Tapping the Power of the Placebo

Tapping the Power of the Placebo
by Howard Brody, M.D., Ph. D.
From Newsweek, August 6, 2000
Sugar pills are potent medicine when taken in the right spirit. Can we put them
to practical use?
It looked like a medical miracle, and in a sense it was one. Before undergoing
experimental brain surgery for her advanced Parkinson’s disease, the patient was so
stiff she could barely take a step. A month or two later a TV news magazine filmed
the same woman striding easily across the room. The miraculous part is that her
operation was a sham. As part of a study of fetal-cell transplantation, researchers
had placed her under anesthesia and drilled holes in her skull – but they hadn’t
placed any new cells in her brain. Her dramatic improvement was due entirely to the
placebo response. The study concluded, in fact, that patients receiving the sham
procedure benefited almost as much as those who had live fetal cells implanted in
their brains.
For decades, the placebo response has been dismissed as the last resort of quack
doctors who had no real treatments to offer, and the fantasy improvement of gullible
patients with imaginary illnesses. But the placebo response is finally coming into its
own as the subject of serious scientific study. In one recent experiment, kids given a
vanilla scent with their asthma medicine eventually started responding to the vanilla
scent alone. Clearly the mind can heal the body when bolstered by hope and
expectation. The question is whether we can consciously exploit the power of
placebos. I believe that we can.
Researchers have identified several of the pathways linking mental states to physical
health. We know, for example, that calming thoughts slow the production of harmful
stress hormones. Mental states can also modulate the immune system and trigger
the release of internal painkillers known as endorphins. Physicians may someday
manipulate these systems mechanically, by stimulating the nerves that control them.
But until then, sugar pills and sham surgeries are not the only tools at our disposal.
Virtually anything that sends a patient one of four messages – someone is listening
to me; other people care about me; my symptoms are explainable; my symptoms are
controllable – can bring measurable improvements in health. In one study, Canadian
researchers followed people who had recently approached their family physicians
about headaches. The patients who said their doctors had listened closely to them
also reported getting more relief, and the difference was still measurable a year after
the visit.
Just as good physicians send these healing messages to their patients during every
office visit, we can learn strategies to send them to ourselves. One strategy is to
examine the stories we tell ourselves (and others) about our illness. Stories are
powerful tools, for when we create a narrative about something, we feel we have
explained it. In states of sickness, we tend to focus on what might go wrong and how
little we can do for ourselves. Such stories can actually worsen the illness, by
fostering feelings of dread and helplessness. But they’re not the only scenarios we
can construct. I once had a patient who suffered from severe frequent migraines.
He was between jobs at the time, and had begun to fear that his headaches had
made him unemployable. When he looked closely at his “headache story,” he found
that he was making the migraines worse. At the first twinge of pain, he was
constructing a panicky theory about how he would soon be totally incapacitated.
Once he had learned to reassure himself that he could handle his migraines, they
became less debilitating. He soon started a new job, and after a year at work he had
lost only one day of work to his headaches.
Tapping the placebo effect is not always as easy as talking to yourself. Sometimes
the best strategy is to join a patient support group, where you can share your story
and learn from those of people in the same predicament. In a now classic study
conducted at Stanford during the 1980s, psychiatrist David Spiegel showed that
breast-cancer patients assigned to a support group lived an average of 18 months
longer than those receiving standard care, even though their breast cancer had
metastasized before the study began. If we look at the group’s activities – members
listened to each other, cared for each other, and worked together to understand and
manage their symptoms – its success is not surprising. These activities send the
very messages that engender the placebo effect.
Whether you join a support group or not, you can get more out of medical treatment
by pursuing a sense of control. More than 20 years ago researchers taught a group
of nursing-home residents how to make more choices in their daily lives. For the
next year those who received the control training enjoyed better health, and lower
mortality, than residents who didn’t get the training. In another study, researchers
taught patients with various chronic illnesses how to be more assertive in their
dealings with physicians. In one center after another, groups of “in-charge” patients
showed less disability than their untrained peers. Anyone can apply these strategies
to achieve better health. That’s why sugar pills are such powerful medicine. The
power lies not in the pills, but in ourselves.
Brody teaches family practice and medical ethics at Michigan State University. His book “The
Placebo Response: How You Can Release your Body’s Inner Pharmacy for Better Health”
was recently published by HarperCollins.