Positive Health Online

The word placebo – Latin for 'I will please' is normally used to describe inert substances – sham pills or injections. New drugs are tested against placebos in clinical trials to assess their efficacy. Unaware they are given placebos, volunteers believe them to be genuine drugs that will produce beneficial effects. Research shows they are effective in at least 30 per cent of cases.

The placebo effect has been measurable in a wide range of conditions, including hypertension, arthritis, depression, angina and pain. A report in 2000 by the House of Lords Science and Technology Committee stated "the placebo effect is not just an imagined experience but can positively improve objective biological measures of health".

How Placebos Work

Underlying the placebo are complex psychological and physiological mechanisms with the mind at its centre. It is powered by patients' belief that they will get better. Its psychological potency is enhanced by the way treatment is administered – the attitude, skill and belief of the practitioner. It is the practitioner/patient relationship that releases the placebo.

Current theory relates the placebo effect to psychoneuroimmunology (how the mind affects the body). In the book The Human Effect in Medicine, the authors, both doctors, explain how the brain can reverse disease via neurotransmitters called neuropeptides. In simple terms, neuropeptides are triggered by thoughts and emotions, in a physiological sense, such as expectancy and optimism. In turn, this activity mobilizes the body's powers of self-healing.

Relationships likely to empower the placebo are those that appreciate that the patient is an integral part of the healing process. Most GPs in their drug-orientated surgeries tend to miss out on this crucial relevance. Providing encouragement and empathy within a patient-centred environment can provide the psychological boost that triggers physical changes. By virtue of their philosophy, complementary practitioners are better at empowering the placebo to reinforce their treatments.

Case Studies

Arthritis

In his book, Mindpower, Dr Vernon Coleman describes how a patient suffering from arthritis visited his surgery. Instead of giving her the usual painkillers he told her that he was prescribing a new drug that evidentially provided lasting improvement. He said that he thought the drugs would help her a great deal. She also collected a prescription for antibiotics for her son's skin condition.

The pharmacist had only one of the two drugs in stock. She began taking these and after two days she was virtually free of pain and walking freely. Delighted with the results, she went and told Dr Coleman. However, mistakenly, she had taken the antibiotics meant for her son. Antibiotics could not have had any effect on her arthritic joints. Despite this, her doctor's enthusiasm for the new drug inspired her belief that it would relieve her pain. This mobilized a placebo effect.

Eighty-three arthritic patients were given placebos instead of drugs. In this group the same number of patients experienced relief as those given genuine drugs. The patients who reported experiencing no benefit were given injections of sterile water. Sixty-four per cent of them reported relief or improvement. Injections usually inspire greater expectancy than inert pills.

Placebo Surgery

A now discontinued operation for angina (internal mammary artery ligation) reportedly provided at least 60 per cent relief of pain. The placebo procedure involved an anaesthetic and cutting the skin but no surgical intervention. This group of patients believed they had received genuine surgery and also showed 60 per cent improvement.

Psychological Disorders

A study on depressives showed a 39 per cent placebo response at four weeks and 20 per cent at six months. A double-blind trial on patients with panic disorders showed a 34 per cent response to placebos. There is a 67 per cent placebo response for dementia

Complementary Medicine (CAM)

Considering the placebo is such a powerful force, imagine the difference it can, and does make, to valid therapeutic techniques.

Many factors elevate people's moods. Choosing a highly recommended practitioner will create positive expectations in people prior to their initial consultation. Studies show that a relaxed therapeutic setting helps maximize the placebo effect.

Time is necessary to build good therapeutic relationships. The average GP's appointment lasts about ten minutes. A CAM therapist probably spends more time with a patient in one consultation than they spend in a year with their GP.

The holistic approach does not distinguish between mind and body. It treats the individual not their disease. A genuine understanding of patients' needs makes them feel valued and boosts their self-esteem. It encourages self-empowerment.

Mobilizing patients' inner resources in this way can shift any negative tendencies. Communicating through touch also has an emotional significance.

The strength in complementary medicine lies in recognizing the significance of meaningful practitioner/patient relationships that provide the framework for growth and healing. Working with these powerful tools to catalyse self-healing is both challenging and rewarding. It facilitates the health and development of both practitioner and patient in the best possible way.

Bibliography

1 Dixon M Dr and Sweeney K Dr. The Human Effect In Medicine. Radcliffe Medical Press. 2000.
2 Coleman V Dr. Mindpower. European Medical Journal Rp. 1994-2003.