Placebo Effect

Definition: a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that treatment.

The term “placebo” refers to a dummy pill passed off as a genuine pharmaceutical, or more broadly, any sham treatment presented as a real one. By definition a placebo is a deception, a lie. But doctors have been handing out placebos for centuries, and patients have been taking them and getting better, through the power of belief or suggestion—no one’s exactly sure. Even today, when the use of placebos is considered unethical or, in some cases, illegal, a survey of 679 internists and rheumatologists showed that about half of them prescribe medications such as vitamins and over-the-counter painkillers primarily for their placebo value.

There’s one more strange twist: The PiPS [Harvard’s Program in Placebo Studies] researchers have discovered that placebos seem to work well when a practitioner doesn’t even try to trick a patient. These are called “open label” placebos, or placebos explicitly prescribed as placebos.

The placebo effect is not a single phenomenon but rather a group of inter-related mechanisms. It’s triggered not just by fake pharmaceuticals but by the symbols and rituals of health care itself—everything from the prick of an injection to the sight of a person in a lab coat.

And the effects are not just imaginary, as was once assumed. Functional MRI and other new technologies are showing that placebos, like real pharmaceuticals, actually trigger neurochemicals such as endorphins and dopamine, and activate areas of the brain associated with analgesia and other forms of symptomatic relief.

Steps to maximize the effect of a placebo:

1. Choose a pill color that you associate with success in what you want. What color do you associate with sleep? Use that color for a "sleeping pill".
2. Use capsules rather than pills because they look more scientific and therefore have a stronger effect.
3. Compose a set of instructions that cover not only how to take them but what exactly the pill is going to do.
4. A higher price increases the sense of value. It will make them work better.
5. One of the key elements of the placebo effect is the way our expectations shape our experience. Make it very official-looking: the pill bottle, the label, the prescription, the receipt from the pharmacy, the instruction sheet, etc.
6. Have or be an empathetic caregiver. Having another person involved (like the prescribing doctor or other caregiver) who expresses genuine empathy and wants you to get better helps the effect.
7. Follow the regimen. It is important to take the capsules faithfully and as directed, because previous studies have shown that adherence to the treatment regimen increases placebo effects.
8. Be patient and positive. Tell yourself things like, "Like any medication, the placebo might take some time (minutes, days, weeks, whatever seems appropriate) to build up to a therapeutic dose."

Some types of people are affected more by placebos than others.

Worriers, people with higher dopamine levels, can exhibit greater levels of attention and memory, but also greater levels of anxiety, and they deal poorly with stress. Warriors, people with lower dopamine levels, can show lesser levels of attention and memory under normal conditions, but their abilities actually increase under stress. The placebo component thus fits into the worrier/warrior types as one might expect: Worriers tend to be more sensitive to placebos; warriors tend to be less sensitive.

Source: "Why I Take Fake Pills", Smithsonian Magazine