How powerful is the placebo effect?

 It’s known as a natural microbiological phenomenon 1, which has baffled scientists for decades and sparked heated debates about the controversial use of its application in medicine today 2,2.5, which questions the importance of honesty and integrity over the health of a human being. But what exactly is this placebo effect and how powerful is it?

 "placebos are supposed to be nothing"

The word placebo is Latin for “I shall please,”3 but placebos are supposed to be nothing 4. They’re just inactive drugs with bogus ingredients that are supposed to be chemically inert and were made with the sole intention of being fake 4. Useless. Simply a sham drug. They can take a number of forms, from sugar pills to shots of saline, and fake creams to brightly coloured capsules, and are given out during drug trials as a control, so doctors can analyse whether a new drug treatment is an improvement from a placebo.

But why not just measure the new candidate drug against a sample group of people who just don't take any form of medication? Well, it’s to help factor the placebo effect, a phenomenon that’s hard to measure and even tougher to investigate 4, yet alone understand.

Even with the administration of a placebo, a patient still gets better. And it all boils down to, trust, hope, expectation, and simply the power of belief5.

 

The placebo effect is the beneficial impact or improvement in health from taking a placebo, which is mainly due to the patient’s belief that the drug is real3. Typically, placebos have been shown to work in about 35-45% of cases in patients 6, and it’s been exploited and used by physicians for a number of centuries. Researchers believe that placebos instigate a psychological response, where subconsciously, you're thought process and physiology changes after its administration6.

 

It was first mentioned in the late 18th century, but it wasn't until 1955 when Professor Henry K. Beecher, an American anaesthetist who taught at Harvard University, published an article called “The powerful placebo,” which fully explored the natural phenomenon. Whilst treating injured soldiers during World War II, he ran out of morphine, hence in desperation, injected the wounded with shots of saline instead. However, he didn’t reveal any of this to his patients and continued to inform the soldiers that he was still using injections of the powerful painkiller morphine. Miraculously, 40% of the soldiers said their pain had been reduced 7, so upon his return to the United States, he decided to investigate this mysterious effect further.

 

The article he wrote was a revelation in the field6 that brought to light many intriguing factors of the little-known placebo effect1, through the results of many controlled experiments his team carried out. It stated that over a third of patients benefitted from taking a placebo, and it was the breakthrough which not only engaged the medical community but convinced them this effect was actually real6, initiating many studies of the placebo effect thereafter.

 

Although it has been nearly sixty years since the article was published, there are still many unanswered questions regarding the placebo effect, and that is in part due to the many difficulties in researching.  Difficulties in researching

Some clinical trials regarding the placebo effect can consume half a patient’s life6,4. This means that not only is the process for evaluating data extremely slow, but these studies are often expensive and take time for the results to be verified by repeats.

 

Also, many people are uncomfortable with the idea of participating for a research program that involves the placebo effect, since they often feel betrayed after putting faith into, what they thought, was real medication, and trust into the doctor prescribing the drug4.

 

Furthermore, experiments require subjective reports from patients, for example trying to measure pain, and the results aren’t always conclusive; especially when prior expectation can influence subjects and lead to perceptual errors.

 

For example, the Hamilton scale is used for measuring depression6, however, a difference of just 1.8 points (on the 51 point scale) is large enough for a drug to be considered chemically potent and “clinically significant.” An improvement in sleeping patterns results in a 3 point change. 6

 

Many conditions, such as the common cold, are self-limiting. They will resolve by themselves anyway, with or without placebos or drugs, so when symptoms disappear it can be down to mere coincidence, however, this is extremely hard to factor into experiments, where statistical data is key. 6

 

Moreover, if one were to take an ineffective, empty capsule at their sickest, the chances are they’d recover afterwards, in exactly the same way that if you crossed your fingers after rolling a double one, your next roll is likely to be higher8. Most illnesses remit as part of their natural course, so their symptoms wax and wane simply by their own accord, and this can skew data from an experiment, especially since everyone’s recovery period and the immune system is unique.

 

There are 3 main components of the placebo effect that contribute to the overall potency of placebos; that is the improvement of a patient's symptoms after taking a “dummy pill.”6

?Positive belief and expectation on part of the patient

?Positive belief and expectation on part of the physician

?A good relationship between the two

 

One reason that the body responds to a placebo is that people are consciously and subconsciously connecting environmental cues and a healing response13.5. They seem to almost anticipate the effects of medication. But there are still many questions that have yet to be answered, such as how the placebo effect works and perhaps more intriguingly, why??

 

In order to investigate the power of the placebo effect, so-called double-blind experiments (where neither the patient nor the doctor knows whether the given medication is the experimental drug or the placebo), are often carried out to ensure unbiased, statistically reliable results are collected. However, this can be flawed since midway through experiments, patients could realise if they are on real medication (due to side effects noted from previous experience) so their expectation changes; this is known as breaking blind 6.

 

Unsurprisingly, diseases, where the placebo effect is most noticeable, are often linked with psychological factors, such as stress and anxiety6. Patients suffering from Irritable Bowel Syndrome, depression and pain seem to have a higher response to placebos4.

 

But ultimately, the biggest factor that has held back research is pharmaceutical companies withholding studies from publication. This is because it would damage their reputation, and although they aren’t obliged to publish these results, they have been heavily criticised for not doing so. Prozac only published 27/145 reports that concluded that placebos were better than their drugs.

 

Strengthening FACTORS

 

There are also a number of unique and strange insights into the little-known placebo effect, as Dr Ben Goldacre discusses in the Guardians “Bad Science". Much of this research has been carried out by Dr Irving Kirsh, a professor at Harvard University who has been studying the placebo effect for over 30 years.

 

The slightest of differences in the makeup of a placebo can have huge impacts on its effectiveness, and this is all to do with expectation.

 

Size : Size matters. If a placebo is larger, then the power of the placebo effect is enhanced. So patients who take a larger sugar pill feel markedly better than patients who take smaller pills. 9

Colour : The potency of a placebo also relies on its colour. Different coloured pills tend to have different effects on patients; blue pills are used against anxiety, almost as a sedative, reflecting the mind’s connection between the colour and peace and nature, whereas red placebos are used for reducing pain since marketing studies showed these to be more effective. In this way, the mind relates the colour of the drug (which has no medical bearing whatsoever) with its physiology. 10 

 

The number of pills: Taking 2 pills is found to be more effective than taking just one. It increases the therapeutic effect since it raises expectations about the potential benefit of the treatment, even though the pill is full of inert chemicals, and this was the result of an experiment concerning stomach ulcers. 11

 Capsule, Injections and Surgeries: Taking capsules is better than taking pills. Injections of salt water (a saline solution which neither harms nor helps the body) are even better than taking pills. 4,6,8. The brain recognises that an injection feels like a more serious treatment than a couple pills and this superficial, neurological process creates far greater expectations of the more severe treatment 12. Hence this way the procedure seems more “real” and the mind registers this, contributing to an ever greater power.

 Furthermore, a sham surgery has recorded the best placebo effect in trials 12.5. A simple operation where the surgeon makes an incision with arthroscopic devices and then sews it up again has produced proven improvements in the patients' symptoms 12. Groundbreaking research has been done to bring to light this stranger, more complex aspect of the placebo effect, regarding the body’s response after a sham surgery.

 

Dr David Kallmes is a famous radiologist who works at the Mayo Clinic, and for over one and half decades he's been treating broken backbones by injecting them with a specially formulated acrylic bone cement, in an effective procedure called vertebroplasty 12. In most cases it was deemed a huge success, however in some  cases when the procedure went horribly wrong, patients still responded in a positive manner.4

 Controversially, he designed a trial where one group of patients received the real treatment, and the other would be given a placebo4; in this case a fake operation. The latter group was treated exactly the same way, given medication by vein prepped and local anaesthesia was given in order to make sure the experiment was as fair as possible.

 

But surprisingly, people who have been given a sham surgery still recovered4, and according to the results, a placebo can be as effective as the real treatment, which has been carried out on over 1 million people. The sham surgery would be more financially viable and save billions of pounds, whilst also reduce patient recovery time. 12.5 

 

Patient interaction

 

As a society, we take comfort in the routine of going to a doctor and relax when our troubles are takes seriously13.5, with many visits to the GP resulting in a prescription being written up, and patients feel a sense relief when handed a few colourful pills which are filled with hope and expectation that provides them with a clear course of action which can help them to recover. 13

 

PRICE : In 2008, researchers at Caltech proved that people enjoy cheap wine more if they think it's expensive4. In a very similar way, brand image/cost can also affect the power of the placebo effect. Patients who were told they were trialling a supposedly more expensive drug would have more vastly more noticeable improvements in their health, perhaps due to their higher expectations of the drug simply due to its price tag14. This inexplicably leads to a longer lasting placebo effect and a quicker recovery, thus enhancing the power of the placebo.

 Also, if it’s packaged in a flashy, expensive box or there is a clear brand of the drug as opposed to a non-branded pill, the results are even better. 14,14.5

 

A study carried out 7 years ago at Duke University in the US brought to light the extent of which price factors in harnessing the placebo effect4. Dan Ariely, a professor of psychology, discovered that after administering electric shocks in 82 participants and offering placebos advertised as pain reliever costing either $0.10 a pill or $2.50 a pill, 85% of participants receiving the more expensive placebos reported significant pain reduction, whereas it was only 61% of the group receiving the cheaper pill experienced pain reduction.

 

The findings of this experiment and other studies like it suggest that price impacts the effectiveness of placebo pills. One possibility for why this is the case is that people correlate higher prices with better quality. Thus, the simple expectation and belief of better quality are enough to create a more potent placebo effect for higher priced items. 15

 

Genetics: Susceptibility to the placebo effect might even be genetic. A study conducted seven years ago in Sweden tested a small group of people who had a social anxiety disorder. After a treatment consisting of a placebo, all the subjects were tested for a variant of a gene called tryptophan hydroxylase-2, responsible for the manufacture of the neurotransmitter serotonin (which is related to regulating mood as well as a host of other functions). The majority of the subjects who responded well to the placebo had two copies of this particular gene variant, while those who didn't respond to the placebo didn't. 16

 

Location:

Moreover, there are interesting contrasts in the effectiveness of a placebo depending on where it’s being taken 17. Because expectations are largely affected by the cultural environment, effects are likely to vary from place to place 17.7. In America, a placebo is more likely to work 17, perhaps because there are a much more faith and trust placed on the highly qualified doctors by patients. A barrage of advertising, which is infamous in the USA, may also have inadvertently amplified the placebo effect6.

 

About 1 in 10 Americans over the age of 12 take antidepressant medication. 6,6.5

 

TIME:After thorough research carried out by a number of professors, it is thought that the placebo effect is more powerful (that is it is more likely to improve and have beneficial impacts on patients) nowadays compared to a few centuries ago 17, perhaps reflecting on the increase of not only trust in the doctor on the patients behalf, but also belief and faith in the many hours of scientific research which goes into bringing a new drug to the market.

 Moreover, with medical technology improving every day, and more funding for research for professors and training for doctors, more faith and trust is being placed on the efficacy of the medication. Pharmaceutical companies often base their own products on certain placebo characteristics that appear to influence how patients respond to them. 6

 

It’s no mere coincidence that Pharmaceutical companies have considered these factors when bringing a new drug to the market. They take advantage of this 9 phenomenon by carefully considering every aspect which can help boost the effectiveness of the drug and therefore its $ales. From the blue packaging on anti-depressant pills to the brand name, design logo, and even the price of the medication, lengthy board meetings take place at these billion dollar Pharmaceutical companies to carefully plan every detail 6.

 

For example, Zoloft, Cymbalta and Paxil antidepressant pills are all blue, whilst opioid and ibuprofen painkillers tablets are red.

 

These examples of placebo all rely on overlying expectations that the drug will be beneficial, expectations that can be strengthened if the drug is more expensive or delivered in a more ‘intense’ procedure. The idea that the neurological details in the brain can have a physiological effect is difficult to comprehend and goes against all medical and scientific logic, and many people still have reservations about whether the placebo effect is actually real. 2 10

 

DEPRESSION

?75% effectiveness of antidepressant medication is due to the placebo effect 6

? Over 50m prescriptions for antidepressants written in the UK per year 18

? Is worth an estimated$19 billion for pharmaceutical companies 35

? Prozac Zoloft Paxil Effexor Serzone and Celexa are the 6 top selling antidepressants

 

It’s one of the main areas of a study carried out regarding the placebo effect6, and its common knowledge that depressant pills aren’t exactly wonder drugs (psychiatrists know that any given depressant has only a 50% chance of working6). However, after considering remission rates and factoring in the placebo effect, many have questioned the usefulness of antidepressant pills, and with very good reason to do so.

 

The Food and Drug Administration state that if a drug outperforms a placebo in 2 independent studies, without untoward side effects, it will be approved. But the relative advantage of the new drug over the placebo is not considered, be it 2% or 200% more effective than an inert pill.

 

But perhaps what many psychiatrists don’t know is that in over half of the 47 trials, placebos outperformed the 6 “leading” antidepressants and only 20 of the candidate drugs showed measurable advantage6. One could argue that antidepressants only have minute advantages over taking a placebo 6, as well as having adverse side effects.

 

Pharmaceutical companies don't publish these results of the trials since it has a detrimental impact on their brand image, and therefore their sales, hence its left to the likes of Dr Irving Kirsch and Dr Roger Greenberg to extract the data from the FDA.

 

After meticulously scrutinising unpublished results from the drug trials, Roger Greenberg, a professor at NY medical university, found out that around two-thirds of patients would do just as well or even better with placebos instead of real drugs, according to his book “From Placebo to Panacea."

 

The hopelessness of depression is the expectancy that a terrible state of affairs is not going to get better. Do placebos provide a fully proven cure? No, but it does instil hope for a patient, which can’t go underestimated13. 11

 

Parkinsons

 

Parkinson’s disease is a degenerative disorder of the central nervous system which leaves its sufferers with symptoms which restrict movement, such as shaking and a loss of balance, as well as extreme depression. It develops due to a lack of dopamine being produced in the motor areas of the brain 20, a biochemical hormone responsible for suppressing pain and regulating emotional responses. This substance is a neurotransmitter (a chemical released by nerve cells to send signals to neurones across a synapse) and can be produced by doing multiple numbers of things, from taking ecstasy to doing exercise. It’s known as a natural painkiller. 20.5

 

As an inhibitory neurotransmitter, it blocks the tendency of that neurone to send a transmission 21. Dopamine is strongly associated with reward mechanisms in the brain, and drugs like heroin, opium and cocaine increase the levels of dopamine in the brain.

 

The placebo effect is so prominent in Parkinson’s disease because it’s proven to release dopamine 21, the exact substance which is lacking in patients, so it eases its symptoms. This dopamine production is activated after the brain registers it has taken medication, in hope and expectancy that it works, even though all that has been administered is a placebo. So the placebo taps into the brains internal pharmacy and actually changes our physiology4. This is proven to help ease symptoms for the short term and helps to real ease as much dopamine as amphetamine or speed can.

 

4 Pain, Parkinson's and Depression may seem unconnected, yet these conditions share circuits in the cerebral cortex. This part of the brain helps to analyse a situation and its consequences. If you expect pain to diminish, the brain releases natural painkillers. Somehow, anticipation trips the same neural wires as actual treatment does4. But how exactly a chemically inert substance can trigger this physiological change is what scientists are trying to find out and ultimately years of research have been carried out but to no avail.

 

 

The sports placebo

 

It doesn’t have uses limited to the medical world; a placebo can enhance sports performances as well. Dr Chris Beedie, who has a PhD in sports psychology, conducted a study based on Manchester’s velodrome to help uncover interesting insights about the placebo effect.4

 

Some of the UK’s top cyclists were invited to take part in an investigation examining the effect of legal performance enhancing supplements, but little did they know these legal supplements were just dummy pills made with corn flour.

 

 

Firstly, he asked the cyclists to do a sprint trial, so a baseline performance is measured to help get a sense of their natural competitive time. Then, they were instructed to repeat the time trial four hours later, this time taking a brightly coloured pill before they set off. It’s interesting to note that Dr Beedie revealed to the participants which time trial he expected would be faster, and also inspired confidence and reasoning with his prediction.

 

In spite of the fact that the riders were tired from their earlier race, the analysis shows that over half of them were quicker the second time around. This had nothing to do with the cornflour, but with the power of the placebo. According to Dr Chris Beedie, in sports performances, we can expect to see improvements of 2-3% with the aid of a placebo 4, and it’s this 3% which can make the difference between a Gold medal at the Olympic games and not even finish on the podium.

 

Ethical hole

Perhaps one of the greatest problems facing researchers and doctors is the unethical values the placebo promotes 2,2.5, since for it to work at its best they have to convince patients they’re getting a real drug whilst trying to improve a patient’s health.

Fabrizio Benedetti, an Italian physician who works at the University of Turin, suggests telling patients the truth by saying: “‘I’m going to perform a procedure which is known to activate endogenous analgesic substances in your brain. Thus, your pain will subside in the next few minutes.' Even though you give a placebo, I believe there is no deception in this sentence.” 22

A recent news article published by the BBC reported that over 97% of 783 GP’s questioned admit to prescribing a placebo for one of their patients. 22,22.5

 Perhaps even more surprisingly, about one in 10 of the GPs in the study said they had given a patient a sugar pill or an injection of salt water rather than a real medicine at some time in their career22.

 

But this shouldn’t be so surprising given that less than 7 years ago in America, nearly half of the 600 doctors questioned admitted to prescribing placebos in the form of vitamins and sedatives4. Although these pills aren’t chemically inert, doctors know that it’s highly unlikely that they will cure a disease through its chemical properties. The placebo effect can be enhanced by a thorough examination during the consultation, even if the doctor knows that he won’t find anything to further add to the diagnosis. 13.5,4 This simply reassures the patient and makes them feel looked after, with somebody taking their problems seriously.

 

And if a patient is adamant and requests treatment, there is very little else a GP can do, according to Dr Clare Gerada, Chairwoman of the Royal College of GPs. Doctors sometimes prescribe a placebo because the patient insists on taking some type of medication. She goes on further to state that it was perfectly acceptable to use a placebo as long as it didn’t cause harm and wasn’t expensive22. 

It’s a very easy way to get rid of paranoid patients who simply can’t comprehend that time and bed rest is all that can truly help them, but we all know that prescribing the likes of antibiotics as a placebo can have a detrimental effect.

 

One common example for when the prescription of antibiotics would be inappropriate is when a patient has a cold or other illness caused by a virus. 23 Antibiotics are only effective in treating bacterial infections, not viruses, but many patients believe that they need to take a form of medication anyway. The use of antibiotics in these circumstances leads to a higher rate of antibiotic resistance, an issue which is commonly reported through the media. 23

 

TRUST

 It isn’t solely reliant on deception. One of the most peculiar things about the placebo effect is that it’s still effective if the patient knows the truth; which seems completely implausible. It still works (but not quite as well) even when the people are told it’s a sugar pill, according to a study carried out in 2002 by Harvard’s Ted Kaptchuk 13. Eighty people with Irritable Bowel Symptoms participated in the trial. Half were given no treatment and the other half, that was given a placebo, showed significant improvement in their symptoms through the self-healing process over the course of three weeks.

But even if doctors were ready to fully exploit the placebo effect, the real question is would patients be willing to hand over complete trust and put faith in their GP so they can decide which course of action is best? 15

 

Pharmaceutical companies

There is little money to be made through sugar pills and placebos; hence very little research has been done into this matter since it’s the drug companies which fund nearly all of the studies about drugs. However, even real medication with active ingredients benefit from the placebo effect, and the FDA has required that drugs be tested against placebos since late 1970 to ensure its effectiveness is due to its biochemical properties. 6

If a candidate drug outperforms a placebo in two independent studies, and if it does so without untoward side effects, the FDA will approve it for use. 6

The benchmark standard for establishing efficacy is the randomised clinical trial, in which patients with a particular disorder are randomly assigned to receive either the active drug or a placebo. The medication is approved only if its effect in treating the disease is reliably superior to that of a placebo. In trials, every drug response is assumed to be partially a placebo response, and the drug effect is only the additional benefit.

 

However, this has drawn much criticism since companies are notorious for skewing data using selective statistical testing, and there is still a debate over the how chemical significance and clinical significance should be defined in terms of percent. 6

 

For antidepressant studies, less than 20 percent of the overall improvement is down to the chemical efficacy of the drug. This means, according to Dr Kirsch said, that "80 percent of the drug effect is the placebo effect." 6

 

Are we wasting billions of pounds on worthless drugs and medication that owe their success to clever marketing and cashing in on peoples blind trust and faith 6.5, because the complex placebo effect is undermining clinical trials?

 

Nocebo

 

The mind can play tricks on the body to help it recover from a disease, pain or tiredness; however, it can also manipulate the body so it feels worse 17. If a placebo instigates negative side effects, it’s referred to as a nocebo, Latin for “I will harm”3, and is known as the placebos evil twin counterpart. 

 

Hence the nocebo effect is used to describe when a placebo produces prominent and undesired side effects. In general, the side effects of nocebos are similar to those of active drugs 4, with migraines, upset stomachs and nausea most prevalent, but usually with a much lower incidence rate.

 

The nocebo effect highlights the role of patient’s expectation and beliefs, and an example of it would be when one dies of shock after suffering from a non-fatal wound. It is generated entirely by the subject's pessimistic belief that unpleasant consequences would occur17, and raises the question, “should Doctors actually disclose the side effects of a treatment if it is proven to enhance them?”

 

If expectations filled with hope can improve a patient’s health, it stands to reason that negative expectations mixed with fear, anxiety and scepticism can do the opposite, and result in the patient feeling even worse.

 

Due to obvious ethical issues, limited experiments have been carried out regarding the nocebo effect; however, there has been plenty of observation as well as some carefully handled research. In most cases, participants in a trial investigating the effects of a candidate drug against a certain disease have already been prescribed active medication previously to help cure them. Thus, even if a placebo is administered, they may anticipate similar side-effects. 17

 

Usually, patients included in trials of psychotropic medication have already received previous treatment with active medication in the past, as most major psychiatric disorders tend to follow a chronic course4,6. Hence, even if they are given placebo this time, they may anticipate side-effects similar to those that they experienced when they were receiving treatment with the active drug. Also, patients may be influenced by the list of side-effects experienced by their friends or relatives who have received such treatment in the past, and by the list of potential side-effects described by the researchers before obtaining informed consent.

 

Just as doubts have been cast on the beneficial effects of the placebo, so have questions been raised about the nocebo effect. Even typically healthy people who are not taking any medication have been shown to have a high frequency of a range of symptoms which are similar to the side-effects investigated during Randomised Control Trials 4. Thus, side-effects reported by patients on placebo may be a reflection of pre-existing or spontaneously occurring symptoms rather than being placebo-induced. 18

 

HOW

 (Not by reason, but simply by trust)

 A scientific explanation for the placebo effect is that a placebo subconsciously stimulates the release of endorphins, a body’s natural painkilling hormones after it has been administered.

 A study was conducted by researchers at the UCLA Neuropsychiatric Institute in 2002, where two groups of patients received experimental antidepressants and a third was given a placebo. After several weeks of taking the prescribed pills, each group’s brain activity was measured using electroencephalography, (EEG). 6

 

Patients who had been given the placebo showed a greater increase in brain activity than those that were using the real antidepressants. However more intriguingly, for patients taking the placebo, the brains activity is centred at the prefrontal cortex. According to Professor Tor Wager of Columbiana university, a placebo taps into processes in your brain that produce physical results that really shape how your body responds to external factors. 18.5

 

The brain isn’t being “tricked” by a placebo; it is proven to respond to a placebo in a different way. 19

 

Placebos not only lead to measurable effects in the brain, they've also been shown to relax muscles and nerves to bring pain and symptom relief to patients. So while the placebo effect is indeed in your head, it's not just psychological. 4 19

 

A groundbreaking study at the University of Michigan in 2004 showed that the placebo effect is related to endorphins; natural pain relievers located in the brain. Healthy subjects were given a painful yet harmless injection in the jaw while their brains were scanned by a PET scanner, and they were then asked to rate their pain level as the researchers injected more or less saline to keep the pain level at a consistent rate during the brain scan. 24

 

The subjects were then given (what they thought) was a pain reliever, and all of them experienced a decrease in their pain levels after receiving the placebo19.5. However, they also showed a change in brain activity in the brain's opioid receptors (which receive endorphins) and its areas related to processing and responding to pain. The expectation of pain relief caused the brain's pain relief system to activate. Research into this matter has proven that anticipation of relief from pain discharges opioids and dopamine, which drive the reward response.

 

As shown in the studies for Parkinson’s disease, they play a huge role in the placebo effect. 4

 

But this theory doesn’t explain why placebos are effective for asthma, for example, nor delves into the detail of how a chemically inert pill can release biochemical in the brain.

 

WHY??

The main question is, why is an inert pill needed to activate the powerful placebo effect? Why can’t one get better by themselves, since all the chemicals the body needs are waiting to be released into the brain? 20

 

Harnessing its power in the future

A faith healer may offer us a sugar pill that is pharmacologically inert, yet this can persuade us to initiate an immune response. A national flag won't deflect an enemy bullet, yet it can boost soldiers morale and make them determined to fight on.

 

Despite sixty years having elapsed since the publication of “ The powerful placebo,” the placebo effect still remains poorly understood 25, but it’s vital for the profit-driven healthcare industry to research into this matter6, so the placebo effect can be harnessed. This could result in fewer people using and becoming addicted to dangerous medication with adverse side effects.

 Most patients walk into a GP trusting that the doctor knows what's best, but if people were told about the use of placebos, would this undermine creditability and trust? Are honesty and integrity more important than a patient’s health?

The way in which placebos could be utilised ethically would be improving the way in which a treatment is given without the need of lying to patients in the process. A greater investment of time, money and thought could be diverted into creating a greater sense of positivity and a friendlier environment.

This change of behaviour may have a significant effect on the speed of recovery after normal treatment, instilling a greater sense of hope and expectation within patients that would enhance existing treatments, and make them even better. 21

  

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