Give me placebo please! | The Mail of the Sun

Discovering how the so-called “placebo effect” works and how it can be strengthened can do more for our health than all existing medicines. Arthur Kleinman, an anthropologist at the Harvard Medical School (United States), wonders in an article published by New Scientist magazine whether the placebo is a threat to scientific medicine, in view of the things that are being say on the subject. Kleinman bravely adds that perhaps a deeper understanding of the phenomenon would make many traditional and alternative healing strategies no longer seem like mere superstitions in university settings.

To please or to cure?

The origin of the concept "placebo" dates back to the 18th century, when it alluded to the product prescribed to satisfy rather than benefit the patient. The current definition refers to a substance or treatment that is not capable of causing any effect in the body. It is therapeutically a zero to the left. However, the one observed in patients when it is administered is called the “placebo effect”. It shouldn't act on any symptoms, but it does.

Continuing the tangle, conventional medicine and pharmaceutical companies believe that only treatments can be responsible for healing. That is why in the studies the placebo effect is considered as "equal to zero" and the drugs, to be considered as such, must show a greater potency. The fact is that the placebo achieves in many cases results equivalent to the drugs and, above all, it reveals that the body has very powerful resources.

Wouldn't it be smart to know these resources in depth to enhance them? Doesn't the placebo prove the correctness of alternative therapists when they speak of the "power of self-healing"?

Howard Brody, a family medicine expert and researcher at Michigan State University, believes that “healing chemicals and resources exist within us; if we learn to push the right buttons and manage the signals coming from our environment, these chemical pathways are activated.”

It has been shown that when a person believes they are receiving pain treatment, their body triggers the production of endorphins, substances similar to hormones and opium-derived drugs, such as morphine. These compounds cancel the pain signal, induce well-being and collaborate with the immune system.

Although some authors have wanted to limit the placebo effect to the perception of pain, the truth is that the body has a complete pharmacy: it can internally produce agents that raise or lower blood pressure, reduce joint inflammation, change the mood and even shrink tumors until they disappear.

The incredible power of the placebo is also evident outside the office. A group of young people can get drunk drinking non-alcoholic beer. You can also spend a whole night of insomnia after drinking coffee... decaffeinated.

When the placebo wins

There is no medicine that does not take advantage of the placebo effect, although the intention of conventional medicine is to banish it. A pain reliever does not produce the same results if taken inadvertently dissolved in a drink. A 1998 study showed that at least half of the effects of an antidepressant are due to placebo. More radical is Irving Kirsch who in his book The Emperor's New Drugs affirms that the effect of antidepressants is a myth. The real credit goes to the placebo.

The pharmaceutical industry struggles to find products that beat placebo. The US government requires that the efficacy be demonstrated in at least two studies. Despite all the strategies they employ to make positive results, the makers of the popular antidepressant Prozac, for example, had to conduct five expensive trials before two came out in favor of the drug.

A recent study has shown that the pain reliever acetanomiphene (paracetamol) does no better for treating back pain than pacebo. It makes them even worse: those who take it recover from low back pain in an average of 17 days; those who take placebo, in 16. Of course, the placebo does not cause side effects like the drug.

The therapeutic potential of the placebo effect has hardly been explored. What would be achieved if it were reinforced on purpose? This approach still faces the prejudices of conventional medicine. According to a Parliamentary Commission convened in the United Kingdom to discuss ethical issues, "prescribing placebo is bad medicine because its effect cannot be predicted or trusted" and involves "a certain degree of deception of the patient."

There is a curious paradox, since it is used when it is expected not to cure, and is avoided when it could help to cure... Well, not all doctors give up. Studies show that at least half use to prescribe placebos. He does it every time he prescribes antibiotics for viral infections, vitamins for fatigue, and dozens of mild-acting medications. They actually expect the patient's body to work.

The brain knows how to heal

Fortunately, the placebo effect has advocates. Herbert Benson, director of the Institute for MindBody Medicine at Deaconess Hospital, Harvard Medical University (United States), argues that the brain stores in its memory certain access routes to healing and transmits signals that stimulate the internal pharmacy so that generate naturally healing chemicals. For this reason, he suggests that the placebo effect be used as a therapeutic tool: "it is safe, cheap and has stood the test of time."

The experts convened by the National Center for Alternative and Complementary Medicine (NCCAM) of the United States to a conference entitled "The science of placebo: towards an interdisciplinary investigation" affirmed that "a new evaluation is making its way, because research provides evidence of mind-brain-body interactions at the cellular and molecular levels.

“In the new model –they continue– the placebo effect operates through psychosocial mechanisms such as beliefs, symbolic conditioning and expectations. These mechanisms evoke physiological responses that affect the neurological, immune, endocrine, cardiovascular, gastrointestinal and other major systems and organs, producing improvement in diseases”.

The new vision reinforces the methods employed by alternative medicines, based on the stimulation of self-healing capacities through a variety of means. Many therapists have not been taught it at the University but intuitively know how to enhance the placebo effect in their patients. They may even do it unconsciously, with the sole intention of making their patient feel better. Isn't that what healing is about?

Trust in the therapist

According to Franklin G. Miller, a bioethicist at the US National Institutes of Health, the placebo effect is a phenomenon of “interpersonal healing” in which the physician plays a key role. A study shows that in Germany the placebo effect is much stronger than in other countries. Apparently, the reason is credibility, the prestige that doctors have in that country. When the patient trusts that the doctor knows how to discover what the problem is and that he will offer the best solution, the body collaborates more forcefully.

If we stop to think about what trust depends on, we will realize that it is based on aspects that citizens usually demand from doctors. Credit is given to the professional who has time to listen and examine, who takes a humane interest in the patient, who shows seriousness in his work and who, at the same time, encourages him. Words like “you'll feel better in a few days” help healing and phrases like “we'll see” or “I'm not sure the treatment will be effective” don't.

The conviction and enthusiasm of the doctor are authentic medicines because they favor the hope of the patient. Other factors that may favor a positive response are feeling under the control of competent professionals, social contact with them, the information received about the disease, as well as the feeling of receiving a treatment that is the result of rigorous medical knowledge.

The ritual element

The white coat, the stethoscope around the neck, the syringe or any machine that seems sophisticated act as symbols that convey to the patient the feeling that they are receiving a powerful action. Apparently, the placebo effect is enhanced in an environment where miracles seem possible. Therefore, there is no contradiction between therapeutic advances and the power of self-healing. They complement each other, as long as the former do not depress the latter.

As the therapists display their powers, they must convince patients that their bodies are wise and capable of healing. In the same way that a wound closes and disappears, many other damages that are not in sight are continually repaired.

Therapeutic experience

Everything that surrounds the treatment can have some kind of impression on the patient and therefore on the success of the therapy. For example, it is known that large or very small pills are more effective than medium ones. So is dividing the dose into several doses instead of administering it once a day. Even the colors of the pills have consequences: the warm ones are stimulating, and the cold ones, calming.

On the other hand, treatment should move wisely between provoking cathartic moments and periods of relaxation. Catharsis, which impacts the psyche and emotions, mobilizes the body's resources in an extreme situation, while the subsequent relaxation allows the body's energy to focus on self-healing mechanisms, instead of dispersing in the form of muscular tension. and nervous. Breathing control is essential in this regard.

• Symbols are an effective stimulus on deep layers of the mind that in turn influence physiological processes. Other people, places, things, or actions can be searched for as reinforcing symbols. They can be religious images, lucky objects or with a personal meaning that we associate with healing. This symbolic effect does not exclude but is added to that of the active substance or therapeutic technique.

• Mental images are a means of communication between deep levels of mind and consciousness, as seen in dreams. Psychologist Jeanne Archterberg proposes visualization in a state of deep relaxation (when theta-type electrical brain waves predominate).

• The combination of visualization and biofeedback (technical control of physiological variables through monitoring) is used in the treatment of addictions, post-traumatic stress, multiple personality disorders, depression, chronic fatigue or bulimia.

The culture of the patient

An urbanite, who feels integrated into the business world and who values ​​technology, will let himself be cured by brand-name pills that he buys at a good price in a pharmacy. Another who loves nature and the simple life will feel that she is restored to health with plant extracts, healthy foods and energy-type therapies or in which she can actively participate. This is such an important factor that ignoring it can have negative consequences: if a person takes a pill fearing its side effects, there is a good chance that they will experience them.

Any treatment that aims to support self-healing processes should take into account the attitude towards life, health and illness. The way we are in the world, the way we think about ourselves and others, as well as the type of emotions we experience, play a fundamental role in the maintenance of health or its recovery.

Whatever the problem, negative thoughts and emotions should be dealt with first. During the treatment of a disease it is necessary to be convinced of the possibility of a cure. Optimism has a proven healing effect. The therapies that pay special attention to the psychological aspect are therefore recommended. Homeopathy, for example, insists on the need to care for and recover mental well-being as a condition for healing. For this same reason it is an optimal medicine for prevention.

Since childhood, society should promote love for life and admiration for its manifestations. A culture of health takes care of contact with nature and other living beings as well as respect, freedom, solidarity and above all, affective ties. Only people who feel loved are capable of pampering their bodies, which implies meeting their needs, respecting their rhythms...

The opposite values, which favor illness and depression of self-healing capacity are fear, isolation, competitiveness, contempt, false needs, distrust...

That the placebo effect goes from being ignored to being favored consciously represents a challenge not only for the science of medicine. It is also a challenge for everyone, an opportunity to live more fully, developing the potential that the human being possesses and that remains hidden.

How does the placebo effect work?

BRAIN ACTIVITY Imaging diagnostic technologies have made it possible to advance in the study of self-healing processes associated with the placebo effect. When taking a placebo that is expected to have an analgesic effect, certain areas of the brain are activated, such as the prefrontal, orbitofrontal, and insular cortices, the anterior cingulate zone, the nucleus accumbens, the amygdala, and the periaqueductal current of gray matter. At the same time, there is an increase in endorphin and dopamine levels. IMMUNE CONTROL The placebo-stimulated brain can direct orders to metabolism and the immune system and produce all kinds of biochemical changes. In this way it is possible to get the brain to control the levels of glucose, iron or antioxidants, among other physiological variables. Dr. Gustavo Pacheco-López, from the Institute of Behavioral Sciences of the Swiss Federal Institute of Technology, in Zurich (Switzerland), suggests that there is a neocortical-sympathetic-immune axis that explains the relationship between patient expectations and the physiological effects of placebo.CONDITIONED RESPONSE By associating a stimulus (such as a prick, a sound, a taste, a smell, or the simple swallowing of a pill) to a treatment, its effect can be reproduced only through the stimulus. For example, if the first few times that an asthmatic person uses a bronchodilator spray they smell a strong vanilla smell, on subsequent occasions the smell will be enough to generate the effect of the medicine, without the medicine. Therefore, if an active substance is administered and from a certain moment it is replaced by a placebo, the patient experiences the same benefits. MAIN INDICATIONS Among the diseases most indicated for placebo therapy, depression, panic, childhood behavior disorders (such as hyperactivity), gastroduodenal ulcer, irritable bowel syndrome, asthma, diabetes, dermatitis, upper respiratory tract infections, chronic fatigue syndrome, benign prostatic hypertrophy, arthritis, allergies and other inflammatory processes. The placebo even proved to be as effective or more effective than the surgical operations carried out in patients with Parkinson's or angina pectoris. However, the placebo effect is always present in the treatment of any disease. THE DURATION OF THE EFFECT The benefits of placebo can be maintained as long as or longer than those of pharmacy drugs. Studies show that, after one administration, they can prevent panic attacks for eight months, angina pain for six, and arthritis pain for two and a half years. Evidence is found in the scientific literature for a surprising variety of therapeutic effects attributable to the placebo effect. There is also the opposite effect or "nocebo", which occurs when the expectations are negative.