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Expectations and the Placebo Effect

What you expect is often what you get, and the placebo effect is at work! We have noted elsewhere that one possible account for the engagement of the placebo effect is the wish to ‘please the physician’, to be a ‘good patient’. According to this Stanford study, this might come as only a few positive words. “… When a health care provider offers a few encouraging words about their patient’s recovery time from an allergic reaction, symptoms are significantly reduced.”

Similarly expectations about the benefit of exercise can be seen to actually impact on life expectancy outcomes. In this study “the team looked at death rates. They used statistical models to account for other factors linked to death, such as age, chronic illnesses, and body mass index (BMI). Even accounting for these risk factors, those who saw themselves as less physically active were 71% more likely to die in the 21 years following the original survey.”

Open Label Placebos … again

An article in Big Think entitled People are knowingly taking placebos—and its working starts to untangle some of the theories about the functionality of ‘open label’ placebos – which describes the engagement of a placebo effect even when people know they’re taking a placebo. 

“Even though they were told that what they were taking was placebo and contained nothing of therapeutic value, those patients who received the placebo reported a 30% reduction in usual pain and maximum pain and a 29% drop in their disability. Incredibly, the placebo worked better than the real pain medication. Participants who took the pain pills reported feeling 9% less usual pain, and 16% less maximum pain. Furthermore, patients taking the real medication reported no change in their level of disability.”

Placebos and pain

Pain is a subjective state – that’s why practitioners typically ask us to ‘scale’ our experience of it, from a ‘1’ (slight) to a ’10’ (unbearable). And while it’s easy to see why the experience of pain is useful in an evolutionary sense (‘keep your hand out of the fire!’) it’s difficult to account for what mechanism is responsible for this experience. Different analgesics may have different effects (and affects) for different people, and some don’t seem to contraindicate – it seems you can ingest an opioid at the same time as paracetemol.

Enter the placebo effect! Here’s a recent research paper on placebos and pain. And also a fascinating article on ‘leveraging the Placebo Effect to Reduce Opioid Requirements’.

So you have a placebo-friendly brain and personality?

It seems there may be characteristics which not only how receptive you are to benefiting from the placebo effect, but also the degree with which it effects you.

In a study published in Nature Communications, two factors seems to influence results:

  • Brain anatomy (such as asymmetry in areas of the brain that control emotion and reward, including the amygdala, accumbens and hippocampus), and
  • ‘Personality’ – especially mindsets “emotionally self-aware, attuned to the body and mindful of one’s surroundings”

At Universal Placebos we’ve always known that awareness and mindfulness are part of the therapeutic value of placebos, of course, which is why our product comes bundled with instructions for mindful and meaningful administration.

“Down the line, the clinician could give five or six questions to the patient and decide whether they should just prescribe a sugar pill to them,” say the researchers. “The higher they score on this personality questionnaire, the bigger their placebo response will be.”

How the Iceman Resists Extreme Cold

Finland’s Arctic circle might not seem like a great place to run a marathon barefoot and in shorts—unless you’re Wim Hof. Hof, better known as “The Iceman,” has attained roughly two dozen world records by completing marvellous feats of physical endurance in conditions that would kill others. Yet even he was understandably nervous the night before his 26-mile jaunt at -4 degrees Fahrenheit.

“What did I get myself into?” he recalls thinking. But from the moment his bare toes hit the snow, he began to feel “surprisingly good.”

MRI scans reveal that Wim Hof artificially induces a stress response in his brain. “By accident or by luck he found a hack into the physiological system,” they say.

How? Well, you know what we think. The placebo effect in action once more!

Sex And The Placebo Effect: Women Learn, And Men Just Listen!

Sex differences for placebo effects not only exist, but they follow some rules, as it appears:

* Despite higher pain sensitivity in females, placebo analgesia is easier to elicit in males;

* It appears that conditioning is effective specifically to elicit nocebo effects;

* Conditioning works well to elicit placebo and nocebo effects, but only in females;

* Verbal suggestions are insufficient to induce placebo effects in women but work in men.

Read the whole article, in Science Trends.

Emerging Guidelines for Using Placebos in Clinical Practice

It is becoming increasingly clear that the placebo effect has a great influence on medical treatment. An international, interdisciplinary team of researchers led by Professor of Health Psychology Andrea Evers from Leiden University has now written a first set of guidelines on how to apply the placebo effect in clinical practice, published in Psychotherapy and Psychosomatics.

It was the result of the first official conference of the Society for Interdisciplinary Placebo Studies (SIPS), which was held in Leiden last year. During an interdisciplinary workshop led by Evers, a group of leading international researchers reached the consensus that knowledge about placebo and nocebo effects could lead to better treatment results with fewer side-effects. According to the researchers, it is crucial that patients receive more information about these effects, and that doctors receive training on the best doctor-patient communication to maximise placebo effects and minimise nocebo effects.

Read the full article here.

PLACEBOS and the immune response

Could brain stimulation slow cancer?

The idea is that ‘the placebo effect’ activates the same ‘Reward Circuit’ in the brain as that “activated by food, sex and social interactions (as well as gambling and addictive drugs)”. This in turn stimulates the immune system and generates ‘anti-tumor immunity’ against pathogens.

This is Scientific American, dear readers, and the claim is based on the kind of clinical experimentation that placebos are now inspiring. Placebo Studies!

“It’s like doing immunotherapy without medication.”

At the moment it’s just been shown in mice, and the ‘data are preliminary’, but even if it turns out only partly to be shown in humans, the implications are profound.

Five myths about placebos

1. The placebo effect is all in the mind.

“In reality, placebo treatments can cause measurable, biological changes similar to those triggered by drugs.”

2. Placebos work only if patients think they’re real.

“Over the past few years, however, scientists have found that this isn’t true. Honest (‘open label’) placebos work, too.”

3. Neurotic, suggestible people are more likely to respond to placebos.

“It’s not neurotic people who see benefits … but rather those who are optimistic, altruistic, resilient and straightforward.”

4. You have to take a placebo to get a placebo effect.

“It’s true that placebos won’t shrink a tumor, cure an infection or replace insulin in someone with diabetes. But many “real” medical treatments — particularly those that modify symptoms like pain, fatigue, nausea or depression — rely on the placebo effect.”

5. Drugs are always more effective than placebos.

A rigorous recent study of 152 trials found that placebo effects are often about the same as drug effects.

For more detail on all of the above, and references to research, read the Washington Post article.

More on ‘Open Label’ Placebos

Open Label Placebos (OLPs) are becoming a Thing, reinforced once more by Ted Kaptchuk’s placebo research group at Harvard Medical School. This article – Open-Label Placebo (OLP): Take This, It Is A Sugar Pill, It Will Help You! – provides us with a succinct update on the current clinical research scene, including valuable reference to two meta-studies which attempt to summarise the current state of our understanding. Importantly, the writers note that formal studies to date “have shown that while openly-applied placebos affect symptoms (depression, motor activity, pain, fatigue, etc.), none have yet shown that it may also affect disease biomarkers. Secondly, patient (self-)selection has to be tested for biases, e.g., whether the recruited patients are prone to respond to placebo, while others not recruited are not. Last but not least, it would be important to know how OLP compares to effective drug treatment of the same condition and in the same patients.”