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The Placebo Effect

The Pill That Doesn’t Do Anything

           A “placebo” is generally thought of as a pill or other medical intervention that has no known curative effects.  Exactly how it works remains a mystery.  But over 50 years of research has shown that placebos can reduce or eliminate symptoms of:
                                                                        Crohn’s Disease
                                                                                Eating Disorders
                                                                                                Parkinson’s Disease
                                                                                                         Inflammatory Disorders
                                                                                                                  and even cancer

. . . just to name a few.

          We know that placebos work, in part, subconsciously, because they are effective even in animals.  

          However, in humans, researchers believe that a large part of the placebo effect is due to our conscious expectations. If a doctor you respect examines you, then confidently proclaims, “You’re in excellent health. It’s just a passing thing – your pain will be gone in a few days,” you’d probably walk away smiling.  

          Whether he (or she) realized it or not, your doctor was making use of two powerful aspects of the placebo effect – the power of suggestion and the power of belief.  S/he planted the suggestion that you’d feel better soon, and strengthened your belief in your body’s health and ability to heal.  As we’ll see, it’s possible to consciously harness these powers of suggestion and belief  to bring about some rather dramatic changes in your health and overall well-being.

If It Goes Away, It Couldn’t Have Been Real

          Many people think that because the placebo effect is a function of the mind, it’s a ‘fake’ treatment. Sp say someone had been given a pill and then their pain went away.  If afterwards they were informed that the pill had “only” been a placebo, they might wonder whether the pain had ever been real, or whether it had just been “just in their head.”

          But researchers who study the placebo effect know that the effects of the placebo are quite real.  If a cancer patient got relief from severe pain after using a placebo, you might be tempted to think the pain had just been “in her head.”  Since there’s no objective way to measure pain, it would be hard to disprove that idea.  But it turns out the patient also showed measurable changes in her blood pressure, heart rate, respiration, and pupil size, along with other physical changes.

          In experiment after experiment, the placebo effect has been shown to bring about real physical changes of many kinds.  Here are just a few examples:

  • Asthmatics who inhaled a fake bronchodilator experienced dilation of their airways as if it had been a real one.

  • Doctors painted some patients’ warts with a brightly colored dye, explaining that the warts would be gone when the color wore off.  In spite of the fact that colored dye has no curative effect on warts, it worked.

  • Colitis is a very painful condition in which the large intestine is severely inflamed and the person experiences intense nausea.  When colitis patients were treated with a placebo, 52% of them reported feeling better.  And in 50% of those treated with placebo, sigmoidoscope assessment of their large intestine showed a decrease of inflammation.

          These are all changes in the direction of greater healing.  But the power of belief and expectation to physically change our body works in both directions.  For example, subjects who were exposed to fake poison ivy, believing it to be real, developed real rashes.

The Placebo Effect Gets Stronger
Thanks to the Pharmaceutical Companies!

          In 1999, Peptide Therapeutics, a British bio-tech company, produced a new allergy vaccine. Initial trials were conducted on patients suffering from food allergies.  The company was delighted to announce that after receiving the vaccine, 75 percent of subjects were able to eat foods they had not been able to tolerate previously.  However, the company’s mood changed (and the price of their stock dropped considerably) after the data on the placebo group came in.  Can you guess what percentage of subjects in the placebo group improved? Also 75 percent!

          In another instance of disappointed pharmaceutical researchers, Genentech was excited to introduce its new, genetically-engineered heart drug, VEGF.  Studies were conducted to measure improvements in the length of time patients would be able to walk on a treadmill after taking different dosages of the medication.  Results showed that patients who received low doses of VEGF were able to walk 26 seconds longer, and patients with high doses were able to walk 32 seconds longer.  But patients who received a placebo were able to walk 42 seconds longer on the treadmill.

          In a study of anti-depressants, the famous drug Zoloft actually did worse than the placebo in relieving depression.

          It looks like the placebo effect may actually be getting stronger over time.  Ironically, this may be due, in large part, to the massive advertising efforts of pharmaceutical companies that have succeeded in convincing people of the power of medications to cure their ills. Since belief and expectation play such a large role in the effectiveness of placebos, the more we believe in the power of pills, and the more we expect them to work, the more powerful a placebo pill will be.

         However, not all placebo pills are created equal. Researchers have found that the effectiveness of a placebo pill has a lot to do with its shape and color – which means that, whether we realize it or not, when it comes to pills, we have more faith in some shapes and colors than others.  The least effective placebo is your ordinary round white tablet.  Similar white pills, but with angled edges, have a stronger placebo effect. The effect is even more powerful with a colored tablet and more powerful still with capsules of colored beads. Injections top them all.

         One of the more creative uses of placebo we’ve heard is placebo expert Patrick Wall’s example of “a doctor who handled the placebo tablets with forceps, assuring the patient that they were too powerful to be touched by hand.”

Epitaph on a Hypochondriac’s Tombstone: “See, I Told You I Was Sick!”

          So if the power behind the placebo is our beliefs and expectations, why bother with fake pills, injections or painted dyes?  Why not try a dose of belief and expectation straight up?

          Dr. Ellen Langer, a social psychologist at Harvard, has done just that.  It was apparent to her that when placebos work, it’s actually we ourselves who are responsible for the improvement in our health.  So she set out to see whether we could learn to exercise our healing power more directly.  She reasoned, if we could, it would help to establish that we do, in fact, have this power within us. 

           Langer conducted a number of intriguing experiments to test her theory. 

          In one experiment, she divided 84 female hotel workers into two groups.

          Before the experiment started, she interviewed the participants and all of them said that they never “exercised” – even though they spent the better part of their day cleaning rooms and pushing carts.  

          For the sake of the experiment, Langer told the women in one group to think of their work as a form of exercise.  They were told not to change any of their previous eating or exercise habits, but to simply think of what they were doing while they worked as exercise. The other group was asked to continue performing their job duties as before.

          After one month, the group that had thought of their work as exercise showed rather surprising changes:

  •     They lost an average of two pounds
  •     Their blood pressure dropped 10 points
  •     Their waist-to-hip ratios decreased

          The other group showed no significant changes, but, according to Langer, “actually gained body fat.”  

          So just by adopting what Langer refers to as a “beneficial mindset,” the first group had made significant positive changes in their health.

          In another simple experiment, Langer tested people’s vision using a standard eye chart.  Simply by turning the chart upside down so that the large “E” was on the bottom instead of the top, people were able to read letters they couldn’t read before. Langer’s interpretation? The standard eye chart – in making the letters progressively smaller – is in effect communicating, ‘Soon, you’re not going to be able to see.’  Without that negative suggestion, people were able to see more.

         In one of her most well-known experiments, Langer set out to show that the negative mindset of our culture with regard to aging has an impact on the physical changes we experience as we age. (This experiment has gotten such widespread attention that it’s being made into a movie called Counterclockwise.)  

          Here’s the experiment:

   In 1979, Langer arranged for 16 men in their 70s and 80s to spend a week at a monastery in New Hampshire. The monastery had been equipped with mementos from the 1950’s.  The men spent their time reading old copies of Life Magazine and the Saturday Evening Post, watching 1959 movies on a black-and-white TV, and listening to Rosemary Clooney and Nat King Cole on the radio.

           The men were divided into two groups.  The first group was instructed to behave as it if really were 1959. They spoke in the present tense about important sports and news events of the day, and wrote brief autobiographies that stopped in that year.  The second group, which arrived at the monastery a week later, was just encouraged to reminisce about the past, without pretending it was actually 1959.  

          The results were striking in both groups.  All 16 men showed improvements in hearing, memory, height, weight, gait and posture. And the group that pretended they were really back in the 50’s showed even more improvements.  Their joints were more flexible, their arthritis diminished, and they showed greater manual dexterity. On intelligence tests, 63 percent of this group improved their scores, compared to only 44 percent of the second group.

          Langer had taken photos of the men before and after their week at the monastery and showed them to people who didn’t know anything about the experiment.  In comparing the two sets of photos, these objective observers judged that all the participants looked younger in the second set of photos.

          Langer concluded that our rigid mindset about what happens to us when we age might be far more responsible for our declining mental and physical health than we think.  Looking back on the experiment many years later, she writes in her book, Counter Clockwise:    

This study shaped not only my view of aging, but also my view of limits in a more general way for the next few decades. Over time I have come to believe less and less that biology is destiny. It is not primarily our physical selves that limit us but rather our mindset about our physical limits.