Placebo: Is it JUST a Sugar Pill?
We’ve all heard of the placebo effect. But what exactly is it and why is it an important concept to understand so we can best take care of our health?
Most drugs are approved by carrying out a placebo-controlled study. This means that one group of subjects are given the actual intervention (i.e. drug, lifestyle change, diet) and the other group (placebo group) are given an intervention that should not have any effect. What researchers are looking for is a statistically significant difference between these two groups.
of model can be influenced by either the subjects or the researchers knowing which group is actually getting the intervention and which one isn’t. As a result, most studies are double-blind. This means that both the subjects and researchers have no idea who’s taking what until the end of the study. What’s interesting though is that nearly all double-blind studies show some benefit for the placebo group.
There was a groundbreaking study published in 1955 (summarizing the results of 26 studies) by a researcher by the name of H. K. Beecher entitled “The Powerful Placebo”, which concluded that an average of 32 percent of patients responded to a placebo. [1. H .K. "The Powerful Placebo," JAMA 159(1955): 1602-1606] This means that if I gave 100 people a sugar pill and told them it was an antidepressant, about 32 of them would feel happier.
Do Antidepressants Work? In a very detailed analysis published in the British Medical Journal, “Efficacy of Antidepressants in Adults,” two experts concluded “that selective serotonin reuptake inhibitors [i.e. Prozac, Celexa] do not have a clinically meaningful advantage over placebo” and “have not been convincingly shown to affect the long term outcome of depression or suicide rates.” – BMJ 331 (2005):155-157.
Many clinician’s are aware of this effect, and some suggest that the response to certain conditions might be as high as 80 to 90 percent.
Conditions That Have Been Associated with a High Response to a Placebo
- Anxiety and depression
- Claudication, intermittent
- Common cold
- Cough, chronic
- Diabetes, type 2
- Gastric ulcers
- Hay fever
- Menstrual cramps
Factors That Influence Placebo Response
Harvard psychologist Herbert Benson has noted three main factors that that improve the placebo response.
- The belief and expectation of the patient.
- The belief and expectation of the practitioner.
- The interaction between the practitioner and the patient.
Benson believed that this effect yielded beneficial results 60 to 90 percent of the time.
How Can You Benefit From the Placebo Response?
In order to benefit from the placebo effect, the effect has to be activated by a prescribing practitioner that you wholeheartedly trust. It is then important for practitioners to explain the why of their recommendations. If a patient knows why they are following a recommendation, the result are most lively to be positive. This is why education is an important part of my consultations. I never make any recommendation without thoroughly explain the why.