I am fascinated with the concept of the placebo effect. When I became aware of it as a kid, I was astonished, – it was a hair on fire moment for me. I could hardly believe that almost every adult knew about this; that what you believe could affect your body, – physically. I was equally amazed to discover that adults never seemed to act on that belief. I wondered why because this linkage between belief and physical response spoke of something deeper about us. I wanted to know more and I held that thought for many years.

In an attempt to more fully understand the placebo effect, I turned first to the dictionary to see how others defined it. The word ‘placebo’ is derived from the Latin ‘placere’ meaning ‘to please’. In contemporary use it is defined as:

“a substance having no pharmacological effect but given to placate a patient who supposes it to be medicine.” [Random House Webster]

In clinical trials of prospective new drugs, placeboes are administered to patients as controls so that the efficacy of a drug can be assessed beyond that of the placebo. This routine consideration is taken because some patients that receive placeboes have improved during the trials and it is necessary to separate the effects of the placebo from those of the drug under evaluation. The phenomenon that results in patient improvement without the drug is termed the ‘placebo effect’ which itself is defined as:

“a beneficial effect produced by a placebo drug or treatment due to the patient’s belief in that treatment.” [Oxford]

To me, the key points in the above definition are “beneficial effect” and “a patient’s belief”. In other words, a patient’s belief has a positive effect on their medical condition. This effect is so well known and established that we take it for granted and yet it seems to be discounted as a component of a response to our medical challenges. Medical research justifiably focusses on the most effective drug or procedure for a given medical condition. However, if benefit can be obtained by belief, even false belief such as with placeboes, we should not look past this phenomenon. It is worthy of a deeper dive to understand how and why this is.

The search to know more about the placebo effect has identified at least three categories of factors that contribute to its expression and intensity in trials:

  • Study involvement – the participation in a study, typically in a structured setting,
  • Engagement in a ritual of treatment such as taking a daily pill or submitting to routine testing and
  • Supportive relationships between the patient and caregiver.

There is some evidence to suggest that the influence of these factors is cumulative with a stronger response when all factors are experienced by the patient. Other studies have also noted a significant placebo effect even when the patient was aware that he/she was taking a placebo.

All of the above appear to me to be external factors, i.e., external stimuli, whether intended or not, which influence a patient’s belief. But it is more than just belief. A belief that gravity exists would not likely trigger a placebo response. However, a belief in healing or pain relief of some dimension seems to do the trick. In other words, the patient wants to be healed and has an expectation of healing. In medical trials, a placebo patient often arrives at this belief by trickery when they are given, for example, a sugar pill instead of medication. From a clinical perspective, this is expected to trigger all of the same psychological factors as those who are actually receiving the drug. Analysts can then “see” the effects of the drug rising above those of the placebo when they compare results across all patients. That interest is focused on the biological response with the mental or belief factors taken out of the equation. My interest lies in the part that is taken out of the equation; a patient’s expectation when it results in significant medical improvement without drugs and often induced by trickery,- in short, the placebo effect.  I am also interested in knowing how this process would work if one would substitute intent for trickery – that is to say, if a patient in similar settings focused their intent on healing rather than being tricked. I have many questions. Here are a few.

  • Has the placebo effect been documented across a wide range of diseases and conditions?
  • Are placebo effects limited to symptomatic relief or do they also have beneficial impacts on the underlying condition?
  • How prevalent is the expression of placebo effects in a wide cross section of patients?
  • Are there observed/measured factors that influence the expression, rate, or significance of the effects?
  • Can informed intentioned be substituted for subterfuge in establishing a belief that results in an equivalent outcome?
  • Is the placebo effect malleable and scalable?
  • Is the placebo effect transferrable – can it be shared or taught?
  • What are the internal factors that influence a patient’s response (i.e., their nature of belief, religious or non-religious beliefs, outcome expectations)?
  • How are the mechanisms of the placebo effect similar or dissimilar to prayer?

The fact that the placebo effect exists at all is astounding to me because of the big picture potential it presents. What we think can affect our health. What potential is there for this to be studied, understood, and applied to give each of us more control of our health and general well-being.?

Kevin Deeny