The power of placebo - much ado about nothing, or the magic in our brains?

         

If there's a phenomenon in drug development that is as confounding as it is intriguing, it has to be a frequent observation seen in drug trials and everyday medicine that we call the "placebo effect". So, someone who thinks that they are receiving a therapeutic designed to impact an illness or affliction actually responds to a sugar pill with improvement in their condition. How come?

Not that you will ever hear pharmaceutical companies touting placebos as the next big thing, for obvious (financial) reasons, the phenomenon does exist and one reason why it remains a black box is because the answer resides in a very complex black box, of sorts - the human brain. If we can indeed observe a significant medical response to an empty capsule, in even some cases, then it implies that our brain itself has the power to heal.

Sounds far-fetched? Of course it does, but science itself is becoming more and more far-fetched these days, and science may indeed be able to answer the questions surrounding the mystery of the placebo effect. The power of suggestion and expectation may have a much greater impact on us than previously believed possible, and this concept was the subject of yet another fascinating episode of David Suzuki's Nature of Things recently. 

The program was captioned as "Brain Magic - The Power of Placebo", and took off right here in downtown Montreal at the MUHC's MNI with Dr. Amir Raz who specialises in the power of the mind; whether it be under hypnosis or utilising what he calls "focused attention" or "susceptibility to suggestion". It was shown that a young male who thought he was drinking several gin and tonics not only began to exhibit physical symptoms of intoxication, but further, his brain activity also seemed to mimic that of an alcohol-altered network. 

Admittedly, I remain very skeptical of that observation, and I daresay that the individual was chosen for good reason, in that he indeed was "susceptible to suggestion". I remember when a famous hypnotist came to our university union once, and a bunch of us (yes, after a few beers!) volunteered for the screening process by the inimitable Kenny Craig (no, it wasn't really him!) and the fun began. Rather remarkably, out of the six of us, the two that I had bet money on being "susceptible" were retained on stage, while the other four of us got unceremoniously kicked off the stage almost immediately. 

The things that "Kenny" made those two do had us falling off our chairs in laughter, and it is truly a shame that this happened in the pre-smartphone era because it would have been priceless to have been able to show that to our friends, after the fact. As it was, they had to live with months of "abuse" from all those that had witnessed the performance. But, although I make light of it, that show did convince me that for those "susceptible to suggestion", the power of the mind is indeed a powerful phenomenon. 

"Our shamans wear white coats instead of feathers, you might have to wait three months for an appointment to see them and they might charge you a lot of money—all of that creates a lot of expectation." says Dr. Raz.  

Things moved on to Professor Ted Kaptchuck of Harvard Medical School who has an entire program dedicated to study of the placebo effect, and based on various of his own observations with patients responding to placebos, he also buys into the power of the mind to actually change our physiology and positively impact our health. 

"There's no pharmacological agents, but the rituals and symbols of medicine activate neurotransmitters, relevant areas of the brain, that actually change the experience of illness and alleviate symptoms."

As skeptical as I still was, Kaptchuck elaborated further on an open-label study done on 80 irritable bowel syndrome patients, wherein 40 people were given some form of therapeutic, and the other 40 were given sugar pills - and they knew it. So, in this example, it was not a case of individuals thinking they were taking a drug, they knew they were taking a sugar pill, twice daily. This should sort out the placebo effect, right?!

Wrong. Astonishingly, twice as many patients in the group openly taking placebo exhibited positive responses in comparison to those taking nothing at all, which was a rather shocking result given that they knew they were swallowing a placebo. So are we saying that the mere ritual of seeing a doctor and swallowing essentially anything is sufficient to invoke a response in some people?! 

The placebo effect has even been observed in much more drastic situations such as wounded soldiers receiving saline drips in place of morphine (because they ran out of the drug in the field) or even Parkinson's disease patients reacting like they were given dopamine-releasing drugs when they were not. In each case, the power of the brain, the magic in the mind, seemsed capable of causing a therapeutic effect in the absence of any therapeutic. 

Speaking of dopamine, it seems that our response to placebo may well have something to do with the reward centres in the brain, and our potential dopamine and opioid release in response to a neutral pill may well be something that is genetically encoded in our DNA. Just like hypnosis itself in fact: some of us are very susceptible to it and some of as are not. It appears that the whole thing is wrapped up in the symbolism and ritual of medicine, the human connection and relationship with the doctor (or modern day shaman!) involved, and our inherent desire and/or belief that they will cure us.  

Children make very complex patients for drug trials in the pharmaceutical industry, in part because of their strong susceptibility to suggestion and their trust not only with caregivers but also in that they will be made better by those caregivers. The separation of the placebo effect from that of the actual drug in those trials makes life very difficult for pharma, making pediatric trials risky and not exactly a top priority. 

 We are beginning to better comprehend how the mind could possibly produce a physiological change similarly to that of a costly drug designed specifically for a given disease. Although it is far from hard science today, there are indications that there is real science (not magic) behind it. Perhaps the most intriguing aspect of the placebo effect is that with all of our technological and medical advances, we cast aside that most valued (by patients) aspect of medical treatment - doctor/patient relationship, symbol/ritual and bedside manner - and a healthy increased dose of that might do wonders for our health in and of itself?!

On that note, I am off home to the newly stained and planted terrace to ask she-who-must-be-obeyed to make me a stiff double gin and tonic, on repeat - but if she chooses to replace the gin with tonic - that's her decision. Given the potency of the placebo effect, it looks like either way, I am in for a very pain-free early summer evening! ;)