We are aware that in trials, when testing new drugs, or even when testing drugs generally, there is wide use made of a ‘sugar pill’ or a placebo.
The placebo effect has always been scorned by many of the medical profession. However, the results have been tested and there is no denying something works with a placebo, even when it is just a sugar pill.
This is all about the power of our thoughts and expectations, which have now been seen to surpass the effects of drugs. A group of people with Parkinson’s disease were asked to test levodopa, the standard drug treatment for the disease. This drug raises levels of dopamine in the brain. The participants were told that they were probably going to be given the drug, but there was a chance they could be given a placebo instead.
Brain scans after the study revealed that levels of dopamine were higher in every case. However, what the participants didn’t know was that none of them had taken levodopa but had been given a sugar pill. Could the expectation of a result cause chemical changes in their brains? (Arch. Gen. Psychiatry, 2010).
While using placebos in studies, over the past 20 years, it has been noticed that the placebo effect has been getting stronger.
In fact, it is getting so strong that it is matching, and sometimes surpassing, the effects of painkillers, in a way stopping the development of new drugs in their tracks.
Several major new drugs have fallen at the last hurdle when tested against a placebo response. This could cost a drug company upwards of £1 billion in research and development for a product that has to be scrapped.
Researchers at McGill University in Montreal discovered the phenomenon of the rising placebo effect when they looked back at 80 trials testing painkillers to treat pain from nerve damage, carried out between 1990 and 2013.
This is all about the power of our thoughts and expectations, which have now been seen to surpass the effects of drugs
There was a steady increase in the placebo response, but drug responses remained stable, over those years until, in the most recent studies, people reported a 30 per cent decrease in pain, whether given a drug or the placebo (Pain, 2015).
Numerous other trials that have set out to deliberately trick the participants have still shown positive effects from a placebo. In some cases, the participants were told they were taking a placebo and still felt benefits.
So how is it that a placebo can match the healing effects of a powerful painkiller or salve? Scientists reckon a placebo pill affects the same pain pathways targeted by drugs. PET (positron emission tomography) and MRI (magnetic resonance imaging) scans have shown that pain-reducing responses are accompanied by reduced neural activity in pain processing areas of the brain and spinal cord, even when someone has taken a placebo. In other words, thoughts and expectations are activating the same pain-reducing processes as the drugs do.
It is not just pain that is affected. A range of conditions have shown improvements such as Parkinson’s disease, depression and even psychotic episodes. Psychosis is recognised as a severe mental health problem in which the sufferer loses touch with reality – and yet the condition has been reversed with a sugar pill.
Ted Kaptchuk, a professor of medicine at Harvard Medical School, has been studying the placebo effect for years, but he still cannot really explain what is happening. He believes it is to do with the drama of medicine. That can include all the medical paraphernalia, pills, symbols and interactions with the doctor. “All those things merge, triggering brain mechanisms of expectation and potentially contributing to a placebo effect,” he says.
Damien Finniss at the University of Sydney agrees that the effect involves many different factors. However, he believes that you do not have to hand out a placebo to have a placebo effect. It is part and parcel of routine clinical care. Doctors have known this for years. The German Medical Association reports that placebo prescriptions are ‘booming’ and ‘half of German doctors’ are prescribing them regularly.
Similar behaviour can be seen in Canada, where 20 per cent of psychiatrists and non-psychiatrists say they have prescribed a placebo. Among the psychiatrists, 60 per cent describe placebos as genuinely helpful and of therapeutic value (Can. J. Psychiatry, 2011).
One theory is that the placebo effect is rising because it is cancelling out the effects of drugs by using the same neural pathway the drugs are targeting. Expectation and anticipation are everything and the placebo is merely a device that ‘allows’ the painkilling process to begin.
If this theory is right, it is very bad news for the drugs industry. Instead of spending billions of dollars on painkillers, antidepressants, anti-Parkinson’s drugs and antipsychotics, we just need to take a sugar pill and let the brain do the rest. When it comes to healing, perhaps it really is the thought that counts.
kathryn@maltanet.net