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The Placebo Effect - Real or Imagined?

  • Writer: Patricia Faust
    Patricia Faust
  • Jul 23, 2020
  • 3 min read


We are hearing about clinical drug trials to evaluate a possible vaccine for COVID-19. A treatment group is compared to a control group. The treatment group receives the drug compound being investigated. The control group receives a placebo. None of the people in the study will know if they got the real treatment or a placebo.

Why do they run a study this way? Researchers compare the effects of the drug and the placebo on the people in the study. That way, they can determine the effectiveness of the drug and monitor side-effects.

The Placebo Effect

Placebo controlled studies are the cornerstone of medical research. No study testing a new drug or procedure is approved without evidence that it performs better than the control group. Even when the control group showed improvement, researchers did not know the mechanism of how it worked. So, placebo was relegated as evidence of coincidence. They became an annoyance when the control group made improvements. If the study group and the control group came out with comparable results the study was stopped. At that point the decision was to study placebos.

A placebo can be anything that seems to be a real medical treatment but isn’t. (e.g. pill, injection, cream, surgery, or other treatment). What all placebos have in common is they contain no active ingredients that can affect your health, but after taking them you feel better. The active ingredients of placebo are:

· The therapeutic ritual

· Social and emotional context

· The clinician/patient relationship

Placebo studies have found that when clinicians deliver treatment in a warm, supportive manner, they can influence treatment outcomes. (Dr. Sarah McKay, Neuroscience Institute)

There are certain conditions that respond positively to placebos:

· Depression

· Pain

· Sleep disorders

· Irritable bowel syndrome

· Menopause

The Power of the Placebo Effect

Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Hospital Medical Center, stated that “Placebos may make you feel better, but they will not cure you. They have shown to be most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea.” The action of placebos is still not understood but it involves a complex neurobiological reaction that includes everything from increases in feel-good neurotransmitters, like endorphins and dopamine, to greater activity in certain areas of the brain linked to moods, emotional reactions, and self-awareness. “The placebo effect is a way for your brain to tell the body what it needs to feel better,” says Kaptchuk.

Placebo Effects Arise from Expectations

That is a prevailing idea that placebo effect is the result of positive thinking. Contrary to this belief, patients do not just imagine placebo responses. Numerous brain-imaging studies have confirmed that placebos cause measurable changes in neurobiological signaling pathways. When you expect a pill to have therapeutic value, this expectation activates reward pathways in the brain, in turn stimulating the release of substances called endorphins, which are chemically similar to opiates like morphine. Like morphine, these endorphins bind to opioid receptors and cause pain relief. Therefore, in response to positive expectations of treatment, your brain becomes flooded with its own supply of natural pain killers.

Placebos can also increase the release and uptake of dopamine, a neurotransmitter involved in reward-motivated behavior and decreased pain sensitivity. In anticipation of benefit when a placebo is given, dopamine receptors are activated in the regions of the brain associated with reward.

The most startling placebo-related discovery is placebo is not just one mechanism. Instead, there are as many placebos as there are illnesses and treatments. They act in different ways, at different times, and even impact people differently depending on a number of factors, including genetics. Finally, as proof that placebo effect is a genuine biological phenomenon, genetics can influence the strength of the effect.

As a psychosocial contextual cue that elicits a biological response, placebos can be words, rituals, or any other input that creates expectation.

The very act of expectation changes your brain, but it doesn’t work alone. This is a complex action. Memory and motivation also impact placebo. Moderation of anxiety, activation of the brain’s reward centers and learned responses all play a role.

Placebo Effect Is Real

The placebo effect is real. Research is evolving into various ways that the Mind-Body connection can heal us. Honoring the ability of our mind-body connection to heal us is a profound shift in medicine. We are lucky to have this modality for safe healing.

References:

Harvard Health Publishing, Harvard Medical School. (August 19, 2019). The power of the placebo effect. Harvard Men’s Health Watch.

McKay, S. Placebos & the power to heal. The Neuroscience Academy

Pinch,B. (September 14, 2016). More than just a sugar pill: why the placebo effect is real. Retrieved from sitn.hms.harvard.edu/flash/2016/just-sugar-pill-placebo-effect-real/

WebMD. What is the placebo effect? Retrieved from https://www.webmd.com/pain-management/what-is-the-placebo-effect?

Wildermuth, E. (October 30, 2017). Placebo in the brain. Retrieved from https://sapienlabs.org/placebo-in-the-brain/

 
 
 

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   And suddenly it is May!! April turned out to be an extremely busy month and I was caught off-guard by the start of May. There are a lot of activities and celebrations that kick off May and start the Spring-Summer season. The 151st Running of the Kentucky Derby was May 3. It was a mudder this year. We had experienced consistent rain throughout April, and it hasn’t left the area. The horses in that race are incredibly beautiful even when they covered in mud! Sovereignty, a three-year-old colt was the winner!! In a move I applaud, the owner of this beautiful horse was asked if they were going to have him run in the Preakness, the second leg of the Triple Crown. This owner deferred his answer because he wanted to talk to his team, but most of all, he wanted to see how Sovereignty was doing. The Preakness is only a couple of weeks from the Kentucky Derby and the lure of winning the Triple Cown has resulted in some bad decisions about entering a horse that hadn’t recovered from the Derby. May 4, was the 27th Flying Pig Marathon. If you have been following me for a while, you would know that my husband Russ and I volunteered at the race, running a fluid station for the Leukemia and Lymphoma Society for 25 years. This race is amazing. Last year it was voted as one of the Best Marathons in the Country. I watched from the comfort of my dry home (still raining) and finally got to see what happens at the finish line. The stories of the runners were great! This race was the first time that the male winner had ever run a full marathon! The female winner had run many marathons, but this was the first time that she ran the Flying Pig! It sounded like she will be back next year because she said she was thinking while she was running that this was the most fun marathon, she had ever been in. (I can’t imagine even thinking while I was running a marathon!) Then there was an older woman who had just finished her 159th marathon! She was incredible! Next week she is on her way to New Zealand to run again! Everything these runners practice can be applied to maintaining a high-functioning brain. Of course, the lifestyle they practice is phenomenal for brain health. I teach about neuroplasticity and the power that we possess to change our brain. But to do that we must be dedicated to that change by repetitively and consistently challenging our brain. It is a marathon for brain health that we must live.

 

   May is Older Americans Month, and it is a time to recognize the contributions of older adults and highlight the positive impact they have on communities. The 2025 theme is “Flip the Script on Aging” encouraging individuals and communities to challenge negative stereotypes and celebrate the diverse experiences of aging. Celebrations often involve community events workshops, and activities designed to engage and connect older adults.

 

   I am booking online and in-person presentations for June. Topics are extensive. Contact me at patricia@myboomerbrain.com if you would like to discuss a presentation for an event or organization.Enjoy the renewal of May.

 

My very best, Pat

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