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3. The Placebo Effect

Placebo effect is the term applied by medical science to the therapeutic and healing effects of inert medicines and/or ritualistic or faith healing practices. When referring to medicines, a placebo is a preparation which is pharmacologically inert but which may have a therapeutic effect based solely on the power of suggestion. It may be administered in any of the ways in which pharmaceutical products are administered.

Sometimes known as non-specific effects or subject-expectancy effects, a placebo effect (or its counterpart, the nocebo effect), occurs when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work.

The placebo effect occurs when a patient takes an inert substance (sometimes called a “sugar pill”) in conjunction with the suggestion from an authority figure or from acquired information that the pill will aid in healing and the patient’s condition improves. This effect has been known since the early 20th century. Wikipedia

Western medicine has to acknowledge the placebo effect, even though it is unable to understand the mechanism by which it works. The reason is simple; the placebo effect operates also when real medicines are administered. This causes a major problem when trying to analyze the effect of new drugs. Is the patient’s improvement due to the activity of the drug, or due to the placebo effect?

That’s why double-blind studies, where one group is given the active drug and the other given a non-active drug, are the only way to know if the active drug is worth anything. To give to you an idea of just how powerful the placebo effect is, if 24% of the people taking the active drugs improve and 20% of the people taking the placebo improve, this is considered a significant success for the active drug.

How well the placebo effect works depends on the whole variety of things. It is most effective for treatment of pain and other “subjective” symptoms, with success rates of 60 to 70%. Last month they released a study showing that placebos were equally as effective as Prozac and other SSRI drugs at fighting depression. As I mentioned before, Prozac pulled me out of the awful depression brought on by MS. If a placebo would’ve worked just as well, why wasn’t that tried first?

The problem is, for Western medicine, the use of placebos to treat actual sickness raises all sorts of ethical problems. In order for the placebo to work the patient needs to believe that he is receiving real medicine. That means that the doctor is forced to essentially lie to his own patient. For obvious reasons that makes most doctors feel uncomfortable. Not only that, one could hardly blame a patient for suing a doctor for malpractice if he found out he was being “played” by the doctor rather than being “treated”.

To give you an idea of how important it is that the patient “believes” that he is receiving a “real” drug, when doing double-blind studies the placebo administered is often an amphetamine, or vitamin B-12. This is in order to cause the patient to “feel” the drug, and thus believe he is in the group getting the active drug rather than the placebo. This apparently makes a big difference to how well the placebo effect works.

The various psychological explanations for how the placebo effect works are thoroughly inadequate. It has become clear that placebos can have a real physical effect on the body. It turns out those people given placebos to fight pain, when given a drug that blocks the effects of opiates have their pain return. This indicates that the placebo effect caused the body to release endorphins, the body’s natural painkilling version of an opiate.

A “placebo response” can amplify, diminish, nullify, reverse or, even, divert the action of an “active” drug.

Because a “placebo response” is just as significant in the case of an “active” drug as it is in the case of an “inert” dummy drug, the more that we can discover about the mechanisms that produce “placebo responses”, the more that we can enhance their effectiveness and convert their potential efficacy into actual relief, healing and cure.

Recent research strongly indicates that a “placebo response” is a complex psychobiological phenomenon, contingent upon the psychosocial context of the subject that may be due to a wide range of neurobiological mechanisms (with the specific response mechanism differing from circumstance to circumstance).

The very existence of these “placebo responses” strongly suggest that “we must broaden our conception of the limits of endogenous human control”; and, in recent times, researchers in a number of different areas have demonstrated the presence of biological substrates, unique brain processes, and neurological correlates for the “placebo response”. Wikipedia

Using pet scans and functional MRIs, the real, biological effects of placebos is beginning to be studied.

“Spontaneous remission” is how doctors describe it when someone gets better for reasons the doctor doesn’t understand. This includes all “miracle cures” whether the result of the waters of Lourdes or the ayahuasca of a South American Shaman. In other words, spontaneous remission is simply a euphemism for Western sciences ignorance of how the body can heal itself, in cases where Western medicine is unable to help.

As a multiple sclerosis patient, my only hope for a cure is to somehow cause a spontaneous remission to occur. Who knows, if doctors were allowed to use placebos, maybe they could cure me with the placebo effect. But they aren’t allowed to use them, so I can just forget about that.

What’s a rationalist to do? The offerings of Christian Science and all the New Age Pyramids, crystals, magnets, herbs and what have you can’t possibly work for me. I simply can’t bring myself to believe in any of that stuff. Without belief — no placebo effect. Without placebo effect — no spontaneous remission.

The only chance I’ve got is to try to force myself to believe in the unbelievable. This is not easy for an agnostic, secular humanist like me. In fact it’s impossible.

The only time I’ve ever believed in the unbelievable was as a result of psychedelics. It’s amazing to me that the only chance I might have for a cure is completely illegal in this country. The decision to outlaw psychedelics back in the 60s was the result of a real fear on the part of the government at the time that the hippie movement would overwhelm them. Richard Nixon once actually said that Timothy Leary was “the most dangerous man in America”.

Of course those fears are long behind us. The idea that psychedelics pose an addiction problem like the other hard drugs is absurd on its face. Psychedelics are self-limiting. The more often you use them the less well they work. Not only that, you don’t take psychedelics to “feel good”. As often as feeling good, they can scare the shit out of you.

In addition in order to get the effects of ayahuasca you have to be willing to endure real discomfort first. More often than not it makes people throw up with a vengeance and often gives them an extreme bout of diarrhea. Maybe that’s why the Supreme Court recently allowed ayahuasca in the ceremonies of the Brazilian church that uses it. Before that the only legal psychedelics were peyote used in the ceremonies of the Native American Church. Guess what? Peyote also makes you puke…

I am a deeply law-abiding person. Both because I understand the necessity of having laws, as well as the desire to avoid the stress associated with the fear of getting caught.

But these drug laws, in addition not helping society, are standing in the way of my only chance to cure my multiple sclerosis. So screw them!

How dangerous would it be for me to take ayahuasca, whether here or down in South America? Checking on Medline this is what I found:

There was no evidence that ayahuasca has substantial or persistent abuse potential. Long-term psychological benefits have been documented when ayahuasca is used in a well-established social context. Conclusion A decoction of DMT and harmala alkaloids used in religious ceremonies has a safety margin comparable to codeine, mescaline or methadone. The dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal. Addiction 2007 Jan; 102(1):24-34.

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April 18, 2008 - Posted by | Uncategorized

2 Comments »

  1. This is unfair. You better write some more VERY SOON. Please. I’m not a patient woman, and I’m a fellow Norther Californian. -Jen

    Comment by Feisty | April 18, 2008 | Reply

  2. In Search of Placebos Online

    Fascinating thread – maybe you’d be interested in our story.

    Having become interested, and absorbed a lot of the online (and growing) discourse about the ‘placebo effect’, a small group of us (one a practising homeopath) set out to find how we might buy products actually branded as ‘placebos’, so as to make them available to those who choose to consciously benefit from the ‘placebo effect’.

    There are historical precedents for such, listed in Wikipedia and elsewhere, and there are interesting studies on the ‘informal’ (deceptive?) prescription of placebos by modern physicians – e.g. provision of antibiotics to treat a virus, provision of saline injections – with all the accompanying ethical dilemmas.

    But the closest we’ve come to a branded placebo is CEBOCAP, available through Walgreens in three strengths (!) by prescription only (!!) – see http://www.walgreens.com/library/finddrug/druginfo.jsp?particularDrug=Cebocap&searchChar=

    It seems that Cebocap is manufactured by Forest Pharmaceuticals (www.frx.com/products/index.aspx) but we can’t find any reference to them on the Forest site. Cebocap is also listed at http://www.canadacure.com/drugsearchAtoZlist.asp?Search=n,
    but that site notes that it’s “Only Available By Prescription … and Not available in Canada”.

    There are some great spoof sites around, like the article in the Onion already referred to in this thread, and we have a terrific spoof poster from a head site called Tripzine. But no REAL placebos 😉

    As adherents of homeopathy, criticised by many as one big placebo anyway, we’re fascinated by this. We’re able to source plain sugar pills, since that’s the base for many of the homeopathic remedies, but no one seems to have taken the step (had the nerve?) to come straight out and label something as a placebo. Perhaps it’s the assumption that the patient mustn’t *know* it’s a placebo s/he’s taking, but as also cited elsewhere in these pages, there are tantalising suggestions that even in such cases the placebo effect may still kick in. (And it’s not so strange anyway to imagine why ‘no blind’ placebo tests – on placebos – don’t often take place!)

    Like homeopathy and other CAMs, the value of it all seems to reside in intangibles, which makes it so problematic for materialist views of the world – values such as trust, intention, confidence, mutuality, relationship with practitioner. It’s like the placebo can offer us the affordance of ‘getting out of our own way’ and allow room for the body’s innate capacity to heal.

    So … the long and the short of it is we recently decided to set up a website as a clearinghouse for information and references to the placebo effect, and to actually package and offer placebo pills for sale online. As far as we know, we’re the only ones actually doing it, rather than just joking about it. And the content of our placebo pills? 100% sucrose. Why should anyone buy a bottle of placebos rather than, say, eat the occasional few grains of sugar from a bowl, or self-inject saline? As we say, we think it has to do with the contract, the intangible qualities involved in engaging with a formal interaction which inspires healthy somatic affects. This goes to the heart of homeopathy as well – we don’t see placebos and homeopathy as uncomplementary (to use a phrase).

    It’s early days, but so far the reaction has been good. Our intention is absolutely serious, stemming from our commitment to CAMs, but we also want to hold the information lightly, have fun with it, and take a bit of a poke at the medico-pharmaco juggernaut.

    Check us out if you like – http://www.placebo.com.au

    With best wishes

    Universal Placebos

    Comment by Universal Placebos team | April 30, 2008 | Reply


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