The Placebo Effect
LATELY, A FEW DAYS before my period is due, I start to feel a little nauseous, my sense of smell becomes more acute and I get the overwhelming urge to nap. While these may seem like garden variety premenstrual syndrome (PMS) symptoms, there’s more to it than that. You see, I’m trying to have another baby—have been trying for four months now—and I suspect my nausea, heightened sense of smell and sleepiness is my body translating my burning desire to have a child into the physical symptoms of pregnancy. Hope, unquenchable, goes viral, creating a contagion of expectation within. Then my period comes, and I know that I have been tricked once more by my body’s willingness to play along with my mind. This is just one of the ways the placebo effect and I are on intimate terms; there are more. My son demands kisses to make his boo-boos better; I take an aspirin and my headache immediately starts to improve, even though there is no way the medicine can reach its target that quickly; and I swear by my nightcap of warm milk to put me to sleep, which is probably due more to conditioning than cause and effect. The mind leads, the body obediently follows, yet how this precise choreography works still tantalizes scientists. But even though the logistics are elusive, the new research into the placebo effect offers a compelling silver lining: The mind-body connection plays a huge—and hugely underestimated—role in our ability to heal ourselves.
Your brain on placebo Placebos, loosely speaking, are inert substances or treatments—sugar pills, sham acupuncture, saline injections—that improve symptoms in nonspecific ways. Until the 1950s, doctors considered placebos to be bogus treatments, using them simply to placate their most demanding patients. It wasn’t until 1955, when Henry Beecher, an anesthetist trained at Harvard University in Cambridge, Mass., published an article called “The Powerful Placebo,” claiming placebos were potent, effective and potentially dangerous, that researchers began to take placebos seriously. The rituals of taking medicine and receiving treatment, scientists discovered, could not be separated from medicine’s curative prowess. Salt injections masquerading as morphine actually decreased pain; fake knee surgery improved mobility in the joints. Conversely, “nocebo” effects (the unpleasant, and even harmful reactions that arise in a patient after taking a placebo as a treatment known to have negative side effects) also had to be considered. Some inert “medications” produced side effects associated with taking certain medicine, such as nausea and drowsiness. In other words, doctors discovered that the body is willing to take the good and the bad. It’s worth noting that situations can trigger the placebo effect just as much as fake treatments. The mere sight of a doctor’s iconic white coat and stethoscope—the authority and knowledge that these symbols convey—can trigger a healing response, probably due to a decrease in stress. When patients anticipate something beneficial will occur, dopamine transmitters spring into action, doling out pleasure in the form of natural painkillers called endorphins. Opioids, neurotransmitters that work like opiates, which block the body’s ability to signal pain, may also flood the body after a placebo is administered. But while scientists are getting savvier at pinpointing these specific biomechanical responses from placebos in the laboratory, they still have many questions. “We don’t know fully how the placebo effect happens in real diseases over time,” says Ted Kaptchuk, associate professor of medicine at Harvard Medical School. “The newest neurobiological theories on placebos suggest that in some situations the appearance and rituals of treatment activate brain areas similar to when one takes drugs.” So, for the drug to work, you may not need the drug at all. This isn’t exactly great news for Big Pharma.