Scientists now understand that the mere expectation of a therapeutic benefit can activate a variety of chemicals in the human brain.
One unfortunate outcome of all this work is that profit-seeking companies and individuals now have a new weapon.
It is no longer necessary to demonstrate the effectiveness of their proposed therapies; it is enough to assert that these work because of the placebo effect.
For several decades now, many scientists, including me, have been working hard to reveal the full power and scope of the placebo effect – the amazing ability of a simple sugar pill or other non-pharmaceutical “fake intervention” to improve someone’s quality of life. This research has been crucial to giving scientific credibility to a powerful psychological effect. But the advances of science have also backfired, spawning an alternative industry that preys on the vulnerable.
The placebo effect describes how the mere belief and expectation of receiving a drug may produce a benefit, such as a reduction in pain. Albeit strange at first sight, the placebo effect is based on profound and fascinating mechanisms in the human brain, and highlights the power of attention given to a patient by a caregiver.
As a neuroscientist, I have been working on understanding these mechanisms for 30 years, alongside other researchers around the world who specialise in everything from biochemistry to physiology, genetics to brain imaging. What has emerged is an understanding of how the mere expectation of a therapeutic benefit can activate a variety of chemicals in the human brain, such as pain-relieving opioids and cannabinoids, as well as pleasure-enhancing dopamine. Placebos, a doctor’s words and drugs can all share some common mechanisms of action.
All this means that some alternative medicines can indeed have positive outcomes for patients, though not necessarily through the mechanisms that the therapy’s inventors supposed, but rather through a placebo effect. This holds true for treatments ranging from strange talismans to acupuncture – studies have shown that pain relief is about the same for patients receiving true acupuncture with needles, for example, as for those receiving sham acupuncture with trick needles.
The scientific advances in understanding placebo are fascinating. But one unfortunate outcome of all this work is that profit-seeking companies and individuals now have a new weapon: it is no longer necessary to demonstrate the effectiveness of their proposed therapies; it is enough to assert that these work because of the placebo effect.
I receive myriad eccentric proposals for new therapies, ranging from talismans and concoctions to mascots and weird rituals. Their inventors claim that these are capable of inducing substantial health benefits and often seek my endorsement. These proposals have stepped up sharply in recent years. Sadly, the science of the placebo effect is fueling this new breed of pseudoscience.
Placebos do not cure
As far as we know, placebos do not cure, but can sometimes improve quality of life. Research tells us that placebos can reduce symptoms like pain and muscle rigidity for sufferers of Parkinson’s disease, for example, but they don’t affect the progression of the disease – the degeneration of brain cells keeps advancing. There is plenty of confusion on this point and unfortunately many claim that they can cure virtually all illnesses with placebos.
Here are some things we do know. Placebos and opioids have been shown to influence the same pain-inhibiting systems in the brain, with powerful results. In sufferers of Parkinson’s disease, placebos have been found to be as effective as amphetamine in doubling dopamine concentrations. For those with anxiety and depression, placebos have been found to act on the same brain regions as selective serotonin reuptake inhibitor drugs (SSRIs).
People can also be trained to have a response to a placebo by pairing it, for a while, with a pharmaceutical intervention, a
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