During World War II, wounded soldiers on the battlefield were dropped off into military hospitals at every second. Working in northern Africa, American surgeon Henry Beecher panicked, as with the scarcity of morphine, it would be a life-or-death situation to perform surgery on gravely injured patients. Desperately, he replaced the morphine injections used to calm patients with a saline solution, which surprisingly quieted the patients down as well. Beecher became one of the first to discover the power of the placebo.
Latin for “I shall please,” placebos mimic real treatments in appearance but are supposed to have no effect when received by patients. A placebo, which can take the form of sugar pills, water injections or fake incisions, is most often used to test the effectiveness of a certain drug (Now, in clinical trials, primarily for ethical reasons, placebos are replaced by an existing drug known to work). As an example, let’s say there are 100 patients with heart disease in a medical trial. Fifty patients would receive the tested drug and the other 50 patients would receive the placebo (fake drug) that looks exactly like the tested drug, so there is no bias in the response. If there isn’t a statistically significant difference in the results, the tested drug is deemed unsuccessful and billions of dollars in investment goes to waste. From this, placebos were given a negative connotation as drugs continued to fail to pass the threshold required to appear in the market.
However, more recently, fewer drugs are passing that standard to reach the market as placebos have given more and more, a similar or sometimes even better effect than drugs tested, called the placebo effect.
The placebo effect refers to the contradictory phenomenon that patients feel better even after receiving a fake treatment. It emerged in the 1700s when doctors, who had run out of medicine to give like Beecher, realized that giving patients fake drugs could alleviate their pain. Though it was only first thought that the effects were purely psychological, recent research suggests otherwise.
The brain expects to be recovered by receiving a certain treatment, triggering physiological factors in the body that improve symptoms. This is called pharmacological conditioning, and similar to how Pavlov’s dog learned to associate food with the sound of a bell, a patient’s brain connects the taking of a pill to pain relief, causing the brain to naturally release endogenous opioids and endorphins, which bind to opioid receptors. Opioids inhibit the production of GABA, which thus stimulates dopamine, a “pleasure” hormone that gives feelings of happiness, ultimately reducing pain. Rather than the chemicals in the medication itself, the expectation in both the conscious and subconscious mind that the medication will treat oneself relieves the symptoms of a patient.
But it’s not just the treatment patients intake. Another aspect of the placebo effect is the feeling of being supported and taken care of by others. A study from Dr. Luana Colloca of postoperative patients revealed that when they were given treatment from a hidden robot, they would need twice the amount of drugs as when receiving an injection from a nurse they could see. When a strong relationship of trust is developed between patients and medical providers, oxytocin, one of the many happiness hormones, is stimulated and blocks spinal cord neurons from sending pain signals to the brain. The social context, or what we think of our physical and social settings, affects the effectiveness of a certain treatment.
The degree of the effect of the placebo also varies between people. A 2012 study by Harvard Medical School researcher Kathryn Hill found that the catechol-o-methyltransferase gene (COMT), which controls dopamine levels in the prefrontal cortex, determines one’s response to a placebo. There are three types of COMT genes in humans: HPS (High Pain Sensitivity), APS (Average Pain Sensitivity) and LPS (Low Pain Sensitivity). Even with similar conditions, people are sensitive at different degrees. Other research also shows that women’s opioid receptors are much more efficient than men’s; women only need half the dosage of men’s. Extreme variance in DNA across all people will require personalized treatments to be fully successful.
The discovery that placebos can have powerful effects on patients is beneficial in many ways. For one, patients wouldn’t have to repeatedly take addictive painkiller drugs that can have risky side effects. They also wouldn’t have to spend their paychecks on expensive medicine that could even exacerbate their condition.
It’s important to realize, however, that though placebos can help relieve symptoms, it will not be able to zap a cancer tumor or grow a new leg. Rather, placebos focus on changing the mindset we have in perceiving pain. Of course it is hard to give yourself the placebo effect. But if it’s that sugar-cellulose pills, saline injections or fake incisions can change the way we feel, then looking for ways in everyday life to reduce perceptions of pain may be the solution to better the manner in which we maintain a lifestyle. To do that, following the recent “self-care” boom might be the way to go.
Spending quality time with loved ones, expressing kindness, exercising, eating a balanced diet (including wine and chocolate!), meditating and writing a nice comment to Erika are just a few ways to feel good and produce happiness hormones, which will go a long way to even change how our bodies feel. The mind is one of the most powerful medicines. Make sure to take care of it.
Erika Pilpre is a junior at Aragon High School in San Mateo. Student News appears in the weekend edition. You can email Student News at firstname.lastname@example.org.