The Placebo Effect
Photography by: Christian Northeast
Why drug companies care Of course, pharmaceutical companies aren’t too worried. After all, most of us are conditioned to reach for a pill—and that’s not likely to change any time soon. But drug companies are paying attention because they have a vested interest in proving that their medications are appreciably more effective than placebos, and doing so is more challenging than it may sound. “Placebos can give a 40 percent to 45 percent positive response with many conditions,” says Steven Brewer, M.D., medical director of the Canyon Ranch resort spa in Tucson, Ariz. What’s more, the placebo effect seems to be getting stronger—against newer drugs and established ones alike. Why? Part of placebos’ newfound strength has to do with the discovery of inconsistencies about how a drug’s effectiveness is measured. At any given testing site, for example, what is considered “improvement” often varies dramatically, thereby improving the placebo’s chances of being as effective (or more so) than a drug.
But the biggest reason for the placebo effect’s rise in effectiveness may be advertising. Drug commercials and ads push associations that subliminally create a slew of positive expectations, which in turn cultivate a higher placebo response. “The placebo effect increasing has to do in part with the power of marketing creating the perception that these are effective drugs,” says James S. Gordon, M.D., founder of the Washington, D.C.-based Center for Mind-Body Medicine and author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression (Penguin Press). “Incredible enthusiasm can be generated if you market something long, hard and enthusiastically enough.” The drug industry’s marketing savvy, ironically, turns out to be a double-edged sword, making the drug more popular but also intensifying its ability to summon a placebo effect.
The idea that the placebo effect is amplified by advertising begets the question: Do some people respond better to placebos than others? Just as placebo means, “I shall please” in Latin, placebo responders tend to share the personality trait of—you guessed it—agreeableness. Openness, trust, even thrill-seeking, which, according to a 2008 study from McGill University in Canada, correlates with the dopamine (reward) centers in the brain, all make up the profile of placebo responders. Finally, it could be the cultural mores of our time, which champion yoga, selfempowerment and an attitude of gratitude. “People are more open to utilizing the mind-body connection and not just wanting a pill,” says Brewer.
Whatever the reasons for placebo’s growing prominence, it’s making both health care practitioners and patients take notice. Of course, for believers and practitioners of alternative therapies, it confirms what most have suspected all along: Healing is a highly contextual affair, subject to appearance, suggestion and empathy. “Mainstream medicine used to use the placebo effect to try to debunk alternative therapies by saying the effects were all in the mind,” says Anne Harrington, professor of the history of science at Harvard University and author of The Cure Within: A History of Mind-Body Medicine (W.W. Norton & Company). Now the tables may be turning, and studies of the placebo effect seem to be calling into question the efficacy of conventional approaches. Alternative medicine, says Harrington, may be gaining new respect for its longtime appreciation of the contextual aspects of healing—“the role of human relationships, expectations, anticipation and the reassuring sense that a health care provider is both competent and caring.”