Wednesday, March 4, 2009

HEALTH: Placebo effect - All healing is self healing

The placebo effect can be produced not only by inert tablets, but also by sham surgery, and false information.
The placebo effect can be produced not only by inert tablets, but also by sham surgery, and false information.

THE word placebo itself originated from the Latin for "I will please". In the old days, the doctors used to give "dummy" pills to complaining patients to "soothe and get rid of them" and many of them reported feeling better! This is the "placebo effect".

According to the online dictionary, wikipedia, there can be many forms of placebo. Among them are:

- Inert pills, creams, inhalants, injections and other means of "administering" pharmacological drugs

- Medical devices (such as using ultrasound) that appear functional but are actually not

- Sham or "useless" surgery that involves only skin and superficial insertions.
- Electrodes implanted in the brain when their stimulation is said to be on but is not.

- Acupuncture over non effective acupuncture points, or with needles that only appear to stimulate.

Enhancing placebo

Some have claimed that even the physician is a placebo. The doctor's confidence and attitude matter. Hence, the doctor's good "bedside manners" is a powerful medium in making the patient more at ease.

Research finds that a patient's recovery is greatly increased by words that suggest the patient "would be better in a few days", and if the patient is given treatment, that "the treatment would certainly make him better" as opposed to negative words such as "I am not sure the treatment I am going to give you will have an effect".

The effects of placebo may be enhanced by:

Colour: Red, yellow, or orange, "hot coloured" tablets work better as stimulants, and "cool" coloured ones -- blue green, or purple -- as depressants.

Size: Big rather than small capsules

Number: Two tablets are more effective than one.

Brands: Branded proprietary tablets are more effective than unbranded ones.

High price: Studies have shown that telling people they are taking a novel form of codeine (actually a placebo) that costs US$2.50 (RM9) rather than 10 cents increased the number of people reporting pain relief from 61 per cent to 85.4 per cent.

Injections: Compared to pills jabs have a larger effect.

Devices: Sham acupuncture are more effective than inert pills.

In the middle of the 20th century, clinical trials as to the effectiveness of medical treatments started to use control conditions in which people received inert or sham treatment.

Hence, the word "placebo" shifted to its present sense of a drug, surgery, or other medical procedure which suggested effectiveness because it was expected to be.

It was not the actual pharmacological or physiological action. The term "placebo effect" arose also around this time.

Blanking placebo

We know new drugs are measured against the placebo effect because a good percentage of people get better just by taking sugar pills.

I think a lot of us don't take the time to consider how crazy this is. Some major health conditions are "cured" by just the belief that the pill or injection will work.

People are cured because they "believe" or "are convinced" that something is being done for their "disease" when nothing is really being done at all.

This is obviously power of the mind stuff, but until recently scientists had never been able to actually "see" the placebo effect actually working in the brain.

New technology has changed all that. With Functional Magnetic Resonance Imaging (fMRI) and Positron Emission Topography (PET) scans, researchers can now see the brain work in real time.

Jon-Kar Zubieta, a neurologist at the University of Michigan, used some amazing trickery in order to discover that the driver of placebo effect in the brain is an area called the nucleus accumbens.

Indeed, it is that area of the brain that is responsible for our expectancy of reward.

The PET scans revealed that the placebo caused an actual dopamine boost with highest dopamine release coming from the nucleus accumbens.

All the subjects experienced some relief, but some more than others.

So the researchers used fMRI on the same subjects to see if there was a correlation between those who got the best placebo effect with those who potentially had the most active nucleus accumbens.

While using fMRI to monitor brain activity, they had the subjects play a game where they could receive monetary rewards. The anticipation of reward intensified the activity in the nucleus accumbens.

The cool part is that the people who had the highest activity in the nucleus accumbens during the game are the same people who had the most profound placebo effect in the pain part of the study.

So it seems that it pays to have a nucleus accumbens that hums if you want to get cured by a sugar pill.

I have been thinking about this study a lot and it begs this question. Could we actually train ourselves to enhance our expectancy of reward, thus strengthening the nucleus accumbens?

If so, this might mean we could develop some ability for self healing.

Rather than avoiding the placebo effect, why not make it work for us. In other words, if you believe or expect to get cured, you are likely to get cured. It goes back to the notion that "all healing is self healing".

Datuk Dr Rajen M. is a pharmacist with a doctorate in holistic medicine. Email him at

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