The word placebo can mean different things to different people. For some, placebos mean fake, not real or even dangerous. Other people, however, view placebos as a favourable, physical treatment. But what exactly is a placebo, and is it beneficial?
In 1959, American physician Stewart Wolf described a placebo as ‘any effect attributable to a pill, potion, or procedure, but not to its pharmacologic or specific properties’ (I assume he was referring to the wicked witch of the west when talking about potions). In other words, a placebo is some form of treatment which has caused a positive effect but not due to the mechanisms expected.
The best-known type of placebo would be in pill form. A patient receives a pill which they are told will have positive effects, but the medicine has no actual qualities to it. It’s a sugar pill which serves no physiological purpose…like when Zayn was in 1D, OOOOOOOOOHHHHHHHH.
However, the pill can have psychological impacts due to a person’s beliefs and expectations about the healing effects of the supposed ‘medication’. This effect can lead to improvements in a person’s sense of wellbeing as well as improved symptoms and physical function.
Although the pill example is the simplest type of placebo, placebos can come in many different forms; massage, acupuncture, exercise, even rest!
A person’s belief and expectation in treatment has a significant impact on the effectiveness of the procedure. Thinking something is going to work, is more potent than if it does or doesn’t in some situations. A study on long-distance running found that people improved their performance if they believed they had taken a performance-enhancing supplement. The ‘supplement’ was only lemon cordial and a pinch of salt!
With regards to pain and injury, placebos have been a topic of considerable controversy. One area, in particular, has been manual therapy. Manual therapy is considered a hands-on approach by a clinician through massage, manipulations, mobilisations etc. At one point it was thought clinicians were acting like Patrick Swayze in the movie Ghost. They would mould, poke and prod tissues until they had cleared all toxins, released adhesions and removed scar tissue. Unsurprisingly, this is yet to be evidenced. However, people have improved with these techniques. So what gives?
Again, placebos seem to be the culprit. There are many variables which can affect how a patient perceives a manual therapy treatment; the type of technique, the communication with the clinician, the environment around them. Without even being aware, all these variables (and more) can have placebo responses.
For example, say a massage therapist looks like Selena Gomez. Already on a subconscious level, I feel a connection to this person. She then explains what she thinks is causing my pain. If I’m able to stop staring at her, and her theory is in line with what I believe, my confidence in her as a professional increase. I’m already primed to have a positive outcome before she has even started the treatment (I’m also definitely primed to sign up for another ten sessions!).
So actual changes are going on, but how exactly does a placebo response work? Well, it seems to come from our beliefs in the placebo which create an expectancy. This expectancy prepares the body to react to the oncoming treatment.
This expectancy is similar to jumping in cold water. Before diving in you know the water is cold, all previous experiences of cold water wash through your body. On a subconscious level, you make all the necessary adjustments, e.g., increased blood pressure, faster heart rate, vasoconstriction of blood circulation etc. All this causes the shock of the water to not feel as awful as what it would be, say, having a bucket of ice-cold water thrown over you…
The expectancy from the trait causes us to be conditioned to the stimulus and respond each time similarly. This means the more a particular act is expected, even if the act is slightly different, we will react similarly. So if someone were to EXPECT massage to improve their pain, there is a higher likelihood a massage will help with their pain.
Well slap my ass and call me Tash-Teesh-Tosh, this is good, right? Even if it’s not precisely known why something has been improved, if it takes away someones pain, or betters their performance, then the treatment should be encouraged?
To an extent, yes. We should try and take advantage of the positive effects of placebo, as they have been shown to be beneficial in many circumstances.
However, with great power, comes great responsibility. The placebo effect should be used ethically. If someone is given a manipulation and told this may help improve pain, this is a responsible way of using the placebo effect. But if someone is told that they need to receive a manipulation once a week for the rest of their lives or their injury will return, this would be unethical.
Far too often treatments are given credit when they have done no more than induce the placebo effect. If these treatments are used instead of other procedures that are cheaper/more readily available/easier to use/time efficient than there is a serious issue.
The placebo effect is a part of our everyday lives, whether we realise it or not. When used appropriately, the placebo effect can help us in many ways both psychologically and physiologically But we have to be wary about not allowing ourselves to become reliant on a treatment (or a person) that’s not doing what it’s advertising.
It’s also imperative that we know why an intervention works, i.e. if it’s likely to be a placebo or a specific mechanism is at work, a topic which has been explored in more detail here. If we don’t know why an intervention works then we can’t improve it and we risk ending up believing and using pseudoscience at a cost to the person and society as a whole.