By: Kathy Gruver, PhD
Award-winning author, speaker and educator
We hear so much about the placebo effect, but usually in the context of pharmaceuticals and the famed ‘double-blind, placebo-controlled study’. Or crediting it with curing someone that was faking or is emotionally susceptible. However, according to some cutting edge research and doctors searching for answers, the placebo just may be a big part of the future our healthcare.
In the past, placebos (from the Latin “I shall please”) may have been given to please or placate patients, to distinguish “real” ailments from those that were “imagined” or “psychosomatic” or even worse, to distinguish “genuine” patients from “malingerers.” It was thought if a patient responded to the placebo, then they were clearly making up their illness. After all, the placebo doesn’t do anything. Or so they thought.
The placebo effect had never been given so much attention until Beecher’s paper The Powerful Placebo was published in 1955, stating that the placebo was effective in 35% of patients. Since then medical professionals and laypeople alike have been debating the importance of this phenomenon. Though Beecher’s study has been criticized the past 15 years as statistically incorrect and containing much research bias, there is no argument that his groundbreaking paper has at least made scientists question this phenomenon. Meanwhile, researchers have moved so far forward as to image the brain to see what sections are activated by the placebo and have proven that it is not only all in one’s head, but in the brain as well. Studies have also shown that placebo treatments are effective for specific ailments like pain, depression, skin conditions and asthma. There is no doubt as humankind moves into the future of the placebo that more evidence will surface regarding its multitude of benefits.
As I mentioned earlier, Beecher introduced a study called The Powerful Placebo and we cannot escape the fact that the placebo is real and it works for many people. The placebo effect is difficult to prove. We see that we can program our physiology with our words as a means of changing expectations and outcomes. We can also illustrate the placebo effect with fake drugs and procedures. The question is how, when, why and on whom will it work? These are questions yet to be definitively answered, but I say, if it might work…let’s use it!
There is no doubt to the strength and power of our thoughts. We’ve all worked ourselves up into a fit from stress and anticipation of an event that we dread or something that we’re not even sure is going to happen. Giving asthmatics a blanket with cat dander on it and encouraging them to breathe deeply can trigger an asthma attack, even if the blanket is brand new and was never near Fluffy.
Patients scheduled for meniscus surgery were prepped, anesthetized and cut open. They were then stitched up and shown pictures of the surgery. Their pain went away. But their meniscus wasn’t really repaired; they were just told it was and they got better. Parkinson’s patients who have a brain stimulator installed to help with systems will see an increase in symptoms if they are told it’s going to be turned off for a brief amount of time, even if it’s not adjusted at all. We have incredible power in our thoughts, to control our bodies. And since our brain can’t recognize the difference between what we’re thinking and fantasizing about and what is really happening, it makes sense that the placebo effect could be an effective healing tool.
One of the big questions is how do we test the placebo in an ethical way? Sham knee surgery certainly did seem to be effective, but we can’t go around tricking people into having surgeries. Dr. Benedetti, a researcher out of the University of Turin in Italy has done numerous studies on the placebo by using open vs. hidden treatment and has written books about the research. In this method, the placebo and/or real medication is either given directly to the patient and told it is a drug, or completely hidden from view so that the patient doesn’t know that anything is happening. The results have been startling. Using hidden vs. open treatments seems to be the future of research to show just what power the placebo has for healing.
There are so many phenomenal studies on the placebo effect, but I included this one because Dr. Benedetti is doing some amazing research and has written an entire book on the placebo effect. This is my summary of just one of his studies. Enjoy.
What is the placebo effect and what is the best way to test for it, questions Benedetti in his recent study of placebo analgesia. There are so many mechanisms underlying the placebo response; expectation, conditioning, regression to the mean or a patient trying to please the physician. He proposes that the best way to measure placebo is to have a complete non-treatment group. But how? The key is open vs. hidden treatment. This takes away the anticipation, expectation, and verbal cues. His research shows that proven pain medication like morphine and tramadol are significantly less effective when given through hidden injection than open ones when the patient expects the pain to decrease. This strongly illustrates the link between the patients’ perspective and is a new method of illustrating the placebo effect.
When the patient is unaware that a treatment is being administered, the treatment is less effective. If the drug is really effective, symptom reduction should occur with distribution of the medication, whether hidden or open. The following example clearly illustrates this point.
A doctor gave a patient a powerful pain medication and told them their pain would subside in moments. In contrast, another patient was given a dose of powerful pain medication from a hidden machine. They found that the dose needed to reduce pain by 50% was much higher with the hidden dosing than with the open dose. During the first hour post-surgery, pain ratings were much higher with hidden dosing than with open dosing. Similarly, patients had a faster relapse when they were told a medication was being stopped as opposed to it being concluded without their knowledge. They conclude that the awareness of the treatment, presence of the therapist and expectation of outcome are clinically relevant. Secondly, when the treatment must be interrupted, it is more beneficial for the patient not to know. The researchers believe that more investigation involving open vs. hidden treatment will improve the understanding of the placebo and how it can be used effectively in treatment.
Until all the information is available, stay positive, be in control of your thoughts and be well!
 Crow, J. (2006). The placebo response. Practice Nurse, 31(12), 27-30.
 Beecher, H. (1955). The Powerful Placebo. Journal of American Medical Association. 159(17):1602-6.
 Kienle, G., Kiene, H. (1997). The powerful placebo: Fact or fiction? Journal of Clinical Epidemiology, 50(12), 1311-1318. (As cited by Nimmo, 2005).
 Benedetti, F. (2006). Placebo Analgesia. Neurological Science, 27, S100-S102.
 Colloca, L., Lopiano, L., Lanotte, M., Benedetti, F. (2004). Overt versus covert treatment for pain, anxiety and Parkinson’s disease. The Lancet Neurology, 3(11), 679-684.