The immense potential of placebo

If you were alive in the region of Egypt during 4th century B.C and you had a physical ailment, you would go to a physician who would be wearing long black robes, some mystical jewelry probably including many amulets, he would have his elemental tools which would look weird, uncommon and dangerous, and probably an assistant who would be no less freakish. Now irrespective of what treatment he would give whether it’s through magical spells or through ingesting some random pseudo medicine (pseudo because it does not involve any direct and known mechanism of action) and you would come out satisfied with a sense of having being cured of your illness. This phenomenon of healing a symptom or disease either using an inert substance or without employing any effectual treatment altogether; where the subject has either has a 'feeling' of improvement or has genuine improvement in his/her condition is my friend called a Placebo Effect!!

Now the word Placebo in Latin means I shall Please, and most of how the placebo was supposed to be working (at least the physicians believed it so) was indeed through giving a sense of ease, the method of the treatment was as important as the treatment itself. Advancing forward a few thousand years, in the middle of 18th century an English physician shows that a dummy treatment against metal tractors worked equally well. But studies like these are an individual case and mostly without any control group or with numerous subjects. However, recent studies offer much more insight into this captivating phenomenon.One research for example in late 20^th century was where Ian Kirch gave one group of participants decaffeinated coffee and another group caffeinated coffee they observed that informing the groups about whether the coffee was caffeinated or not changed their expectations, and the group who was told the coffee was caffeinated when it was not, a similar response to caffeinated coffee like increase heart rate, increased attention, increased systolic blood pressure was observed. In another study conducted recently, a bunch of British cyclists were given a pill and were told that this is a legal performance enhancing substance. Later when their lap times were compared with previous runs where they had not received any pill, they saw an increase in performance by a few seconds (which is huge in the case of highly competitive sports where the difference between 1^st and 7^th place might be within a sec, and cycling is one of them). Well what is surprising here is that….. the pill they received never had any performance enhancing drug!(what a doozy) All it had was corn powder which is not known to enhance the performance in any known way. Isn't this incredible? It would be so great if we all were given a pill like this before we sat for exams, or went for job interviews. For all you know it might also be used to cure erectile dysfunction!! (there goes my weird imagination).

Well even more incredible is this next study: Where people complaining about severe back pain were given a sham surgery rather than a real surgery to correct their spinal cord (which is the primary and universally accepted treatment). The procedure was carried out in the same way, for similar duration (the doctor even made cuts in the skin) and everything was made to look real; just the difference was that no surgery was performed. What would have happened? Any guesses? I will tell you… what happened was (drum rolls please) that patients who received the sham surgery felt better in reality and lost their back pain completely! (Some of them were even able to do horse riding). This study does not just question the logic or need of surgery in cases like these but also surely put a nail in the head in favor of placebo research.
The question however that still remains is all this just a psychological effect? Is it all in the mind? Or are there definite physical changes happening inside the body also? If there are then how could they be measured?
An Italian researcher found out exactly that! He tested subjects in the Swiss Alps for their ability to climb in low oxygen conditions and measured various health signals, one of which was to measure the levels of neurotransmitter PgE2, which is supposed to rise in response to low levels of oxygen inside the body. But when the subjects were given fake oxygen and tested for the levels of PgE2 afterwards, they showed identical level compared to a case where real oxygen would be given. Now this truly is a physical change at the molecular level caused by a placebo! You could not ask for much more proof. Not enough? Still skeptical? This study would surely put you ocean deep into believing placebo is for real.

Parkinson’s patients are usually given a drug (like levodopa) which increases the amount of dopamine in their brain. This reduces the symptoms associated with Parkinson’s. In one study people with Parkinson’s were told to stop their medication for three weeks, during which all the symptoms of Parkinson’s reappeared which included inability to walk, trouble in talking, less coordination etc. After that they were given a placebo drug and told that it is a real medicine. What occurred next astonished the researchers! They saw that all the symptoms were gone and the patients immediately started feeling better, they could walk, talk properly, and even play piano which requires considerable coordination. It doesn’t end here; the real effect was that they could measure genuine increase in levels of dopamine in the brain of these patients after they received the placebo! This definitely is substantial evidence in favor of placebo and its ability to induce physical changes in the brain and body of an individual.  

Moreover, it turns out that the effectiveness of placebo is influenced by a lot of other factors like the size of the pill (bigger pills are more effective), taste of it (the bad tasting pills work better than good tasting ones), what is truly hilarious is the influence of price of the pill on its effectiveness; which was confirmed by Prof. Dan Ariely. He demonstrated that a 2 dollar fake aspirin was much more effective than a 10 cent fake aspirin (and he won the worthy IgNobel prize for the finding). The studies do not end here, I could go on describing truly fascinating and counterintuitive studies like these involving Pain, irritable bowel syndrome, dental surgeries, reduction in tumor size etc.

Placebo it turns out is all about expectations, it is truly fascinating how just by 'Believing' that you are being cured, you can actually feel much better, in simple words: you are telling your body to cure itself, or to feel in a certain way. isnt this got darn amazing that we all have the capacity to cure ourselves ? 

But it is prudent to ask: are placebo effects not working through deception? Because after all it is only after the outcome of the experiment that one is told that they were administered a placebo. The answer seems to be NO! There is evidence out there which prove there is no need of giving placebos in disguise. The world’s leading expert on placebo Dr. Ted kaptchuk (a Harvard professor) conducted studies where patients were told that they were receiving a placebo. And still they observed similar effects! It seems that from a Doctors enthusiasm to the promising care of a nurse to going to a box of pills and taking them, everything creates a level of expectations in our brain and even the routine procedure seems to be an encouragement enough for us to believe in it. Almost like a classical conditioning, that popping a pill will lead to building up expectations and start feeling better (just like a dog salivating after a bell).

Now placebo certainly has limits to what it can achieve, for example it cannot fix a broken arm, or reverse a heart attack. But wherever it has been possible, placebo is showing some immensely promising results. And looks like a powerful plausible alternative to conventional treatment methods.

It is also possible that traditional treatments like Ayurveda, homeopathy and all sorts of other vague treatment methods might be working through Placebo effect. The multitude of cases claiming curing of diseases corroborates this hypothesis.  

Here is one more reason for my interest in this domain which goes beyond the amazing psychology behind it, to its utility in the drug trails in the current medical system. Why i am focusing attention to this fact is my concern over the type I errors(incorrect rejection of a null hypothesis) we might be making while testing various drugs to bring into the market. It raises a question to whether using placebo or dummy pills as control for various drug trail studies is appropriate or not. As we have seen in many cases mentioned above that placebo has effects of its own, and cannot be considered to be a good candidate for a control trail
what if many failed drug trails are actually enhanced effect of placebo than a lowered efficacy of the drug? How could we check for significance in this hazy double sided positive comparison?

Well these are the questions that only Extensive and dedicated Research could solve.
But the compelling Placebo research seems to have immense potential for many treatments.

It is wonderful how we all carry the innate ability to cure ourselves. And as this saying goes-

"In the province of the mind, what one believes to be true either is true or becomes true." - John Lilly

(Caution: I advertise the quotes only in this specific domain)

Thanks for reading!

And always remember : stay curious!!