What is a placebo and the placebo effect in simple words, examples and how it works

Posted on Sep 23, 2022      56

What is a placebo and does it always have therapeutic properties on the human body? Where do they apply, and what is the principle of this miracle cure?

Who is more susceptible to the placebo effect, and, of course, interesting cases and facts. All this you can see in this article. Let’s start with the concept.

What is a placebo?

A placebo is a substance with no obvious therapeutic properties, but used in medicine. A placebo is an imitation of a medical intervention.

The term placebo first appeared in the 14th century. It was the name given to people who were hired to weep for the deceased at a funeral.

Placebos can come in several dosage forms:

  • tablets;
  • powders;
  • solutions.

A placebo is a neutral drug that is unlikely to do any harm, but it will not do any good either, so it is often referred to as a placebo. To make tablets and powders, lactose, chalk, starch, sugar and other substances that have no pharmacological effect are usually used. Distilled water may be used as a solution.

However, the composition of the placebo taken does not matter, the main thing is that it is safe for the patient. The panacea is the patient’s self-humor and belief that the pill, powder, or solution will help. This phenomenon is called the placebo effect, and the following paragraph will be devoted to it.

After the assassination attempt at Ford’s Theater, the doctor applied a powder from a crushed mummy to the wound of Abraham Lincoln. Unfortunately, the placebo effect did not work here, and the 16th President of the United States died the next morning.

The placebo effect is widely known. Pacifier drugs help a patient recover, but they can also have just the opposite effect.

The placebo effect has an antipode, the nocebo effect. Unlike the placebo effect, it has a negative effect on the body; a healthy person can get sick because of his or her hypersensitivity. The nocebo effect will be discussed in the next article (here it is).

How are the two effects different? The placebo effect cures, but the nocebo effect cripples. Here is the major difference.

What is the placebo effect in simple words: the principle of action

The term placebo effect was first introduced by the American military doctor Henry Beecher, who published an article in 1995 entitled “The Powerful Placebo”. He discovered it during World War II in 1944. There was no morphine on hand at the right time. Henry Beecher went to the extreme - instead of painkillers, he injected a saline solution into a soldier’s thigh. And to his surprise, the soldier got better.

The placebo effect is a subjective feeling of relief after taking pacifier drugs, or after procedures that are unlikely to significantly affect the patient’s body. What procedures, you ask? It can be anything that will make the patient believe the therapy is effective, from talking to the doctor to reciting a spell.

In simple terms, the placebo effect is a situation where a person feels better if they believe they are actually being treated.

How does it work? The placebo effect is built on suggestion and self-infusion. Under its influence, several neurophysiological mechanisms are activated, which causes an improvement in the patient’s well-being. These same mechanisms (endocannabinoid, endorphin, dopaminergic systems) are activated during laughter or sex.

A placebo rarely cures a disease, but it can improve a patient’s condition or remove symptoms.

Why Placebos Work: Causes

  1. The expectation of improvement, the psychological placebo effect. Here, everything is simple. If a person expects to get an effect from the treatment, he gets it. The doctor can be too convincing, supporting everything with a bunch of procedures. You will believe in the treatment's efficacy. But placebos may not always help. Aim indicators, such as blood sugar, will remain at the same level. The person may feel some relief, but only at the expense of belief.
  2. Conditioned reflex. In Pavlov’s dogs, salivation is triggered by a call, even if there is no food. For a placebo, such a call is pills, a doctor, a white coat, injections, etc. A person over life becomes accustomed to feeling better after taking a pill, powder, injecting an injection. A placebo, because of a reflex, causes the same sensation. Types of placebos can affect a person in different ways.
  3. Natural recovery. The body can cope with the disease itself, which can coincide with the period of taking real medication or placebos, which can cause patients and doctors to be deluded.

What kind of placebo works best and what affects it?

The placebo effect depends on the form of release. Injection is the most effective form. Next comes the capsule and the regular pill finishes the top three. But what about size? You are unlikely to be surprised, but a large placebo pill has a greater effect than a small one.  With the dosage also everything is logical. If a person takes two placebo pills, the effect will be stronger than that of a person who was given one pill.
Two placebo tablets taken at once are more effective than one twice a day. Even the color makes a difference. Blue placebos will have a stronger effect as a sedative, and yellow placebos work better as an antidepressant. Let’s not forget the brand and cost. An expensive and well-known drug will put you on your feet faster than a cheap and unknown counterpart.

What placebos are used for: examples

It would be strange if people did not use the healing bonus of the body in their lives. So where is the placebo effect used and when is it appropriate?

In pharmacotherapy

Treating a person with a placebo in medicine is unethical. After all, to prescribe a patient any medication that has nothing to do with medication in the usual sense is cheating.

According to the recommendations of international and national organizations, doctors should not use a placebo as part of therapy. Especially to treat serious diseases, such as autoimmune diseases, infectious diseases, and cancer.

Oxford and Southampton University conducted a joint study in which they found that 97% of British doctors had given patients a placebo at least once in their medical practice.

Despite the lack of indications that a placebo is necessary, doctors sometimes prescribe a pacifier drug to a certain range of patients. For example, to see if medication is needed or if psychotherapy will be enough.

This technique is especially relevant for suggestible people, hypochondriacs (people who worry excessively about their health) or people with anxiety disorders.

In this way, it is possible to avoid the use of various medicines. By the way, homeopathy is based on the same placebo effect.

In the U.S., they produce an interesting pill called Obecalp (just read the name backwards to understand how the medicine works). The pills comprise sugar and are given to children to “cure laziness”.

The placebo effect works best for psychosomatic illnesses. It activates neurological and mental mechanisms, increasing the activity of the prefrontal cortex, the adjoining nucleus and the “pleasure center”.

The work of these areas contributes to the production of substances that reduce anxiety and fear, as well as having a relaxing effect. A positive emotional state can help a person recover, but it does not guarantee it.

Placebos are also used for pain relief when the right drug is not available. Also, a placebo can be used out of ignorance, for example, if the doctor thinks the drug is effective, but in fact it doesn’t work.

In addiction medicine

The placebo effect is also used in drug treatment.

The credibility and confidence of the doctor, backed up by pills, ampoules, and various procedures, helps a person believe the treatment is effective. Ignorance and uneducation also play an important role in the treatment of addiction.

At the end of therapy, the patient is convinced that if he or she abuses alcohol or drugs again, he or she will die.

In order to convince the patient of the efficacy of treatment and to instill fear in the patient, the doctor uses a variety of methods in therapy.

Besides pills, vials, and hypnosis, a contract may be used in which the patient handles any potential breakdown. Imitation surgery is also often used to mislead the patient.

During the procedure, the doctor may use a method based on provocation. A solution of nicotinic acid or magnesium sulfate is injected intravenously, and these cause fever and choking. Then the patient drinks alcohol, he thinks that the fever and choking are caused by alcohol. What do we end up with? The fear of death increases.

In clinical trials

Why else would a placebo be needed? It is most often used in clinical trials as a control drug to test the effectiveness of new drugs. The new drugs that pharmaceutical companies create must work better than a placebo. How do trials work?

Test subjects are divided into two groups: the first group is given the experimental drug and the other group receives a placebo. The health status of the first group must not only improve, it must be significantly better than that of the second group for the drug to be therapeutic. If the drug is worse or not much better than the placebo, it is sent back for revision.

A clinical trial is called a “blind placebo-controlled trial” if only the treating physician knows who gets what.

But the most reliable is the "double-blind placebo-controlled study". Neither the staff nor the subjects know who is receiving the placebo and who is receiving the drug. It is considered the most reliable because the doctor will be more persuasive, plus the doctor can’t accidentally reveal the secret to the patient with facial expressions or gestures.

These studies can also be randomized, so patients are randomly selected into groups.

Recently, there have been more and more suggestions that placebo-controlled trials involve three groups. The first two would get a placebo and an experimental drug, and the third would get nothing. What would this be for? To separate the placebo effect from the actual effect (self-healing of the body) and other unaccounted for factors.

The placebo effect can show up in sports and creativity: examples

What else are placebos used for? Every year, more and more new studies emerge that show that the placebo effect can affect different areas. For example, it improves cognitive and creative abilities and increases endurance.

Incredible stamina

Sometimes you don’t even have to take anything. All you have to do is convince a person of their unique abilities. Researchers at Stanford have proven this. As usual, the subjects were divided into two groups, and the gene responsible for endurance, CREB1, was examined in each group.

Participants in the experiment were not told of the results, then the groups were mixed among themselves. One group was told they were endowed by nature with unique endurance, the other group was told the sport was not for them. All the subjects were put on treadmills. What came out of this?

And the result was this: those reported to have incredible endurance ran more and faster (compared to the results before the experiment), regardless of actual genetics.

Creativity and smell

Another example of the placebo effect. Researchers used a placebo as a smell to experiment with creativity. The beginning of the study did not change: the participants were divided into two groups. Only this time, both groups were exposed to the same smell.

The first group was told that the smell they inhaled increased creativity; the second group was told nothing. The people in the first group performed better on the tests than the previous results.

Does the placebo effect show up in animals?

Do you think the placebo effect only works on humans? Then you’re wrong, animals are subject to it too, at least dogs.

A study was conducted involving dogs with epilepsy. They were divided into two groups, as well as people: the control group received the drug, the experimental group was given a placebo.

Scientists found that 79% of the dogs in the experimental group showed improvement. Scientists have three theories to explain why the placebo worked.

  1. Expectations of the owners. The owners’ confidence that the treatment will have a positive effect is passed on to their pets.
  2. Animal Expectations. This is all based on a conditioned reflex. If the animal has had to take any medication before, it knows that its condition will improve afterwards.
  3. Epilepsy manifests itself in cycles. The dogs in the experimental group are at the peak of the disease, so it is likely that the disease briefly recedes on its own, and the symptoms diminish.

Who is more susceptible to the placebo effect?

It all depends either on certain personality traits or on genetics. Let’s start with genetics.

  • Several studies have been done on people with certain illnesses. For example, among people suffering from sociophobia, those with a certain form of the 5-HTTLPR gene are most sensitive to the placebo effect. This was confirmed by researchers from Harvard, who found that the strength of the placebo depends on the form of the gene encoding an enzyme that is involved in the breakdown of dopamine.
  • Several studies claim that personality traits play a role as well. For example, placebo pain relievers are more influenced by optimists and in a stressful situation by pessimists.
  • Cultural factors that shape personality traits also have a certain influence, so people from different countries with different diseases are differently affected by the placebo effect. For example, ulcers from Germany are more sensitive to placebos than people with the same diagnosis from Brazil.

Finally, there are a few more people who are better affected by placebos than others. As already written, placebo effectiveness depends on suggestibility, so pacifiers have the greatest effect on:

  • insecure people with low self-esteem;
  • weak-minded people;
  • people with a weak psyche, including the elderly and children.

The placebo effect can work even if you know about it

It is logical to assume that in order to have an effective treatment; it is unnecessary to tell the patient that he will be treated with useless pills. Is this true?

There is logic in this, but it turns out that placebos work even if the patient is aware of the composition of the drug being taken.

This is proven by a study conducted within the walls of Harvard University. The participants in the experiment suffered from migraine. They were divided into three groups, one of which was given a migraine drug. The second group received nothing, and the third group received a placebo, only in this case the package had information about it.

At the end of the study, the scientists found the placebo reduced migraine pain just as effectively as the real drug.

Ted Kaptchuk, head of the placebo study program at Harvard Medical School, argues that the healing power is the process itself, unpacking the medicine, taking the pill.

Even if one knows that the person in front of him or her is a pacifier, on a subconscious level, the ritual of taking the medicine is associated with a healing effect.

The sight of the pill and taking it makes the brain think that the drug will help the body heal.

Interesting facts about the placebo effect

  • Placebos can cause side effects characteristic of the drug under the guise of which the pacifier is being served;
  • People taking placebo pills can be addictive. Even healthy people who have already stopped taking placebos may experience withdrawal syndrome: the patient’s condition worsens;
  • about 50% of doctors prescribe drugs to their patients that will not do any good, counting on the placebo effect;
  • the placebo effect can be recorded by positron emission tomography of the brain;
  • children are more susceptible to medications that have no therapeutic properties;
  • the mechanism of placebo action is not fully understood.

Instead of a conclusion

The placebo is a medicine cabinet that is always with us and freely available. It does not always work yet, but scientists have not yet fully studied this phenomenon.

Who knows, perhaps in the future scientists will understand the mechanism of the placebo and create effective drugs that work through the body’s inner potential.

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