The Placebo Effect (“Placebo” from the Latin: I Shall Please) has been around for centuries. It acquired its name in the 18th century. For the next couple of hundreds of years, it was used by medical researchers to explain how they tested the efficacy of drugs before putting them on the market. A group of people was given the drug and another group was given a sugar pill. The groups were not told which group was given the sugar pill and which was given the real drug. The real drug had to prove its effectiveness without a doubt and with no competition from the sugar pill. Only then could the tested drug be put on the market. But the placebo and its effect were not taken seriously or were simply ignored by doctors and the pharmaceutical industry. The sugar pill was an anomaly that did not merit study.1, 2,3
Why has that attitude changed significantly in the last couple of decades? Why is The Placebo Effect now a respected area of scientific study?.
Researchers were aware that the sugar pill or fake drug oftentimes had a positive effect. The aim of the drug companies was to work with the new drug over and over until its effects clearly surpassed any positive effects coming from the fake drug. No research was done on the placebo effect to examine its nature or to make it more effective. Researchers knew that sugar pills which did not have an ingredient that could effect change did bring about actual positive physical results such as alleviating pain of various kinds. It even relieved sometimes the tremors of Parkinson’s.4
The Insight of an Acupuncturist
In the last 20 years, however, more and more attention is being paid to why a placebo has positive effects. Ted Kaptchuk, formerly an acupuncturist and now Professor of Medicine at Harvard is recognized as the leader of placebo studies. He has made such significant breakthroughs in the understanding of the placebo effect that researchers in pharmaceutical companies have to take notice.5
Professor Kaptchuk received his BA from Columbia University. He earned a degree in Chinese medicine in China. That latter degree was in acupuncture and herbal medicine. He returned from China and practiced acupuncture. He had success as an acupuncturist but continually questioned why this practice was successful. Sometimes people got well even before he started the treatment. Why? It was this nagging question that led him to quit his acupuncture practice and seek entrance to academia.6,7
The Beginnings of Research Into the Placebo Effect
He gained professorial entrance to Harvard in 1995 mainly because of the reputation of his book The Web That Has No Weaver which dealt with Chinese medicine. He and several others also intrigued by the placebo effect founded an interdisciplinary program at Beth Israel Deaconess Medical Center to study the placebo effect. The program was named PiPS (Program in Placebo Studies) and the Therapeutic Encounter. Kaptchuk knew that the placebo effect worked well in many cases. His program aimed to research why it worked well. The probing questions he asked about the placebo effect and the significant papers he wrote about it gained him a professorship at Harvard even though he did not have a PhD.8
Kaptchuk noted in his acupuncture work that because his clients often got well right before he used the needles something biological had to be going on. But how? The questions he asked were similar to those asked by Dr. Bruce Lipton in The Biology of Belief: Was the environment effecting the changes? Was the manner of the doctor having effect? Did the way (pill or needle) the placebo was given effect the changes? Perhaps the patients’ thoughts brought about healing? Or did the combination of some or all of the foregoing effect the changes? Perhaps there were other as yet undiscovered elements that brought about wellness? “The placebo effect is more than positive thinking — believing a treatment or procedure will work. It’s about creating a stronger connection between the brain and body and how they work together,” said Professor Kaptchuk. He also said that not investigating the placebo “is like ignoring a huge chunk of healthcare.” He urged that health care practitioners “should be using every tool in the box,” while acknowledging and emphasizing that “Sham treatment won’t shrink tumors or cure viruses.”9
The Sugar Pill More Than Inert Sugar
His research and studies showed that patients’ perspectives and the perspectives physicians used when giving the sugar pill or inserting a needle had serious impact on the kind of results brought about by a placebo.10 But in order to convince doctors, he knew he had to have scientific evidence. Cara Feinberg, in an article on Kaptchuk writes, “His chance would come in the early 2000s in a collaboration with gastroenterologists studying irritable bowel syndrome (IBS), a chronic gastrointestinal disorder accompanied by pain and constipation. The experiment split 262 adults with IBS into three groups: a no-treatment control group told they were on a waiting list for treatment; a second group who received sham acupuncture without much interaction with the practitioner; and a third group who received sham acupuncture with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as very schmaltzy care (I’m so glad to meet you; “I know how difficult this is for you; this treatment has excellent result”). Practitioners were also required to touch the hands or shoulders of members of the third group and spend at least 20 seconds lost in thoughtful silence.
The results were not surprising: the patients who experienced the greatest relief were those who received the most care. But in an age of rushed doctors’ visits and packed waiting rooms, it was the first study to show a ‘dose-dependent response’ for a placebo: the more care people got—even if it was fake—the better they tended to fare.”11
Ethics and the Use of a Placebo
His research continued. Professor Kaptchuk did not appreciate that patients were lied to when being given a placebo. He determined to conduct another experiment: Tell his patients they were receiving placebos! He and his colleagues conducted a pilot study to test this matter. Feinberg writes: The results were “published by the peer-reviewed science and medicine journal PLOS ONE in 2010, that yielded his most famous findings to date. His [Kaptchuk’s] team again compared two groups of IBS sufferers. One group received no treatment. The other patients were told they’d be taking fake, inert drugs (delivered in bottles labeled “placebo pills”) and told also that placebos often have healing effects. The study’s results shocked the investigators themselves: even patients who knew they were taking placebos described real improvement, reporting twice as much symptom relief as the no-treatment group. That’s a difference so significant, says Kaptchuk, it’s comparable to the improvement seen in trials for the best real IBS drugs.”12
These findings caught the attention of the NIH (National Institutes of Health) and gave legitimacy to placebo studies. To convince the medical profession though, there had to be scientific proof that the brain could effect changes in the body. While Kaptchuk and his colleagues believed that the brain did indeed effect bodily changes, they had to wait ten years for scientific proof. That came with the invention of PET (positron emission tomography) scans and functional MRIs (magnetic resonance imaging).13
The Scientific Validation of Placebo
Feinberg writes that “In two fMRI studies published in the Journal of Neuroscience in 2006 and 2008,” Kaptchuk and his colleagues “showed that placebo treatments affect the areas of the brain that modulate pain reception. ‘What we placebo neuroscientists…have learned [is] that therapeutic rituals move a lot of molecules in the patients’ brain, and these molecules are the very same as those activated by the drugs we give in routine clinical practice,’ Benedetti wrote in an e-mail. ‘In other words, rituals and drugs use the very same biochemical pathways to influence the patient’s brain.’ ‘It’s those advances in hard science, he added, that have given placebo research a legitimacy it never enjoyed before.’”14
The Placebo Effect is finally a respected field of study in medical science.
A placebo is anything that seems to be a “real” medical treatment — but isn’t. It could be a pill, a shot, or some other type of “fake” treatment. What all placebos have in common is that they do not contain an active substance meant to affect health. Researchers use placebos during studies to help them understand what effect a new drug or some other treatment might have on a particular condition. For instance, some people in a study might be given a new drug to lower cholesterol. Others would get a placebo. None of the people in the study will know if they got the real treatment or the placebo. Researchers then compare the effects of the drug and the placebo on the people in the study. That way, they can determine the effectiveness of the new drug and check for side effects.
Gary Greenberg. What If the Placebo Effect Isn’t a Trick?
4. https://www.healyourlife.com/why-does-mainstream-medicine-ignore-the-placebo-effect “Drug companies are studying patients who respond to sugar pills with the goal of eliminating them from early clinical trials. It inevitably disturbs pharmaceutical manufacturers that in most of their clinical trials the placebos, the “fake” drugs, prove to be as effective as their engineered chemical cocktails. It is clear that effectiveness of placebo pills is a threat to the pharmaceutical industry.” Dr. Bruce Lipton, author of The Biology of Belief.
5. ghsm.hms.harvard.edu/person/faculty/ted-kaptchuk Ted J. Kaptchuk is a professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, Massachusetts. He is also a professor of Global Health and Social Medicine.
7. www.health.harvard.edu/mental-health/the-power… “The placebo effect is more than positive thinking — believing a treatment or procedure will work. It’s about creating a stronger connection between the brain and body and how they work together,” says Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center, whose research focuses on the placebo effect.
“As Ted Kaptchuk at Harvard, who is regarded as one of the world’s leading experts on placebo, put it to me in a recent interview, the study of the placebo effect is about ‘finding out what is it that’s usually not paid attention to in medicine — the intangible that we often forget when we rely on good drugs and procedures. The placebo effect is a surrogate marker for everything that surrounds a pill. And that includes rituals, symbols, doctor-patient encounters.’” Brian Resnick
Cara Feinberg. January February 2013
Cara Feinberg. The Placebo Phenomenon, January February 2013
14. www.nytimes.com/2018/11/07/magazine/placebo…Gary Greenberg. “What If the Placebo Effect Isn’t a Trick?”