5 things people get wrong about the placebo effect

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I once interviewed a woman who’d fractured her spine. For months, she was laid up, barely able to walk. Finally, her doctor recommended an experimental treatment.

She agreed to try it; afterward her pain melted away. A decade later, she’s still playing golf.

In truth, she didn’t get the experimental spine treatment. She was given a placebo.

The “placebo effect” is a phenomenon in medicine whereby patients feel better without the use of drugs.

Although scientists have been studying placebos for decades, there are still a lot of misconceptions about how and why they work. Here are the most common.

1. The placebo effect is all in the mind

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A significant proportion of patients feel better after taking placebos, but many scientists claim that this improvement is totally mental — that patients only think they feel better. Prominent doctors have called the placebo effect a “myth” or the “beer goggles of medicine.”

In reality, placebo treatments can cause measurable, biological changes similar to those triggered by drugs. Studies show that depressed patients on placebos experience increased activity in their prefrontal cortex, which eases their symptoms. Other research has shown that in patients with Parkinson’s disease, placebos trigger a flood of the neurotransmitter dopamine, just as their drugs do. And taking a placebo painkiller dampens pain-related activity in the brain and spinal cord and causes the release of pain-relieving endorphins.

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

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Expecting to feel better is a key ingredient in placebo responses, so it might follow that if a patient knows a treatment is fake, it won’t have any effect. Physicians and researchers have questioned the ethics of placebo use, suggesting that it requires doctors to willfully deceive their patients.

Over the past few years, however, scientists have found that this isn’t true. Honest placebos work, too. In one trial, patients with irritable bowel syndrome were told that they were taking a placebo, yet they still experienced significant relief from their symptoms compared with patients who got no treatment. Researchers have found the same effect for depression, migraines and ADHD.

There are several possible explanations. Some research shows that patients learn to associate taking a pill with a particular physiological response, so when they subsequently take a placebo, their bodies automatically mimic that response — a phenomenon known as conditioning. There’s also evidence that simply being cared for in a trial — even if patients know that a treatment is fake — eases anxiety and helps them feel that their conditions will improve.

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

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Doctors once took a very patronizing view of placebos. A 1954 article in the Lancet, for example, advocated placebos as a means to comfort “unintelligent or inadequate patients.” That belief — that placebo responders are pliable, suggestible souls who simply wish to “please the investigator” — persists today.

Recent studies, however, suggest that anyone can respond to a placebo. Crucial factors include patients’ attitudes toward a particular treatment, their previous experiences (whether, for example, they’ve responded well to a particular drug) and the information they’re given about a treatment. Genes also play a role.

About a quarter of the variation does seem to depend on personality. It’s not neurotic people who see benefits, though, but rather those who are optimistic, altruistic, resilient and straightforward. Scientists think this is because these personality types tend to be more engaged with their treatment and have more positive expectations for it. Neurotic and hostile people are least likely to respond.

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