In one of the German clinics, patients with tuberculosis were told for a month that a new, sensational medicine for their ailment was discovered, which cures better than any currently known drug. The doctors told them about it every day, describing in color the excellent chances of recovery. The medicine, they said, was to be delivered a month later. And now, 30 days later, the patients were told that the miracle cure would arrive any minute.
Finally, the "newest drug" was brought to the clinic. The pills were handed out, and all the patients took a course of the miracle cure, which really had an amazing effect: 80 percent of the patients recovered. Here is just a small clarification - "the newest and most advanced drug" was actually ordinary aspirin, which has no effect on the course of such a serious disease as tuberculosis.
The essence of this phenomenon, called the placebo effect, doctors formulated as follows:
Placebo (from lat. Placebo - getting better) is a chemically inert substance that does not have therapeutic properties, but has a pronounced therapeutic effect on the patient. The placebo effect has until recently been associated with self-hypnosis, such as auto-training. It was believed that a person's health improved due to the fact that he believed in the effectiveness of some drug or procedure, in fact, neutral.
Since the Middle Ages, terrible tortures and even executions have been known, during which no real harm was inflicted on a person. For example, the convicts were blindfolded and announced that they would now cut their throats (cut their veins). Then the executioner carried a sharp object to the indicated place, and his assistants poured warm water onto the hands or throat of the unfortunate man, so that it seemed to him that he was bleeding. Incredibly, people often died from such exposure! Moreover, the picture of death was exactly like death from blood loss. This "harmful suggestion" effect was later called the nocebo effect.
However, quite recently, scientists have found evidence of the "unawareness" of placebo and nocebo effects. A group of scientists from Massachusetts General Hospital, together with specialists from Harvard Medical School, have proven that the placebo effect is based on the unconscious work of the brain. Their article "Nonconscious activation of placebo and nocebo pain responses" was recently published in the journal PNAS. The brain decides how this or that drug will affect us, even before the information about this drug is understood by us, the researchers say.
In clinical and laboratory practice, a lot of facts have accumulated to date that cast doubt on the conscious nature of the placebo and nocebo effects. Many cases suggested that they could occur without conscious processing of visual or verbal stimuli. Often, improvements or deterioration in health occurred in patients as if automatically, without conscious acceptance of the idea that the drug or procedure should have a certain effect on them. In such situations, tomography showed that visual and verbal stimuli were processed by the brain of these people at a lower, preconscious level in the striatum (striatum), which is an integral part of the evolutionarily more ancient basal nuclei of the hemispheres, as well as in the subcortical amygdala. The experiments set by the authors of the study confirmed the hypothesisthat the brain "makes a decision" about the effect of a particular drug unconsciously - even before we thoughtfully analyze the information about it.
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The experiments involved 40 healthy volunteers - 24 women and 16 men. The average age of the subjects was 23 years. At the first stage of the experiment, a heating element was attached to the arm of each subject, which generated pain signals of different intensities in the volunteers. Participants had to rate the intensity of their pain sensations on a 100-point scale, while simultaneously viewing photographs of people on the monitor screen, some of whom depicted weak pain on their faces and others with severe pain.
The participants in the experiment did not know that the temperature of the heating element remained unchanged throughout the experiments. Despite the fact that the thermal effect on the skin was the same, the level of their pain sensations strongly correlated with the images in the photographs, that is, it depended on the associative suggestion caused by the picture of “strong” or “weak” pain. Pain sensations (recall, in reality, absolutely the same), the subjects assessed an average of 19 points when they saw a person depicting slight pain on their face (placebo effect), and 53 points when they saw a face strongly distorted by a painful grimace (nocebo effect).
At the second stage, the experiment was repeated with only one change: photographs of people experiencing pain of varying intensity were shown to volunteers for only 12 milliseconds, that is, in a stroboscopic mode that does not allow recognizing and, moreover, analyzing facial expressions. Once again, scientists could observe an obvious placebo or nocebo effect, slightly weaker, but still pronounced. Participants who did not have time to see or analyze the photo that flashed on the screen rated their pain sensations on average 25 points when a photograph of a person depicting slight pain flashed in front of them in stroboscopic mode, and 44 points if they were shown a distorted grimace of strong face pain.
It turns out that the placebo and nocebo mechanisms operate regardless of the subject's awareness of the signals causing it. “It is automatic and more fundamental than belief and conscious expectation, the mechanism that regulates our reactions and behavior. It is also important that by using this experimental model in combination with functional MRI mapping of the brain, we can study the placebo effect in more detail,”said one of the authors of the article, Kong Jian.
In support of his findings - recently received information from the biologist Peter Trimmer of the University of Bristol. Trimmer says something similar to the placebo effect is found in many animals. It is hardly anyone who has access to lectures on the benefits of the newest drug and the prospects for recovery! However, in Siberian hamsters living in light-simulated winter-summer cages, immunity works much worse during "short light days" and "long winter nights." But it is worth changing the illumination mode to the opposite, and the immunity of animals begins to work much more actively.
Having discovered the mechanism of the placebo effect, scientists could create highly effective and harmless drugs of a new generation, the action of which will be based not on direct interference in the work of certain body systems, but on the launch of protective scenarios at the brain level.
The strength of a person's faith is sufficient even for the effect of "fake" surgical operations.
Mental cement
How about getting rid of the need for surgery on a destroyed vertebra by the power of faith? We are talking about vertebroplasty. This type of intervention is used when severe pain occurs as a result of a compression fracture of the vertebral body. Then, with the help of special equipment, medical cement is introduced into the vertebral body, which allows you to return to its former shape and strengthens the vertebra from the inside, forming its structure.
How might the placebo effect be related to surgery? Dr. David Kallmes has specialized in vertebroplasty surgery at the Mayo Clinic for the past 15 years. He is the leading surgeon of the clinic in this field. He believes that the fictitious operation is as effective as the real one. And it's not that vertebroplasty is useless. Kellms called this "sham surgery."
He first thought about it when he noticed that the quality of the operation is not always related to the effect. Sometimes, even in the case of a not very successful operation, patients felt great. There were reasonable doubts about the reasons for the improvement in well-being.
Of course, Kellms does not argue that the placebo effect can replace tumor resection. However, doctors are beginning to realize that placebos have some power even in surgery.
Lies for life
He decided to conduct an experiment to prove whether vertebroplasty is more effective than placebo. Some of the patients underwent vertebroplasty, and some, not realizing, imitation. Their fate was decided by a random choice of computer. It was a well-played show. The preparation, local anesthesia, puncture, and the surgeon's words were no different. Even the smell of cement in the operating room was felt in both cases.
Some patients had rather serious spinal disorders. However, in the end, it turned out that vertebroplasty did not have statistically significant differences compared to sham surgery. Of course, their bones didn't heal, but the pain went away. The functions were restored in the same way.
This was shocking information, because more than a million operations of this type have already been performed around the world. At the same time, patients who underwent vertebroplasty or placebo surgery felt better than before or without treatment.
It is difficult to talk about the ethical side of sham surgery. However, for the scientific community, it is a prime example of the untapped potential of human thinking.
And 10 more facts about this effect:
1. The placebo effect gets stronger over the years
Despite the fact that the first mention of placebo dates back to 1700, the first serious studies were carried out only in 1970. Based on past and current research, it can be concluded that the placebo effect becomes stronger over time. This can be explained by the improvement of medicine - today a patient, going to a doctor, believes much more in the possibility of being cured than it was, say, in the Middle Ages. The same applies to drugs: it is much easier to believe in the effectiveness of drugs today than 100 years ago.
2. Placebo surgery is effective in treating injuries
Imagine a patient suffering from an injury requiring surgery. After the operation, the victim's condition returns to normal, and he is firmly convinced that the procedure was beneficial. And only a few months later the person learns that there was no intervention, and he was only made to believe that the treatment helped.
The situation described is a positive result of the performed testing of a surgical placebo. And the best part is that fake transactions are much cheaper than real ones.
3. The color of the placebo tablets affects the effectiveness of the treatment
Subconsciously, people are more inclined to believe a beautiful wrapper than its contents. This also applies to medicines, whose appearance can affect the effectiveness of the action.
Yellow placebo pills are more effective in treating depression than red ones because the latter are associated with danger and aggression. Green pills help with anxiety, while white pills help treat stomach disorders. The frequency of taking the drug also affects the result - the more often it is taken, the stronger the effect. In addition, pills from famous brands are more effective than conventional pills. It seems that people are superficial and gullible even when it comes to counterfeit drugs.
4. The placebo has an evil twin brother - nocebo
Just as belief in a positive outcome of treatment can heal, belief in a negative outcome can be harmful. This effect is called "nocebo".
Studies have shown that knowingly false information about the possibility of negative consequences can cause real symptoms of ailments. Another manifestation of the nocebo effect is that patients taking real drugs stop believing in their effectiveness, and it really decreases.
5. You can get a placebo effect from contracting a disease that is not related to the actual disease
Scientists decided to answer the question of whether a placebo can have an effect on people with asthma who will be infected with nematodes (roundworms) and will be treated for them. Bronchial asthmatics were divided into two groups. Some were infected with nematodes, while others were led to believe they were also infected. The first group showed improvement from the placebo treatment, as did the second, despite the fact that they were not infected. It was also strange that many infected with nematodes chose to remain infected after the experiment. Apparently due to the positive effects of worms on asthma.
6. Placebo acts on the body, even if the patient knows it is a placebo
The essence of the therapeutic effect of placebo depends on the patient's belief in the efficacy of the drug. But it turns out that if patients know that they are receiving a "dummy", they continue to believe in the effectiveness of treatment.
In recent studies, patients who were treated with placebo eventually admitted that they knew about it. It would seem, in this regard, the positive result of the treatment should have decreased, but the effect remained, and many continued to take the placebo.
7. The strength of the placebo effect depends on where you live
People in the United States are very prone to hypochondria, so there are significantly more vaccine advertisements in this country and people believe in the power of injections. Europeans, on the other hand, respond better to placebo capsules than to injections.
It turns out that cultural factors have a strong influence on the choice of the method of taking medications. For example, placebo drugs for ulcers are much more effective in Germany than in Brazil. However, when testing placebo on hypertensive patients, Germany showed the lowest results.
Cultural background is a powerful tool for shaping fears, hopes, and expectations about the placebo effect in a given country.
8. The placebo effect can be intoxicating
Recent research has shown that a person can be persuaded to be drunk. Scientists found that people who believed they were drinking vodka (although it was a tonic with lime) had impaired cognitive functions: they were worse at solving simple tests, and their IQ dropped by several points.
Princeton students were the first to discover this property - in a bar where only non-alcoholic beer was served, young people not only had fun and relaxation, but also felt intoxicated. So now you don't have to spend money on expensive alcohol - you just need to believe.
9. Almost all antidepressants are fake
Depression is undoubtedly detrimental to the body, and in recent years, doctors have been handing out prescription drugs for depression like Halloween candy. The proof of their effectiveness is the increased percentage of cured. But in reality, the placebo effect in treating depression is the same, but there are no side effects. This is good news for those suffering from mental illness - all these ailments are associated with impaired brain activity, which means they need to be treated by influencing or deceiving the central nervous system.
10. The placebo effect affects dogs and other animals
Carrying out another experiment, the epileptic dogs were divided into two groups. Some were given the real medicine, while others were given a placebo. Dogs that receive a placebo respond positively to treatment, which suggests that humans are not the only ones affected.
Studies conducted on Siberian hamsters have confirmed that these animals have a similar effect to placebo. Several of the hamsters were convinced that winter was approaching and hibernated, and their bodies were producing enough energy to stay alive. This mechanism explains why we only get better when we believe in the effects of medication.