Placebo Effect

Typical medicines (at least in the United States) usually consist of chemical drugs that have been designed to have particular effects on our bodies. This design usually begins with mathematical simulations and laboratory tests to determine the basic characteristics of the drugs. These tests are frequently followed by laboratory tests on animals, and if the drugs have desired effects in animal organisms, they are used in human tests. The human tests verify that the drugs have desired effects on human organisms. These tests also try to identify harmful side effects that occur in the humans being tested. The checks for side effects usually only test in the near-term of a few months up to a few years. Tests for side effects in the long-term are impracticable due to the relatively long times of a generation. New drugs must pass all of the tests proscribed for the drugs if they are to receive Federal approval for use in the United States.

There are remedies that are not tested in the long and expensive procedure reviewed in the previous paragraph. These remedies are the so-called alternative or holistic medicines that come from natural sources such as herbs. Herbs have been used for thousands of years to cure ailments, and many people accept herbs as proper sources of drugs. In fact, scientists take herbs that work and isolate the active ingredients of the herbs and then synthesize the active ingredients.

One class of remedies that come from herbs, as well as from other substances such as snake venom, are the homeopathic remedies. Homeopathic remedies come from natural sources, but there is one important difference between a homeopathic remedy and a holistic remedy. That difference is the dilution of the substance in homeopathic remedies. For example, consider Arnica, a remedy that comes from a flower and is used with bruises and other damage to ones body, especially to the muscles. A typical Arnica ointment that is used as a herbal remedy may be diluted to 1/10th of the original, while a homeopathic Arnica remedy may be diluted to 1/1,000,000th (or more) of the original substance.

People who accept homeopathic remedies believe that the human body reacts differently to very weak values of a chemical than it does to stronger values of the chemical. And, strange as it may seem, more dilution in a homeopathic remedy means that remedy is more potent. For example, common homeopathic remedies are diluted to 1/10**30th of the original substance rather than the 1/10**6 that was mentioned in the example given above of Arnica (to avoid the use of superscripts in web pages, I'm using the common notation of **X to specify powers of 10). It is this immense dilution that causes many, if not most, doctors and scientists to not consider homeopathic remedies as valid medicines. These persons believe that homeopathic remedies have been diluted so much that none of the original substance remains.

My wife and I use homeopathic remedies and have done so for almost 40 years. We accept homeopathy because it works for us. I won't explain in this post why we use homeopathic remedies, but I will discuss the conflict with my training as an electrical engineer that the use of those remedies has caused. Because of my training in physics, I believe the immense dilution of homeopathic remedies means that none of the original substance remains in the tablet. Yet, I believe that homeopathic remedies work. If homeopathic remedies work, it is not due to the effect of the original substance on our bodies, since typical remedies have none of the original substance. There must be something else involved with the remedies that causes them to work.

Many people who accept homeopathy believe that even though the tablets contain no molecules of the original substance, a force of some kind remains in the tablets, and it is that force that causes the tablets to work. This is a reasonable philosophical explanation, but it is an explanation that can not be proven or disproven via the scientific method. The best explanation I've come up with is that homeopathic remedies may be placebos, and I am happy with my realization that homeopathic remedies may be placebos. The safest medicine is a placebo that works! The reasons I created this post are to explain placebos and to give links to scientific research about them.

Wikipedia says the following about the placebos.

A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect....

In one common placebo procedure, however, a patient is given an inert pill, told that it may improve his/her condition, but not told that it is in fact inert. Such an intervention may cause the patient to believe the treatment will change his/her condition; and this belief may produce a subjective perception of a therapeutic effect, causing the patient to feel their condition has improved — or an actual improvement in their condition. This phenomenon is known as the placebo effect.

Scientists have experimentally looked at the placebo effect, and here are some of their results.

The findings of a comprehensive review of the placebo phenomenon and its consequences for clinical medicine are contained in a new article, "Placebo and the New Physiology of the Doctor-Patient Relationship," published in Physiological Reviews. The effort, undertaken by physician-researcher Fabrizio Benedetti of the Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Turin, Italy, provides an in-depth biological and evolutionary approach to examining the placebo effect in relationship to the doctor-patient relationship.

Described in the Sept. 10 on-line issue of the Proceedings of the National Academy of Sciences (PNAS), the new findings demonstrate that the placebo effect can be activated outside of conscious awareness, and provide an explanation for how patients can show clinical improvement even when they receive treatments devoid of active ingredients or of known therapeutic efficacy.

A new study challenges the theory that the placebo effect is a high-level cognitive function. The authors -- Jason T. Buhle, Bradford L. Stevens, and Jonathan J. Friedman of Columbia University and Tor D. Wager of the University of Colorado Boulder -- reduced pain in two ways -- either by giving them a placebo, or a difficult memory task. lacebo. But when they put the two together, "the level of pain reduction that people experienced added up. There was no interference between them," says Buhle. "That suggests they rely on separate mechanisms." The findings, published in Psychological Science, a journal of the Association for Psychological Science, could help clinicians maximize pain relief without drugs.

Placebos are "dummy pills" often used in research trials to test new drug therapies and the "placebo effect" is the benefit patients receive from a treatment that has no active ingredients. Many claim that the placebo effect is a critical component of clinical practice.

Headache is a very common complaint, with over 90% of all persons experiencing a headache at some time in their lives. Headaches commonly are tension-type (TTH) or migraine. They have high socioeconomic impact and can disturb most daily activities. Treatments range from pharmacologic to behavioral interventions. In a study published online in the Journal of Manipulative and Physiological Therapeutics, a group of Dutch researchers analyzed 119 randomized controlled clinical trials (RCTs) and determined the magnitude of placebo effect and no treatment effect on headache recovery rate.

However, the researchers observed striking differences in the power of placebo, depending on subjects' prior antidepressant use. Subjects who had never been treated with an antidepressant exhibited large increases in prefrontal brain activity during placebo treatment. But those who had used antidepressant medication in the past showed slight decreases in prefrontal activity -- brain changes that were indistinguishable from those produced by the actual drug.

Negative suggestion can induce symptoms of illness. Nocebo effects are the adverse events that occur during sham treatment and/or as a result of negative expectations. While the positive counterpart -- the placebo effect -- has been intensively studied in recent years, the scientific literature contains few studies on nocebo phenomena. In the latest issue of Deutsches Ärzteblatt International, Winfried Häuser of the Technical University of Munich and his co-authors present the underlying neurobiological mechanisms and highlight the relevance of the nocebo effect in everyday clinical practice.