Placebo Effect, Research Paper Example

Abstract

The placebo effect takes place from antiquity and it was in fact largely employed at a time when medicine was extremely primitive and treatments had no scientific basis, but was based on spiritual, ritualistic or misunderstood properties of elements. However, it was only decades ago that placebo treatments and the placebo effect began being studied by scientists. The amazing effect of otherwise inefficient treatment methods in particular contexts determined researchers to conduct various study in order to assess the effectiveness of the placebo treatments. However, most researchers and drug companies were interested in discover if active treatments or placebo ones were more effective, ignoring the question “why does it occur?”. The present paper tries to answer this question by outlining three of the most important theories regarding the placebo effect, and by consulting the relevant literature. It then discusses the relation between the placebo effect and the brain, as well as its effectiveness in treating different types of diseases. Finally, the paper makes suggestions concerning future research that may lead to a better understanding of the placebo effect.

Introduction

The existence of the placebo effect stopped being doubted by the medical community. In fact, it has represented, for much of the history of medical treatment, the most important factor affecting treatment, because healers and patients alike, or patients only, believed in the therapeutic effect of the pills and treatments they tried. As Shapiro and Shapiro (1999) explained, humans were treated with substances that had no effect on the sick, these treatments being sometimes accompanied by curative rituals that worked only as long as the patient believed in the cure. However, during the second half of the 18^th century, when knowledge of anatomy and psychology began to increase, the medical world began to ask for a scientific explanation regarding the benefit of one drug or another (Benedetti 2008). In the same time, placebo medication began to be used for the first time on purpose, whereas until then it had been used either as a trick, or from an authentic conviction that the treatment worked. According to Stephan Schwartz and Larry Dorsey (2012), in the first half of the 18^th century Armaud Trousseau used inert substances for the first time in order to test the effectiveness of a medical treatment. He gave bread pills to patients and was able to find that patients’ condition actually improved, which he attributed to imagination and to the natural cause of the disease.

Over the time, experiences increased in frequency and in complexity and the reality of the placebo effect became known. However, as Benedetti (2008) argues, drug companies, as well as many researchers and physicians are not interested in the placebo effect itself, but rather in determining if the active treatment is better. Thus, according to the author, many of these researchers are not “so interested in knowing why an improvement occurs in the placebo group, but rather if the active treatment works better than the placebo” (p.6). The present paper will therefore try to understand why the placebo works and in what conditions it may be used effectively. In doing so, it will draw upon relevant materials from books and published research articles on the topic. The paper ultimately argues that the placebo effect is the result of a combination of factors of which the physician’s intention is one of the most important.

Review of Literature

Placebos are pills or any type of medical treatment that do not have a real treatment effect for the disease in which it is used (Gibbs 424), but functions however. The totality of responses of the patient to the placebo has been named the placebo effect, a term which was coned in 1855. According to one definition, the placebo effect is “the nonspecific, psychological, or psychophysiologic therapeutic effect produced by a placebo, or the effect of spontaneous improvement attributed to the placebo” (Shapiro and Shapiro 1999). Geers et al. (2005) argued that a definition which includes the physiological and psychological response to an inert substance is appropriate because it does not limit the response to certain individuals, types of treatment, or “either psychological or physiological dependant measures”(p. 143). There are many definitions that aim to describe the placebo effect accurately, but more debatable than the definition are the theories which aim to explain the phenomenon itself.

The first theory which may be considered here refers to conditioning. This mechanism has been described since 1975 (Porto 2011) and supposes the conditioning of the patient to expect a certain result each time he receives a certain drug, after having experienced the result once. As research confirms, behavioral conditioning of the immunological reactions is possible and able to explain the placebo effect. However, conditioning cannot entirely explain the placebo effect because, as Geers et al. (2005) explain, conditioning cannot be used to explain why prior experience with a certain treatment does not increase its placebo effect.

The second theory refers to the brain’s expectation of reward and patients’ certainty that they will be healed. The expectation of reward is one of the two very important mechanisms through which the placebo effect takes place. The brain’s capacity of rendering the expected response is amazing. For example, patients respond better to treatments they perceive as more effective, and, in addition, they experience a faster and stronger relief or amelioration when the placebo is administered by injection (Porto 2011). Dopamine neurons of the tegmental or prefrontal cortex are activated when certain reward, or benefic result, is expected as a result of receiving treatment. Also, the production of endorphins was stimulated by placebo medication, which explains the real benefits felt by the patients. In a study on the consistency in the response to placebo treatment, the following conclusion was reached:

“We found a strong association between experienced placebo effects and subsequent expectancies, suggesting that the experience of placebo effects altered participants’ expectations for future responding. This may account for larger observed correlations between expectancies and placebo responses in later trials. A practical implication of these data is that initial response to a placebo, as might be obtained during the run-in phase of a clinical trial, is likely to be the best way of identifying placebo responders” (Whalley, Hyland and Kirsch, 2008, p.540)

Ben Whalley, Michael Hyland and Irvin Kirsch’s (2008) results suggest that expectation is indeed a very important factor in triggering the placebo effect of a treatment. The patients who are most confident of a treatment’s effect are most likely to experience an improvement of their condition as a result of the administration.

Finally, the motivational perspective involves the genuine desire of the patient to be cured. The motivational aspect of the placebo effect was studied by Andrew Geers and his team of researchers. They explained that the placebo effect may take place as a result of the patient’s desire to cooperate with the physician, or of the desire that the treatment works. The researchers’ series of studies were designed to demonstrate the role of goal setting in determining a placebo effect. The authors discovered that, “when participants were primed with a goal that could be met by confirmation of the placebo expectation, the placebo effect emerged. However, when participants were primed with an incompatible goal, no evidence for the placebo effect was found” (p.155). The authors’ findings thus suggest that the motivation of the patient in getting better may produce the effect of a placebo treatment, or enhance the effect of a treatment, in general.

However, in order to be effective, a placebo treatment must be applied by giving particular attention to the psychological factors that influence the patient’s response to the placebo treatment. According to Bernadetti (2008), “when a medical treatment (for example a drug) is given to a patient, it is not administered in a vacuum, but in a complex set of psychological states that varies from patient to patient and from situation to situation” (p.33). These psychological stimuli refer to the color and shape of the pill, to the sex and status of the physician, to the relationship with the patient, and the healthcare environment (ibid). Moreover, one of the most important aspects is the patient’s expectation: the placebo effect depends on what information the patient receives regarding the expected effect of the treatment and regarding the treatment itself.

The placebo can consist in an inert sugar pill, or an active drug, or a treatment of any kind, regardless of how potent it is and who administers it (Shapiro and Shapiro 2000). The most important factor in the placebo effect is that the patient has to be convinced about the efficiency of the treatment. Also, as N. Gibbs (2010) explained, any drug can have a placebo effect, even active drugs which can have effects on the patients that are not mentioned among its therapeutic effects.

The placebo effect however is not experienced by everybody. In fact, positive placebo reaction ranges from 21% to 58%, according to Shapiro and Shapiro (1999).In fact, as Edzard Ernst ( 2001) argues, many researchers doubt the existence of the placebo effect entirely and instead argue that the perceived changes “could therefore be the result of a misattribution by patients of various naturally occurring and ambiguous changes in their clinical condition” (p.21). However, as author further explains and research confirms, the placebo effect can be noticed when comparing two different groups, of which only one received a placebo treatment. What the researchers agree about is that placebo effect does not always occur. The difference in response however is rather linked to the illness itself, and to the symptoms than to particular characteristics of the patients (Brown 21). Also, the earlier mentioned ‘conditions’ are very important, and in lack of an appropriate context, motivation, and belief, the placebo effect will not take place.

Discussion

As literature shows, the placebo effect is a rather complex phenomenon that takes place in the brain and involves psychological and physiological processes which occur when certain conditions are met. Therefore, placebo treatments are not always effective, and their effect, when it occurs, is not entirely understood by researchers. Many questions are still unanswered regarding each of the theories presented in this paper. For example, even though expectation is an important factor in triggering the placebo effect, mere expectation is not enough, because, otherwise, the placebo effect would take place in many other circumstances apart from medical treatment (Evans 2004). Rather, as Dylan Evans explains, “one crucial factor seems to be the idea that some medical intervention is taking place” (79). Also, one must believe in the power of the medical procedure to produce an effect. Also, it is worth mentioning that, as research shows, children are the most likely to respond to placebo treatments, perhaps because of their genuine trust in adults, in general, and in doctors, in particular (Brown 21). All this suggests that the placebo effect of a treatment depends upon both psychologically-related factors, and upon the type of disease and symptoms experienced by patients.

The theories earlier presented suggest that the answer to the question “why placebo effect takes place, has to with the brain. The brain may be ‘tricked’ to believe that a treatment was administered, and release certain hormones that affect the overall well-being of the patient. This suggests that placebo treatments may work in relieving pain and enhancing the degree of comfort of a patient. Also, it may be effective in conditions of psychological origin, such as anxiety, depression, hyper-activity or other behavioral and mental conditions. However, even though it seems accurate to link placebo effect of psychological and behavioral disorders only, research demonstrated that other disorders are impacted by placebo as well. In fact, research has also focused on the effect of placebo treatments on the immune system and on cardiovascular and respiratory problems (Benedetti 2008). As Benedetti (2008) argues, asthma and cough are responsive to a great extent to placebo treatment, although the mechanisms that underlie these effects are unknown. Therefore, the placebo effect, as many other complex phenomena that occur in the brain, is not entirely understood and much still needs to be explained and understood in this area of study.

Conclusion

The present paper tried to explain the placebo effect by reviewing the literature in the field and briefly outlining the most important theories regarding it. The placebo effect was proved to exist and to have a powerful effect on health, although it does not occur in any situation, but rather, it requires that certain conditions are respected. Thus, conditioning, motivation and expectation all seem to be important in the triggering of a placebo effect, but each of them may cause placebo effects independently of the other or fail to do so either in combination or separately. In addition, certain conditions are more likely to be improved as a result of a placebo treatment than others, and, even though most have to do with the activity of the brain, the process cannot be entirely explained. Future research should therefore focus on explaining the hidden processes that lead to the effectiveness of the placebo effect in the case of particular condition such as asthma and cough.

References

Benedetti, F. (2008). Placebo effects: understanding the mechanisms in health and disease. New York: Oxford University Press.

Brown, W. (2013). The placebo effect in Clinical practice. New York: Oxford University Press.

Evans, D. (2004). Placebo: mind over matter in modern medicine.New York: Oxford University Press.

Ernst, E. (2001)“Towards a scientific understanding of placebo effects. In d. Peters (Ed). Understanding the Placebo Effect in Complementary Medicine: Theory, Practice in Complementary Medicine (pp.17-31). Elsevier Health Sciences.

Gibbs, N. (2010). Placebos and placebo effect. Anesthesia and Intensive Care 38.3, pp.424.

Geers A. et al. (2005). “Goal activation, expectations and the placebo effect”. Journal of Personality and social Psychology, 89.2, pp.143-159.

Porto, R. (2011). “The placebo effect: its importance in treatment”. Sexologies, 20 .1, pp. 15-19.

Schwartz, S. and Dossey, L. . “Nonlocality, intention and observer effects in healing studies: laying a foundation for the future”. In L. Miller (Ed. ). The Oxford Handbook of Psychology and Spirituality (pp. 531-548). New York University Press.

Shapiro, A. and Shapiro, E. (1999). “The Placebo: Is it much ado about nothing?” In A. Harrington (Ed). The Placebo Effect: Interdisciplinary Exploration (pp.12-37). Cambridge, MA: Harvard University Press.

Whalley, B., Hyland, M., and Kirsch, I. (2008). Consistency of the placebo effect. Journal of Psychosomatic Research, 64, pp. 537-541.