For years, doctors used sugar pills and fake procedures—a.k.a. placebos—to test how well "real" treatments worked. One group of people with a medical condition would get an actual therapy; the other would get something that looked and seemed just like it but was known to have no effect on the problem.
And then scientists started noticing something arresting: Many times, those "fake" treatments worked really well, even beating out the therapies they went up against. Take a look at just a few of the recent findings that inspired even skeptical experts to go "Wow":
- Placebos knocked out lower back pain just as powerfully as acetaminophen did in a large, rigorous trial conducted in 2014.
- A comprehensive review in the Journal of the American Medical Association in 2010 found that placebos were as effective as widely prescribed antidepressants for many less-severe cases of depression.
- Nearly 60% of people with irritable bowel syndrome got better when taking a placebo even when they were told outright they'd be getting a fake, according to a 2010 study.
- Scientists looking for limits to this effect even went as far as surgery: A study published in the New England Journal of Medicine found that patients who had a fake knee surgery for osteoarthritis (yes, you read that right—the docs made an incision, then just closed it up) improved as much as those who had the real deal.
What's going on? Science is beginning to understand that the potent ingredient in these placebo therapies may be your expectation that they work. Brain imaging studies show that belief in your treatment can actually change the way your brain works, says John M. Kelley, Ph.D., deputy director of the Program in Placebo Studies at Harvard Medical School. When your brain shifts, your body does, too, sending out chemicals and firing up systems that help you get better.
Consider this real-life example:
One morning in 2013, Wayne Jonas, M.D., a family physician in Washington, D.C., and a professor of family medicine at Georgetown University, was doing his usual hospital rounds and found himself facing a frustrated patient with bone cancer. He was on the heavy painkiller morphine to ease his discomfort, but the drug was making him too loopy to connect with his family and friends in a meaningful way. "He wanted to reduce the meds he was taking, but knew his pain was too intense to stop taking them," says Jonas.
So the doctor got creative. He started asking his patient questions about how he liked to relax. Did he have a favorite movie, TV show, or type of music that distracted him from his pain? The man mentioned that classical music always did the trick. So Jonas instructed the hospital staff to play what he loved each time they gave him his dose of morphine and told the man to listen to the same music when he transitioned to taking the drug at home. Within a week, he got the pain relief he needed with less medication as long as the music played along. Chatting with his wife and laughing with their kids, he felt his spirits rebound.
"The music enabled this man to tap into his body's ability to make natural pain relievers, which amplified the effects of the morphine," says Jonas. "What I helped him do is use the placebo effect—a positive, healing response to something that's medically inert, like music."
Not so long ago, experts considered the placebo effect a completely imagined reaction. Any relief patients reported had to be "all in their heads." Now we know that what you think can promote the healing response—and this may help explain why yet-to-be-proven alternative therapies work for those who swear by them, or why a trusted doc's reassuring words, understanding nod, or validation of your emotions can help you feel better almost instantly.
Brain imaging studies have begun to pinpoint what's going on when the mind gives modern medicine this type of unexpected boost. At the University of Colorado at Boulder, researcher Tor Wager, Ph.D., has used the newest scanning technology to show that if you're in pain, placebos can trigger a release of internal painkillers (see more on this below left) that not only relieve discomfort but also help calm your heart rate and breathing. Physiological changes lead to psychological benefits, too: better moods, tempered stress and anxiety, and less insomnia—"all things that help anyone heal," says Wager.
Practitioners can't prescribe a dummy pill in place of a real treatment for ethical reasons—the American Medical Association has strict rules against this. But advice like "take an aspirin and get some rest" or "there's no evidence this supplement works, but I have patients who've found it to be helpful" is how some docs may work around the prohibition and help you get your mind into the game. One survey found that about half of American physicians would prescribe placebos or might-help-can't-hurt treatments such as OTC painkillers or vitamins to jump-start patients' recoveries; other research suggests the numbers are growing. "What placebo research has shown time and time again," says Andrew Geers, Ph.D., professor of psychology and placebo researcher at the University of Toledo, "is that there is a psychological component to any treatment, and it's possible to maximize that to get the most out of it."
You don't need to enroll in a scientific study to experience the power of the placebo effect—anyone can benefit from the mind-body connection it ignites. Just give these simple, practical strategies a try:
Look until you find an A+ Doc who seems to really care.
All of the verbal and nonverbal ways a physician shows good bedside manner— asking questions about your life and how you're feeling, listening intently, or placing a comforting hand on your shoulder—set you up for the placebo effect to work. In another study on irritable bowel syndrome, published in the British Medical Journal, doctors administered sham acupuncture (needles inserted into inactive points) and provided extra TLC to one group, including lots of reassurance, sympathy, and gentle touch. Just like that, the patients who received special attention experienced markedly more relief than those who got the no-frills placebo treatment.
"It's proof that your relationship with your provider is key," says Kelley. "And the ways that doctor interacts with you—and even whether or not he believes in your ability to get better—plays a role, too." An interesting new twist in placebo research shows that a physician's confidence in a treatment can influence how well you respond to it. "The more your doctor believes something is going to work, the more likely it is that he'll convey this to you, boosting your own expectations of success," Kelley says.
If you've got a physician you like and trust, kudos. But if you've settled for "good enough," ask your family, friends, and coworkers about their docs until you come across someone whose face really lights up when she talks about hers. Yes, finding someone new is often a time-consuming, anything-but-fun process, but the extra effort could mean treatment that comes through for you when you need it most.
A clean waiting room? Friendly staff? All that counts.
If you love your doc's approach but find her nurses rude and the office dingy, it may undermine your confidence in her—which may compromise your body's potential doctoring power. That's because even seemingly small things, like where you're getting treated, can create a context that sets us up for healing, says Kelley. (For instance, you might be someone who believes a painkiller you get at a hospital will be better than what you could take at home.)
Think you don't care about whether a drug is name brand or generic? In one placebo study, people felt better when they thought the med they were getting had cost more. Should you insist on pricey pills and pay for them when insurance won't? Not necessarily, but ask your doctor for some reassurance that the exact same compound is in the cheaper drug. Similarly, it's worth taking a look around at her office. Tally up the little things that help you feel you're in good hands, even down to whether the staff is friendly, your doctor remembers your kids' names, or she wears a white coat. Nothing on the list? Move on to someone else.
Expect great things.
From the unsurprising-but-incredibly-important department: Your optimism about what's happening may determine how well a treatment works. Expectation is the most widely studied mechanism behind the placebo response. Simply put: "If you're starting a therapy and don't expect it's going to be effective, there's a good chance it'll work less well for you than for someone who truly believes that it's going to help," says Geers. Your natural psychological makeup—whether you're reading along and thinking, Wow! This is amazing! or Pfff, it's all a bunch of baloney—matters too. Some research suggests that optimists, as well as those who tend to be altruistic, resilient, and straightforward, are more likely to get pain relief when they receive placebo treatments.
All isn't lost if you're a glass-half-empty type. You can try helping the placebo effect along by reminding yourself of the high success rates of a treatment you're having. "Placebos likely trigger the relaxation response, a reaction in which the body releases some of our innate healing hormones," says Geers. So anything you can do to turn on relaxation—like listening to music, meditating, riding your bike, and maybe even having sex—may help start your body's mending mechanisms.
No one's claiming that placebo treatment will cure cancer, heart disease, Alzheimer's,or any other serious illness on its own—just that it is a valuable but underused tool in our get-well arsenal. Optimist or pessimist, believer or skeptic, it makes sense to plug in to the potential of what's already inside and around you: your brain, your beliefs, and people who care.
How Your Brain Can Squelch Pain
- You're at your doc's office, hurting. You see comforting details, like the med school degree on the wall. The doctor, in her white coat, pats your arm and says she's sorry you're in pain. All of this, whether you realize it or not, kicks off a volley of changes in various parts of your brain (frontal cortex and limbic areas) and body.
- Her caring and her credentials spark the thought: "This smart doctor can heal me." That spurs your brain to release your natural painkillers, opioids.
- The brain stem figures out how much pain you're in and doles out the right amount of opioid from your internal pharmacy. You might feel better already.
- Opioids travel from the brain to the spinal cord and through the body. You continue to form expectations like, "I know my doctor will send me to a good physical therapist." The more opioids you release, the less pain you feel—making you believe in the treatment and setting you up for a better outcome.
Source: Luana Colloca, M.D., Ph.D., a neurophysiologist and an associate professor at the University of Maryland
Placebos in Your Pillbox?
Your brain can make your meds work better. Our minds think that…
Capsules are more powerful than pills. And with arthritis, injections trump both, possibly because the bigger the intervention, the higher our expectations are that it will work.
Multiple doses in a day are superior. Four-times-a-day placebos provided more relief than those taken twice daily, likely due to our brain's saying, "More must be better."
Dr. Oz on Optimism
While the placebo effect can help you get healthier, the "nocebo"effect does the opposite. I was taught in med school that if you give a patient bad news with no hope, they will follow the prognosis. So you have to find the inspirational possibilities while still being honest—especially with yourself.
This story originally appeared in the July/August 2015 issue of Dr. Oz The Good Life.