Placebo Effect

Feda Aziz Amy Blitchok ENG 1060-0013 April 30, 2012 Placebo over Mind For years, scientists and researchers have sought to find an explanation for the placebo effect. What many scientists and researchers do not realize is that placebo or “fake medicine” has been used as early as the revolutionary period in the seventeen hundreds. The mind is a powerful organ, in which controls all our body’s functions and thoughts. Everyday functions such as breathing and walking relies heavily on the most important part of our organ: the mind.

However, through the use of placebos, it is becoming clear that the mind may have an even greater influence on our daily lives, influencing our perception of well- being. The placebo, which is Latin for “to please,” is a sugar-pill that can be taken in many different forms such as injection, liquid intake or by pill. Research conducted by physicians and scientists on placebos revealed that patients who receives treatment for asthma, irritable bowel syndromes, knee surgery and much more showed improvements and are symptom free which in turn demonstrated how mind is more powerful than the body.

The Placebo effect is when the administration of some entirely harmless or inactive drug or pill seems to make people better. It can also reduce the experience of pain by blocking pain signals in the spinal cord from arriving at the brain in the first place. When patients expect a treatment to be effective, the brain area responsible for pain control is activated, causing the release of natural endorphins. The endorphins send instructions down to the spinal cord to suppress incoming pain signals and patients feel better whether or not the treatment had any direct effect.

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This article explained how the mind and placebo work together in sending messages from the brain to the area of pain. Other problems exist in testing placebos' effectiveness. They cannot be used in studies on life-threatening or degenerative illnesses, since taking an inactive treatment rather than a real one could do patients real harm. Tests in which patients know they may be taking placebos show different results from tests in which they are given only a drug.

Patients have been shown to react less to real medicine if they know there is a fifty percent chance they are actually getting sugar pills (Amaral) . Very few doctors are this open about prescribing placebos, but most of them do not outright lie to their patients, either. In general, doctors who prescribe placebos often say that they have something that they believe can help, but they do not know exactly how it will work, either. Supporters of the use of placebos point out that this is not lying; placebos are known to be beneficial in some cases.

The American Medical Association (AMA) policy suggests that doctors could explain the placebo effect to their patients and receive consent to prescribe them in the course of treating any illness. This way, the patients don't know exactly when they might be prescribed a placebo and they could still benefit from the placebo effect ("http://www. ama-assn. org/"). The Placebo effect refers to the situation where patients feel better after taking a medication even if the drug is ineffective. A study proved the effectiveness of placebo medicine in patients diagnosed with heart failure.

When given the placebo to heart failure patients and they took it whole heartedly and faithfully they showed a thirty four percent decrease in death rate. The researchers are unsure about the results but some theories are; mind is as powerful as any organ in the body. People who took their placebo faithfully, and believe it would help, may actually have gotten real help. Also patients who have heart failure have to exercise and cut salt intake so that may have had an important role in the placebo succeeding (Amaral). The placebo effect is a powerful effect that can consistently induce a perceived benefit.

Once the placebo was identified as a valid medication able to create a response, such as becoming symptom free, became more widely used as a control in clinical trials. As a result, the placebo effect has been extensively studied throughout history. In a study; four groups of asthma patients were given albuterol inhalers, placebo inhalers, sham acupuncture, or no treatment. When the researchers tested the patients' lung function, the albuterol, a standard treatment for asthma, showed improvement, whereas the placebos had no effect. On the contrary, half of those who used the albuterol reported feeling better.

But so did nearly half of those who got the placebo inhaler or the sham acupuncture. Doctors may not fully understand the cause of it but what they do know is two inert pills can work better than one, colorful inert pills can work better than plain ones, and injections can work better than pills (Bates). The perception of the benefits was recognized due to the perceptions of the mind, and not to the ingredients that makes up the fake treatment. The placebo effect shows us that the mind heavily influences our perceptions of wellness and health.

The placebo was also used during the Civil War; nurses often ran out of medicine, in order to keep the soldiers moving they injected them with saltwater, and believed it was morphine. Many scientists began wondering how the solider can feel better and become symptom free without taking the actual morphine. Thus, the scientists came to the conclusion that before simply thinking you can feel better you actually will. However, there is the nocebo effect in which the opposite occurs. A patient thinks he will feel bad, and he then will feel symptoms and pain.

Also when a doctor proclaims that the medicine will cause symptoms or pain, the patient is more likely to feel the symptoms (Cloud). While the mind may be labeled as an organ easily fooled by placebos, whose benefit has no physical basis, it is clear that the mind may have an even greater role in behavior. Throughout the world, it is widely believed that the placebo effect simply is of random chance or it temporarily works on symptoms or diseases. To prove the skeptics wrong, a test was conducted with one hundred and eight patients that were divided in half.

Half of them received arthroscopy knee surgery, and the other half received fake knee surgery. Arthroscopy knee surgery requires only three tiny incisions through the skin and the fake surgery received a small cut on their knee. The results were astonishing placebo surgery turned out to be just as effective as real surgery. Many people think it is irrational to be cured by fake medicine, but the truth is patients who were successfully healed by fake surgery were in fact healed by the power of their own minds (Easton).

Placebos can no longer be thought of as a blind fold covering the eyes. These sugar pills induce the mind to create a very real and physical response that may be specific to the placebo; as a result, use of a placebo can become a very seductive treatment option for many. With the ongoing use of placebos, both as a control, and potentially as an alternative treatment, several issues emerge: Such as if the placebo is ethical or not. Furthermore, can it be guaranteed that placebos will generate a safe, and effective, result.

While these pills may seem nonthreatening by being less active than experimental drugs, the risk for harmful and unethical consequences still does exist. Dr. Sobel ,co-author of The Healing Brain, explains “doctors spend a lot of time prescribing and giving medicine when improvement can be just by giving positive reinforcement”. Dr. Sobel also clarifies that if giving positive feedback made patients feel better then why give a placebo or sugar pill at all when you can prescribe yoga or meditation.

For example when a child gets hurt, the compassionate parent would say “a kiss will make it better” and the child walks away tearless because mommy made it feel better. Carefully, studies were conducted and on average, if you take one hundred people with certain illnesses and give them a sugar pill; about a third would be expected to improve (Friend). Some doctors believe that instead of ignoring the placebo effect, it may help to enhance it. A study was conducted in which the placebo effect worked on patients who had irritable bowel syndrome or IBS. In 2008, Harvard's Ted J.

Kaptchuk wanted to treat IBS but in a safe way. He devised a fake remedy which contained fake acupuncture with no needles and plenty of soft talk. Kaptchuk experiment showed sixty-two percent of them actually got better and for the patients who had fake acupuncture and no soft talk saw a forty two percent improvement. Many mainstream medicine and drug companies try to minimize conducting clinical trials, but Kaptchuk argues that instead of minimizing they should enhance it and use placebos more often because it will lower costs of medicine and produce fewer side effects (Herper).

Anesthetist, Henry Beecher, published an article on the use and effects of placebo in treatment of different diseases. Since then, many studies have shown that situations can also trigger the human mind to generate placebo effect. Kaptchuk explains that rituals of treatment activate brain areas in the same way as done by drugs. 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 (Marglin).

Freed and his associates conducted a study examining the outcomes of forty patients, ages thirty four through seventy five, who had severe Parkinson's disease. In this study, the patients either underwent neuronal transplantation surgery or sham surgery (placebo). These patients were randomly assigned to the different groups. In the patients who underwent the sham surgery, holes were drilled into their skulls, but not penetrated. While all of the patients had hoped to receive this neuronal transplant, only half actually did. The rest had the placebo surgery (Amaral).

Freed found that although there was no notable effect among the older patients in either transplantation or placebo surgeries, the younger transplantation recipients showed much improvement as compared with the placebo surgery group. No one from the placebo surgery group benefited from the procedure. Results were measured using the standardized scoring system of the Unified Parkinson's Disease Rating Scale (UPDRS). They measure symptoms of Parkinson's disease including mentation/mood and performance in the activities of daily living, respectively.

Freed, further analyzed results for growth of transplants by using the PET scans. PET scans use nuclear medicine imaging to produce 3-dimensional color images of the functional processes within the human body. These tests all concluded that the only group that benefited from the study was the younger transplantation group, leaving many concerned due to the lack of improvement in their condition. Half of those in the placebo group experienced additional pain, and some experienced trauma. In addition to not benefiting from the procedure, many experienced significant pain from the placebo surgery.

In this case, the mind could not be induced into generating the type of physical response that is desired from this surgery. And further, the potential for pain as well as harm are also clear in this example. It is clear that the ethics behind placebos, given that they are active substances that can induce very real physical responses need to be taken seriously. The mind is a complex organ that may not always respond in the way that we hope it will (Amaral). The placebo effect has shed great light on the complex functions of the mind. The mind has the remarkable ability to generate a physiological and real response to placebos.

Furthermore, the mind can discern a placebo from an experimental drug, as we see through the specific activation of the prefrontal cortex by the placebo. The mind has functions and capabilities that are larger than just thinking, breathing and walking. It not only controls our perception of our well-being, but may control the physicalitys of our well-being more extensively than was previously thought. While the placebo effect has yielded important information on the powers of the mind, we need to think more responsibly about the use of placebos, and the potential effects of these active stimuli on the brain.

Given that placebos do activate the brain, we need to re-address our notions of these pills as inactive sugar pills. What if placebos could have the potential to affect the mind in a way that is not positive? What if placebo pills, and furthermore surgeries, could be harmful to the patient? The ethics of placebos, and the role of the mind in responding to them, should not be underestimated as we move forward in our studies of how the mind works. Our well-being depends on it. There are several recent studies suggesting that placebos themselves are beneficial.

According to a paper presented to the American Psychological Association's (APA) 104th annual convention, the placebo effect accounts for fifty percent of improvements in depressed patients taking antidepressants. Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication, a controversial study done on the effectiveness of using pharmaceuticals in treatment of depression. According to another study, when placebos are given for pain management, the course of pain relief follows that of an active drug The Placebo Prescription, comprehensive non-scientific article on the placebo effect.

For both the placebo and the active medicine, peak relief comes about an hour after administration. The placebo effect seems to be acknowledged, perhaps unwittingly, by most medical doctors when one considers that until recently prescribing antibiotics for viral colds and flus was a common practice (Ammaral. ) A patient's belief in the treatment and the placebo response are dependent upon a variety of factors. First, the patient's expectations of treatment effects clearly influence the responses.

For example, a study in England was done where a hundred men were told that they were taking chemotherapy, when in actuality they were taking inactive saline solution. Twenty percent of these men lost their hair, demonstrating the power of the belief of effects of the treatment. Second, the relationship between patient and care-provider is quite important in determining treatment or placebo results. If there is a positive rapport between the two, then most often there will be a positive enthusiasm for the treatment, and therefore a positive outcome, no matter if a placebo or pharmacologic treatment was used.

The friendliness, interest, sympathy, prestige, and positive attitude of the care- provider toward the patient and toward the treatment are associated with positive effects of placebos as well as of active treatments. For example, in a double- blind study of dental extractions, two groups were compared: the first, where the doctors knew they would administer a narcotic analgesic, a placebo, or a narcotic antagonistic and the second, where the doctors knew they would administer either a placebo or narcotic antagonist. The patients from the first group who received placebo had significantly less pain.

Since the two placebo groups were only different in the doctors' knowledge of possible treatment, this knowledge must have resulted in differences in behaviors by the doctor that influenced patient responses. Third, placebos have time- effect curves and peaks, cumulative and carryover effects after end of treatment which is quite similar to those of pharmacologically active medications. For example, "when varying doses of analgesic followed by a placebo are administered, patients' placebo responses correspond in degree of pain relief over time to their original dosage of analgesic" (Turner).

In addition, dose-response effects have also been documented where two placebo pills were demonstrated to have more pronounced effects than one. In recent decades studies have confirmed the efficacy of various sham treatments in nearly all areas of medicine. Placebos have helped alleviate pain, depression, anxiety, Parkinson’s disease, inflammatory disorders and even cancer. These studies show that people’s perception of their treatment plays an important role in healing. In other words, people not only think that a drug or procedure will benefit them, but over time, they unconsciously associate the taking of medicine with relief.

This essay has stated what the placebo effect is, how it will be used to care for a patient with given evidence and the restrictions of the placebo effect. Up to now medical science has not fully explained what is the cause or causes of the placebo effect. But it seems that it is the result of the patient’s expectation of an effect. The debate will continue concerning what constitutes a placebo, but whether doctors and researchers should continue to use them. Even some supporters of placebo use claim that it is such a loaded word that perhaps we should start using terms like "mind-body medicine" or "integrated healing" instead.

But as long as many people believe that the placebo effect works, they're not likely to go away anytime soon. Work Cited "AMA American Medical Association. " http://www. ama-assn. org/. N. p. , 2012. Web. 29 Apr 2012. <http://www. ama-assn. org/>. Amaral, Julio Rocha and Renato M. E. Sabbatini. Placebo Effect The Power of the Sugar Pill. February 5,the Mysterious Placebo Effect, an article from Modern Drug Discovery Bates, Stephen. "Nothing helps: a placebo a day. " The Wilson Quarterly 35. 4 (2011): 15. Gale Opposing Viewpoints In Context.

Web. 11 Mar. 2012. Cloud, John. "How A Sugar Pill Can Heal (Or Hurt) You. " Time 174. 17 (2009): 59. TOPIC search. Web. 9 Mar. 2012. Easton MD "The placebo effect an amazing reality. " Sunday Star (Easton, MD) 1 Jul. 2007, Supplements HealthWise: NewsBank. Web. 12 Mar. 2012. Friend, Tim. "The placebo effect: Gauging the mind's role in healing. " USA TODAY 15 Jun. 1993, FINAL, LIFE: 6D. NewsBank. Web. 11 Mar. 2012. Herper, Matthew, and Robert Langreth. "The Nothing Cure. " Forbes 185. 5 (2010): 24. TOPICsearch. Web. 11 Mar. 2012. Marglin, Elizabeth. The PLACEBO Effect. " Natural Health 40. 5 (2010): 68-95. Health Source - Consumer Edition. Web. 15 Mar. 2012. "The Powerful Placebo. " Harvard Men's Health Watch 12. 11 (2008): 4-6. Health Source - Consumer Edition. Web. 15 Mar. 2012. "Therapeutic Placebo Effect:A Mind/Body Connection. " placeboeffect. com 10 Apr 2012 <http://www. placeboeffect. com/view. asp? id=25031>. Turner, et al, "The importance of placebo effects in pain treatment and research", JAMA, 1994: http://www. ovid. med. virginia. edu/ovidweb/ovidweb. cgi

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