Until the 1930’s, many medical treatments were of dubious benefit. Those were the days when physicians made house calls, spent time with patients, and sat up all night offering consolation to the sick.

“Physicians gave sugar pills to people who seemed to require treatment and many would get better. There was a powerful placebo response to the ritual of someone caring for you. Many people got better because of the placebo effect and because the body has a tendency to get better on its own,” says Dr. W. Grant Thompson, professor emeritus at the University of Ottawa and the distinguished author of several books including the newly released The Placebo Effect and Health: Combining Science and Compassionate Care, (available at Amazon.com).

Science has only recently recognized a placebo response—with most information coming from clinical trials. Such trials not only determine which treatments are effective, but demonstrate that those receiving placebos have beneficial effects that can only be explained by the circumstances of the treatment, the natural changes over time and the placebo effect.
“I think physicians intuitively knew for generations that there was something more than the physical action of treating a person to make them feel better. But now with fifty years of clinical trial experience, it’s possible to observe in most trials of treatments for chronic conditions and some acute conditions that when you use a placebo control, 40 to 50 per cent of the people in the placebo control group get better,” says Dr. Thompson.

Any discussion of the placebo response involves both the doctor-patient relationship and the body’s inherent ability to heal itself. Some representative research, for example, suggests that placebos perform as well as antidepressants, which suggests that expectation may contribute to making people feel better. Of course, the placebo itself does nothing, but the compassion and authority of the doctor may interact with the vulnerability and fears of the patient to produce a positive effect.

It’s important to draw a distinction between illness and disease—it’s possible to feel better without affecting the course of the disease. The placebo effect appears mainly to mitigate symptoms, according to Dr. Thompson.

“If we’re talking about cancer and you’re measuring the size of a tumor and whether it’s shrinking in response to your treatment, you’re not going to see much affect in the placebo group. But when the outcome measure is something like pain relief or joint mobility then the improvement can be substantial and it appears that the mind and the body are working together to make people feel better.”

There’s an effort among researchers to understand the placebo response in physical terms by doing CT scans, brain scans and functional MRIs with the hope of demonstrating that certain areas of the brain are being altered where the actual placebo effects are occurring.

“I think it’s pretty early days yet. There a lot of other things happening when people are being treated and we shouldn’t jump to conclusions about what parts of the brain are being activated by a placebo effect—that’s one of the frontiers people are working on right now.”

The placebo response won’t improve your hemoglobin, Dr. Thompson confirms, but if you believe that what’s going on in the human brain is a biochemical phenomenon then “…one has to assume there is some change in cerebral biochemistry—but that’s only an assumption. No one has ever shown it. I don’t believe that anybody who has thought about the placebo effect a lot really believes that this can change a physical illness. I hasten to say that health is more than physical well-being. It’s also mental and psychological well-being and that part can be influenced very much by placebo effect.”

He cites the example of the mother and child bond to illustrate the effectiveness of the placebo response.

“If a three-year-old boy falls and skins his knee and he screams with anguish and nothing comforts him except a hug from his mum. The knee’s not any better, but the little boy stops crying and feels better.”

The doctor’s belief in the treatment plays a role.

“And not only the doctor’s belief in the treatment—there are all sorts of verbal and non-verbal communication that occurs to reinforce the effect of the treatment. There’s no question that talking to anyone who’s ill, making them feel hopeful, saying we’ve got something that’s going to help makes people feel better. Regrettably modern medicine allots insufficient time for that.”

The placebo effect is not always benign. An angry patient, an indifferent doctor, unhappy circumstances, all can contribute to the opposite effect, with patients feeling uncertain and worried—it’s called the nocebo effect, the placebo response’s evil twin.

“The placebo effect can be harmful even if the short-term effects are good. I think the downside occurs when there’s deceit involved and the deceit is discovered later and also if it deludes people into avoiding treatments they should have,” reports Dr. Thompson.

Understanding the power of the placebo effect has enormous implications for the practice of modern medicine.

“Every therapeutic interaction has a placebo component. The more elaborate the treatment and the more caring-seeming the circumstances, the more likely things are to have a positive placebo effect,” says Dr. Thompson. “The placebo response has good instructive value for patients, doctors and people who design health care programs…Most doctors are aware of it but are horribly frustrated by the lack of time they have to implement it. It’s a systemic problem—there’s just not enough time for doctors to interact with their patients.”