Optimize success: Enrich treatment with placebo-the body’s own natural healing response*

When randomized controlled studies of pharmaceuticals or surgery find that the treatment is no more effective than the placebo, the authors conclude that surgery or drugs have no therapeutic value (Moseley et al, 2002; Jonas et al, 2015).  Even though the patients may have gotten better, the researchers often do not explore questions such as, why did some of the patients improve just with the placebo treatment; what are the components of the placebo process; and, how can clinicians integrate placebo components into their practice to enhance the body’s own natural healing response.

To explore these topics further, listen to Shankar Vedantam’s outstanding podcast, A Dramatic Cure, from the NPR program, Hidden Brain-A conversation about life’s unseen patterns. Also, read the background materials on the website https://www.npr.org/2019/04/29/718227789/all-the-worlds-a-stage-including-the-doctor-s-office

Placebo effects can be a powerful healing strategy as demonstrated by numerous research studies that have persuasively explored the central features of the placebo effect. The research has found that the more dramatic and impressive the procedure, the more powerful the placebo effect.  For example, branded medicine with brightly colored packaging is more effective than generic medicine in plain boxes, an injection of a saline or sugar solution is more effective than taking a sugar pill, and placebo surgery is more effective than simply receiving an injection (Branthwaite & Cooper, 1981; Colloca & Benedetti, 2005).  For a detailed exploration of placebo, nocebo and the important role of active placebo, see the blog, How effective is treatment? The importance of active placebos.

To see the effect of the placebo in action, watch the well-known British stage hypnotist and illusionist, Derren Brown’s video, Fear and Faith  (https://www.youtube.com/watch?v=hfDlfhHVvTY).  He magically weaves together a narrative that  addresses the powerful influences of the natural, physical, and clinical environment and language used during a ‘therapeutic’ interaction. He shows how the influences of role modeling, the words that increase hope, trust and social compliance, and other covert factors promote healing. It uses the cover of a drug trial to convince various members of the public to overcome their fears using a placebo medicine called “Rumyodin” (which is a made-up name of a fake pharmaceutical) and demonstrates that the limits of experience are the limits of your belief.

This blog post serves as a reminder to ask ourselves as educators and therapists, ‘what can I do to include placebo enhancing components into my practice so that my clinical and educational outcomes are more effective?’  Explore ways to optimize your clinical environment, language use during  ‘therapeutic’ interactions, and role modeling to increase hope, trust and social compliance and thereby optimize your clients’ own natural healing response.

Watch the video: Fear and Faith 

References:

Branthwaite A, Cooper P. (1981). Analgesic effects of branding in treatment of headaches. Br Med J Clin Res Ed. 282, 1576-8

Colloca, L. & Benedetti, F. (2005). Placebos and painkillers: is mind as real as matter? Nat Rev Neurosci. 6, 545-552.

Jonas, W. B., Crawford, C., Colloca, L. , et al.(2015). To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open, 5: e009655. doi:10.1136/ bmjopen-2015-009655

Moseley, J.B., et al, (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine. 347(2), 81-88.

*I thank Richard Harvey, PhD., for his constructive feedback and James Fadiman, PhD., for reminding me to reframe the term placebo into “the body’s natural healing response.”