In the year 1795, a US Physician Elisha Perkins invented a metal rod. These two 3 inch rods with a pointed end were made from steel and brass and were called “Tractor”. Perkins claimed that these unusual rods made from metal alloys can cure inflammation (swelling), rheumatism (pain in joints and connective tissues), and pain in head and face. By applying these tractors on aching body parts, Perkins claimed he could eliminate the root cause of suffering. The Connecticut Medical Society in the US, however, condemned the use of these tractors and expelled Perkins from membership of institution accusing him of medical fraud. However, Perkins convinced three of US medical faculties that his method was a genuine one. His cure was later certified by eight professors, 40 physicians and 30 priests. Soon the technique of Tractors became very popular in the US. Later, a bookseller named Benjamin Perkins introduced these tractors for medical treatment in London. Within no time, this technique became popular in Britain. People were desperately looking for pain relief, and tractors seemed to be a miracle cure. Soon the sale of tractors skyrocketed in Britain.
However, a British physician named John Haygarth was not very convinced with the effectiveness of the tractors. So in the year 1799 Haygarth, experimented to see the effectiveness of this remedy. Because of high demand, these metallic tractors were very costly. Haygarth replaced these metallic rods with cheaper wooden tractors, which looked similar to the metallic tractors. The patients in the part of the study were given tractors, which they assumed to be regular metallic tractors, but in reality, were wooden tractors. To his surprise, Haygarth found that 4 of 5 patients with rheumatism reported that their pain improved after the use of these tractors. Contrary to the Perkins claim, Haygarth found that patients were getting self-cured because they assumed that they were getting the treatment using tractors. Later, Haygarth published his findings in a book called On the Imagination as a Cause and as a Cure of Disorders of the Body.
The results of Haygarth findings were surprising because it proved that patients can be cured even if the treatment was fake. Haygarth had discovered one of the most astonishing medical discoveries to date. After almost 120 years, Medical science later coined a term for these effects when a paper was published in The Lancet in 1920. This paper was the first to use the term Placebo Effect.
What is Double-blind Trial?
During World War II, American Anesthesiologist Henry K. Beecher discovered the true power of Placebo effect. He ran out of pain-killing medicine called morphine. However, he desperately wanted to help the soldiers and so he gave the wounded soldiers saline solution, telling them it was morphine. To his surprise, 40% of soldiers reported that their pain had eased after taking this saline solution. Later, because of Beecher’s efforts, placebos were incorporated in the modern scientific era and double-blind trials were introduced, which became a gold standard for testing the effectiveness of the medicine. In these trials, the doctors administer the actual medicine only to a subset of study participants, while the participants in the other subset are given a fake medicine like sugar pills or saline water. Nobody knows who got what until the results are declared and hence the study is called blind. The drug is said to be effective only when it outperforms the placebo in a statistically significant manner.
“There are men on whom the mere sight of medicine is operative.”
French philosopher Michel de Montaigne.
Is placebo effective?
In certain conditions, the placebo is so effective that it works even when people know that they are taking a placebo. Studies show that placebos can affect conditions such as
- Irritable bowel syndrome
- Sleep disorders
In one study involving asthma, people using a placebo inhaler had the same performance on breathing as during sitting and doing nothing. However, when researchers asked for people’s perception of how they felt, people reported that the placebo inhaler was effective as medicine in providing relief.
In another study in the year 2014 by Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Center, one group took a migraine drug labelled with the drug’s name, another took a placebo labelled “placebo,” and a third group took nothing. Kaptchuk discovered that the placebo was 50% as effective as the real drug to reduce pain after a migraine attack. They later published these findings in Science Translational Medicine.
The reason for the effectiveness of placebo is attributed to a person’s expectations. If a person expects medicine to do something, then it is possible that the body’s chemistry can cause effects similar to what medicine can. So our mind can be a powerful healing tool when given the chance.
The placebo effect is more than positive thinking. It is having a firm belief that a treatment or procedure will work. It’s about creating a stronger connection between the brain and body and how they work together. While Placebos may not always cure the disease, they definitely can make feel better.
Effectiveness of Placebo in real life
These real-life examples show how Placebo can be powerful.
In the year 2014, a study was conducted on 66 Migraine patients to find the effectiveness of labelling of drugs in Migraine. The participants were asked to take a pill for 6 different times. Each time they were given either a placebo or a Migraine medicine called Maxalt. However, there was one more catch. The labelling of pills was changed each time, and these pills were labelled as placebo, Maxalt or neutral. The participants were asked to rate their migraine pain 30 minutes after the start of pain, then take the pill and then 2.5 hours after taking the pill. The result of this study found that the label of the pill affected the pain intensity reported by the participants. While Maxalt provided more relief than placebo, placebo pills were more effective than the no-treatment pill (neutral). But what was surprising was that labelling also mattered. A placebo pill labelled as Maxalt was just as effective as a Maxalt pill labelled as placebo. Thus though the drug was effective by itself, its efficiency reduced, if the patient thought it was placebo. Similarly, a sugar pill effectiveness increased drastically when it was labelled as Maxalt. Thus the patient’s perception of the medicine consumed is very important in pain relief.
In 2018, a study was conducted in 74 cancer survivors with fatigue, which is a lingering symptom in cancer survivors. For 3 weeks, the participants were either given a pill openly labelled as a placebo or were given their treatment as usual. After the 3 weeks, the people taking the placebo pills stopped taking them. But the people who were receiving usual treatment were given the option to take the placebo pills for 3 weeks. After the study completed, the researchers found that the placebo, despite being labelled as such, affected both groups of participants. To everyone’s surprise, after 3 weeks, the placebo group reported improved symptoms compared to those receiving treatment as usual. They also continued to report improved symptoms over 3 weeks after discontinuation of pills. The people who had received usual treatment first and then took the placebo pill for 3 weeks also reported an improvement in their fatigue symptoms after 3 weeks. Thus, despite knowing that they are given a placebo, the cancer survivors reported less fatigue.
In another study in the year 2015, the effectiveness of the placebo effect was studied in 35 people with depression. These participants weren’t currently taking any other medications for depression at the time. Each participant was given placebo pills. However, some of these pills were labelled as a fast-acting antidepressant (the active placebo) while others were labelled as a placebo (the inactive placebo). At the end of the week, a PET scan measured brain activity. During the scan, the active placebo group got a placebo injection, being told that it may improve their mood. The inactive placebo group received no injection. The next week the two groups switched pill types. A second PET scan was performed at the end of the week. The researchers found that people with active placebo reported a decrease in depression symptoms. Also taking the active placebo (including the placebo injection) was associated with PET scans that showed an increase in brain activity in areas associated with emotion and stress regulation. Thus, despite consuming the same sugar pills, the people who thought that they were taking active placebo reported more relief from depression.
These real-life examples prove that Placebos are effective in decreasing the perception of pain in patients. Thus, by thinking that the medicines consumed by them will cure them, people feel the recovery. But what if the perception is reversed? What if someone says that this medicine will cause harm to your body?
The Nocebo Effect
Have you heard about the Nocebo effect? It is the opposite of Placebo. In the placebo effect, a placebo makes one feel better or improves his/her symptoms. In the Nocebo effect, a placebo makes you feel worse.
Imagine you approach a Doctor of treatment of headache. The Doctor prescribes you medicine and warns you that this medicine can make lead to nausea and can make you feel sleepy. After consuming the medicine, you feel sleepy because you think it will happen because of the medicine. After some time, you also feel like vomiting. Though there may not be any side effects of the prescribed medicine, you feel it because the Doctor said so. While research is still going on for the Nocebo effect, it can have devastating effects on the treatment of patients. For example, a person sees his close one suffer and die from cancer. So he develops a belief that cancer is fatal. Several years later when the person is diagnosed with cancer, then mentally he may give up fighting because he thinks cancer is fatal and he feels that he will die soon. Our beliefs are very vital in fighting the disease.
When American footballer Inky Johnson was badly injured during a match, he was brought to the hospital. Doctor’s realized that Inky had busted a Subclavian artery in his chest. He was so badly bleeding internally, that to keep him alive, the Doctor’s had to take the main vein out of his left leg and plug it into his chest to save his life. They cut him six times down his left thigh. They cut him two times across his right rib. They cut him two times across his right arm. They cut him one time across the left side of his neck, and one time across the right side of his neck. After this cutting and fixing operation, the doctor said to Inky,
“Son, you are going to be in this hospital for the next 40 days.”
But Inky had an incredible determination to recover, and it was this strong willpower that made him walk out of the hospital on the third day itself. When he was leaving the hospital, the Doctor said,
“You broke a record. How did you do it?”
Inky smiled and said,
“I would never let a circumstance or situations define my life.”
The above story is an excerpt from my book, “Winning with disability”.
So our perceptions about the disease and our will power to survive are vital in any medical treatment.
Placebo and COVID-19
COVID-19 is the most popular medical term of the year 2020. Although several other diseases are more fatal than COVID-19, yet the hype created by COVID-19 is so immense that a majority of people fear this disease. Daily messages related to COVID-19 keep on circulating among different WhatsApp groups. Some of them are genuine, some are fake. There is a lot of information overload regarding COVID-19 on the common man that his perceptions about COVID-19 have kept on changing over time. Today, in October 2020, it is hard to find a person who is not aware of the COVID-19 and has never heard anything about it. So as we progress into our battle against COVID-19, the perceptions we develop against COVID-19 are going to be vital in winning against this battle. While doctors will do there best to save our lives against COVID-19, our perceptions and attitudes will also play a vital role in defeating COVID-19.
I have come across people with two different mindsets.
One set of people believe that “Nothing happens in COVID-19 except a few mild viral symptoms”. If you believe in this mindset, I am thrilled for you. However, at times, people are so overconfident that they don’t even bother to turn up to the doctor, even if they are COVID positive. They believe that the body will cure by itself. Too much of overconfidence can be fatal in this case, and proper medical treatment is a must.
The second set of people are the ones who think, “If I get Corona, I am gone” Maybe because of their co-morbidities and maybe because of their experiences and painful departure of relatives, they have developed this mindset, which is equally bad. There are now thousands of examples where people and even senior citizens with co-morbidity have fully recovered from COVID-19. So overthinking about COVID-19 is going to result in Nocebo, which we certainly don’t want. Just because it is well known that there will be difficulty in breathing during COVID-19, does not mean that there will be difficulty in breathing for every COVID patient. But by thinking so, we are unnecessarily inviting the problems in our life.
How can Placebo help in COVID-19?
Case-1: You already had COVID-19 infection.
That means if you have survived this infection in the past, there is no need to worry because your body knows how to deal with the virus. That doesn’t mean that you stop all precautions. The simple precautions of mask, sanitizer and social distancing are worth saving you from the trouble you will get if you catch infection for the second time.
Case-2: You are healthy and have got no Comorbidities
If you are healthy and have been lucky to remain free from this virus attack, then there is nothing to worry. Just keep up the precautions and practice positive thinking so that even if you catch this virus, your belief system is so strong that your body itself fights back against this virus.
Case-3: You have co-morbidities but have been lucky to keep the Corona Virus away so far
So far so good. In your case, we need to do one more thing besides the normal safety precautions. You need to work on your attitude towards COVID. Treat Covid-19 as a curable disease and keep up your spirits high. If a normal placebo can treat many big diseases, why will the medicines not cure you? Medicines will do their work, but you have to keep up your belief in them. Trust the doctors and the medicines and you will be okay even if you catch the infection. Never think you will die from COVID-19. The least the doctors want from a comorbid patient is a Nocebo, where the patient believes that these medicines can’t save him. Such a belief system will only make things worse.
“The placebo effect is the single greatest indicator that your capacity to heal starts in your mind”
In the end, I just want to highlight that medicines will do their part. But studies have proved that our belief in the effectiveness of the medicines is very crucial for the medicines to give quick and positive outcomes. So keep thinking positive and all will be well.
“Prayer is the ultimate placebo for every disease” – Jiten Bhatt