Taking a sugar pill can sometimes lead to real improvements in health. How does believing in a treatment, even when it’s fake, trigger physical changes in our bodies?
In: Biology
We don’t know.
Really, that’s the best example you’re going to get. We really don’t have a god damned clue. We know it *exists*. Clinical trials have to account for it in their methodology. But we don’t know.
There are really two types of placebo effects. The more “common one” is really psychological. It’s perception. We can’t get inside someone’s brain and accurately measure their pain levels, but a lot of things are just..perception. When you break a bone you have to deal both with the broken bone and the pain. The bone is physical, the pain is neurochemical.
So given a “pain killer” that isn’t actually a pain killer *has been known* to decrease what the patient perceives as their pain level. It’s all neurochemical after all. Pain’s just the brain interpreting things, and what we’ve found is there’s a real intersection between how someone perceives reality and how someone *thinks* they should perceive reality. So someone who thinks they’re given a pain killer might legitimately believe they’re in less pain.
We kinda understand this one. We’re not sure of the exact interplay of mechanisms here but like. your brain is your ouchie place and also your thinky place and it’s not entirely unreasonable to think there’s some interconnection between the thinky and the ouchie parts. You think you’re in less pain so you…are. We don’t ENTIRELY know why, but it’s all just a bunch of chemicals swimming around in meat jelly so. Weird shit happens.
The placebo effect we absolutely do not understand is that there is a non 0 impact on someone’s *actual health improving*. Like we kiiiiinda get “here this pill will help you with the pain” might cause the patient to perceive less pain, even if the pill is fake.
But we’ve found there exists a statistically significant number of incidents of “here this pill will help your arm heal faster” *and then it does* even though there was no medicine involved. And that’s not just perception. That’s actual tangible medical results from literally no actual medical intervention what so ever.
That one we have not a damned clue about.
There are a lot theories, but a lot thinking is there is a huge benefit to human interaction and feeling cared for.
“No one knows”.
That’s really just about all there is to it. We see it working; we know it works; we don’t know why it works.
Whoever can figure it out will probably have the explanation named after them.
Gene regulatory networks have the capacity to learn, the same way a dog can learn to salivate with the ring of a bell. Give a known treatment with the thing you want the system to associate it with and it’ll learn to give that response with the new stimulus.
It doesnt.
Whats happening is people who take placebos are being given actual cures that they’re unaware of.
This is how you get weird medical trials were placebos cure cancer or other nasty diseases for seemingly no reason.
Its also illegal for doctors to prescribe placebos for some reason. You would think curing a good percentage of your patients with placebos would be worth it if placebos worked the way people thought.
People get very worked up over the placebo effect but it should be noted that the effect is not reproducible, even on the same patient. And there is also an anti-placebo effect as well.
There is a lot of misinformation about the placebo effect. Even scientists and doctors frequently get this wrong, and books and articles get written which are full of nonsense.
Essentially, the best explanation is that the placebo effect does not lead to real improvements in health. However, what it does do, is affect people’s answers to questions asked by doctors and scientists doing studies. People often say that they are feeling better when they take part in a study even if their health is completely unaffected – the reasons for this are not completely understood, but it may be a psychological desire to “say the right thing”, or they may feel better just because they are being distracted by going to an appointment for a study and doing stuff like answering questions and doing tests.
Properly designed clinical trials go to great lengths to record things which are *objective* – in other words, you don’t need to ask someone how they are feeling, but instead this is something which can be directly measured. For example, instead of asking how much you pain someone has, the doctor counts how many painkiller pills have been taken, or checks how many days off work someone had.
One of the interesting things that you see when you look at all the placebo studies done, is that when you compare the results off the studies with the quality of the studies – what you tend to find is that placebos improve health most in low quality studies, and the high quality studies show no effect. This suggests that placebos improving health is not a real thing, but is a false result produced by low quality scientific studies.
Anxiety and a focus on symptoms can magnify minor issues. The belief that something is a cure or that it will mitigate symptoms relieves the anxiety and distracts our focus from the issue. Essentially, the placebo returns us to a baseline, so what once seemed significant is less so.
A good example is actually from Psych 101 textbooks: Pavlov’s dogs. They would salivate when they heard a bell ring because they knew food was coming soon. Their bodies were conditioned with hundreds or thousands of trials for their bodies to respond to the bells. But if food didn’t show up: placebo! Their bodies expected something and did physiological preparations for it. But that doesn’t guarantee it will happen…
The placebo effect only manifests itself in conditions that have a clear psychological component. It will not cure kidney failure or heal a broken leg.
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