Beecher observed wounded soldiers during wartime. When morphine supplies were insufficient, soldiers experienced temporary pain relief after receiving saline injections. In 1955, Beecher introduced the term “placebo effect” and provided a detailed analysis of the phenomenon in his article The Powerful Placebo.
How Does Placebo Effect Work
The exact workings of the placebo effect remain a mystery. However, scientists propose three main theories:
- Conditioned Reflexes – The body responds predictably to familiar stimuli. Since we associate medications with pain relief and symptom alleviation, taking a placebo can trigger the release of endogenous opioids—natural painkillers produced by the body. Studies have shown that placebos activate the brain’s opioid-producing regions.
- Expectation and Self-Regulation – Patients undergoing treatment anticipate recovery, which activates psychological self-regulation processes that help achieve this goal. This can be likened to someone strongly desiring an outcome and their brain subconsciously seeking ways to fulfil that expectation.
- Susceptibility to the Placebo Effect – Some individuals are inherently more prone to experiencing placebo effects. These patients often have heightened dopamine sensitivity and a more suggestible psychological state.
Can the Placebo Effect Influence the Immune System
Scientists remain divided on this question. In 1975, researchers conducted an experiment on rats, feeding them food infused with cyclophosphamide, a drug that suppresses immunity and is used in cancer treatment. After a few days, the rats’ health deteriorated significantly. When the drug was removed from their diet, their condition continued to worsen despite the absence of the harmful agent.
Sceptics argue that the placebo effect cannot influence immunity because there are no tangible factors affecting it. They claim that studies attempting to prove otherwise rely on subjective assessments rather than objective evidence.
Factors Enhance Placebo Effect
Researchers suggest that individuals with a more malleable psyche are more susceptible to the placebo effect. Several factors amplify its impact:
- Size: Larger pills appear to be more effective than smaller ones.
- Price and Branding: Well-known and expensive brands instil more confidence than cheaper, unfamiliar ones.
- Colour: Blue pills are perceived to reduce pain, whereas red pills are believed to have a stimulating effect.
- Method of Administration: Injections tend to have a stronger placebo effect than oral medications.
Interestingly, studies suggest that men are generally more susceptible to the placebo effect than women.
Clinical Trials and Placebo Effect
The placebo effect plays a crucial role in clinical trials. Volunteers are divided into two groups: one receives the real medication, while the other is given a placebo disguised as the active drug. The placebo group remains unaware of their treatment to eliminate psychological bias and accurately assess the drug’s efficacy and safety.
Only once a drug has demonstrated significant results in clinical trials can it be approved for market distribution. This process protects consumers from ineffective treatments marketed with exaggerated claims. Without the placebo effect, it would be difficult to determine the actual effectiveness of medicines.
A 2011 study on asthma patients divided participants into three groups: the first received inhalers with real medication, the second inhalers containing a placebo, and the third underwent simulated acupuncture therapy. Each group believed they were receiving genuine treatment.
After several months, all groups reported improved symptoms. The results were as follows:
- The first group (real medication) experienced a 50% improvement.
- The second group (placebo inhaler) reported a 46% improvement.
- The third group (simulated acupuncture) noted a 47% improvement.
However, when researchers examined lung function, only those who used real inhalers showed measurable physiological improvements. The other two groups continued to have breathing difficulties despite their perceived improvement.
Can Placebo Effect Cure Diseases
The placebo effect can alleviate pain and symptoms, but it cannot cure diseases. While it influences perception, it does not eradicate infections, heal wounds instantly, or eliminate harmful bacteria. Genuine medical treatment is essential for recovery.
That said, belief in recovery can accelerate healing. Studies indicate that cancer patients with a positive outlook have higher survival rates than those who lose hope.
Nocebo Effect: Dark Side of Placebo
“Your test results are excellent! You’re in perfect health!”
“Then why do I keep experiencing headaches?”
“You may be experiencing the nocebo effect.”
The nocebo effect is the opposite of the placebo effect. In simple terms, it occurs when a harmless treatment causes negative symptoms due to a patient’s belief that it will harm them.
The term “nocebo” originates from Latin, meaning “I shall harm.” It was introduced in medicine after doctors observed patients who, despite receiving treatment, reported worsening conditions. To test this, researchers replaced their medications with placebos. However, patients continued to experience adverse effects and insisted that the treatment was making them worse.
Cases of the nocebo effect are common in medicine. Patients often complain of symptoms despite doctors finding no physiological causes. In such situations, physicians may prescribe antidepressants to mitigate anxiety-related physical symptoms, such as stomach pain, heart palpitations, and headaches.
Everyday Encounters with Placebo and Nocebo Effects
Beyond clinical settings, we encounter these effects in daily life. For instance, some individuals claim that a specific diet, routine, or meditation technique drastically improves their well-being—though the change may be psychological rather than physiological. Conversely, people who believe that certain foods, environments, or even technology (such as 5G networks) are harmful may experience real discomfort due to the nocebo effect.
The placebo effect is a powerful psychological phenomenon demonstrating the intricate connection between mind and body. While it cannot replace real medical treatment, it can enhance the perception of well-being, reduce pain, and influence health outcomes. However, it remains a tool of perception rather than a cure. Understanding the placebo and nocebo effects allows for better comprehension of human psychology and the role of expectation in medicine and everyday life.
Advantages of Placebo Effect
One of the main advantages of the placebo effect is its use in clinical trials. Thanks to this, pharmacy shelves are free of ineffective drugs, and you can be confident in the efficacy of approved medications.
The placebo effect also helps alleviate pain. When a patient believes that a treatment should work, the brain produces endogenous opioids, which help reduce pain.
Additionally, the placebo effect increases the chances of recovery. A strong belief in getting better, combined with proper medical treatment, enhances the likelihood of a full recovery.
Disadvantages of Placebo Effect
The placebo effect can contribute to medical ignorance. Incompetent doctors may prescribe placebos simply because they do not know how to treat a particular illness. Physicians should educate patients on when medication is unnecessary, rather than prescribing placebos just to keep them satisfied.
Fraudsters exploit the placebo effect by posing as healers. They claim to “cure” illnesses using spells and herbal remedies, and those who believe in them may temporarily feel better.
It is important to remember that the placebo effect does not cure diseases—it only temporarily masks the symptoms. As we mentioned earlier, it is impossible to recover from an illness solely through the placebo effect.
