The Power of Placebos: Changing the Mind to Change the Body
If your doctor told you that your mind had the power to heal your body better than a surgery could, would you believe them? The placebo effect has been recognized in medicine and been presented to the general public for years. We have mounting evidence that it works, but still, we turn to pharmaceuticals and Western medicine for every ache, pain, and irritation. Here, we’ll explore what the placebo effect really is, examine the evidence surrounding its efficacy as a medical treatment, how it literally changes our minds, and discuss whose minds must be changed to facilitate a wider adoption of placebo treatments in medicine.
What is the Placebo Effect?
The placebo effect has been observed in medicine for years, and has shown an incredible impact on treatments for depression, irritable bowel syndrome, and even arthritis. Before we dive into the immense power of this mental phenomenon, let’s first define the placebo effect. The placebo effect, as defined by Irving Kirsch is what happens when “people obtain considerable benefits from medication, but they also can experience symptom improvement just by knowing they are being treated.”¹ This effect is one of many examples of the mystifying powers of our minds superseding the power of science and technology, and gives us good reason to consider alternative pathways to healing.
As I mentioned, placebo treatments have been used and proven effective across clinical conditions; it truly is a wonder-drug. The most in-depth and prominent investigations into the placebo effect revolve around selective serotonin reuptake inhibitor (SSRI) antidepressant medications. SSRIs function by blocking the reuptake channels that transport serotonin molecules after they are released across the synapse. By doing this, serotonin, which is believed to be linked to mood regulation, remains in the synapse for longer, and thus, has a stronger effect on mood.² However, when we take a critical eye to the clinical trial results that led to these drugs’ approval in the 1990s, we see that the effect, if any, really is not as significant as it seems compared to the placebo treatment. These effects persist for treating many conditions besides just depression. Patients given a placebo antipsychotic drug in a study done by Peter Tyrer of Imperial College London showed an 80% reduction in aggressive behaviors, while patients in the same study who received the actual drug only showed a 60% decrease in aggression.¹ Further, placebo surgeries for patients with osteoarthritis of the knee have been proven to be more effective than the actual surgery, with patients reporting significantly less pain two weeks and one year post-operation, and studies on a breadth of other illnesses and conditions continue to show results similar to these.¹
How Does it Work?
So, how, on a neuroscientific level, does all of this work? The short answer is: we really aren’t sure. The long answer has to do with complex connections between the nervous system, endocrine system, and immune system. These connections exist across different types of placebo treatments, but differ slightly in how they interact with placebo treatments based on the target condition.³ Neurologically, responses seem to connect with pain management networks in the brain including the medial thalamus, dorsolateral prefrontal cortex, dorsal anterior cingulate cortex, and ventromedial prefrontal cortex. EEG studies of placebo treatments for pain management have shown a decrease in pain response network activation and an increase in contextual interpretation networks during treatment. This means that when undergoing placebo treatment, the parts of our brain that respond to pain are less active, so we process less of the stimuli as “painful,” and the networks in our brains that interpret context such as “I’m taking a pill that will make my pain stop” are more active. This shift in activity likely leads our sensations to respond accordingly, and thus, produce the placebo effect when physical sensations are less “prioritized” in producing a physiological response and context becomes the most important factor. Over time, these patterns can be learned and replicated even more easily, which explains the sustained treatment effects of placebos. Once a patient believes once that their treatment was effective, it’s hard to neurologically “undo” that association, even if the association is just with a sugar pill.
One key external factor for successful placebo treatments is an optimistic and trusting relationship between the medical professional who prescribes the placebo treatment and the patient receiving it.¹ This makes sense, because we tend to consider the opinion of a medical professional as valuable, and if they believe a treatment will work, it provides us with even more context to reinforce our own belief that the treatment will work. Unfortunately, these trusting relationships are hard to come by within the American medical system as it currently exists. However, advancements in health technology present a promising opportunity to start to close this gap. With the increase in precision medicine and telehealth options for patients, seeing a provider more often is becoming more possible and accessible for many. A challenge still stands, however, with integrating placebo medicine into clinical practice. From the doctor’s perspective, how could they ethically bill someone for a “fake” treatment? From the patient’s perspective, why should they have to pay for a “fake” treatment? This is where the fundamental issue lies. Without a paradigm shift within medicine about what is considered an effective treatment, placebo medicine will remain no more than an interesting phenomenon.
What’s Next?
Placebos present a compelling case on paper for integration into medical treatment of a whole host of conditions, and their effects are supported by science showing how they change neural function as well as result in physical healing. However, without changing the minds of policymakers, healthcare providers, and patients, their effects will continue to be underutilized and insufficiently understood. So, after hearing all of this — do you think a sugar pill could be worth a try?
References
- Kirsch, I. (2010). The emperor’s new drugs: Exploding the antidepressant myth (Paperback first published in the United States in 2011). Basic Books.
- Selective Serotonin Reuptake Inhibitors (SSRIs). (n.d.). Mayo Clinic. Retrieved December 5, 2021, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- Wager, T. D., & Atlas, L. Y. (2015). The neuroscience of placebo effects: Connecting context, learning and health. Nature Reviews Neuroscience, 16(7), 403–418. https://doi.org/10.1038/nrn3976
This article was written by Emma Clark, who is a senior undergraduate student at UC Berkeley studying Cognitive Science and Data Science, and was edited by Oliver Krentzman and Luc LaMontagne, former Publications Leads of Neurotech@Berkeley.
This article was originally published in Neurotech@Berkeley’s Fall 2021 Edition of Mind Magazine: Change My Mind. To read more, visit neurotech.berkeley.edu/mind.html
