Placebo

You may be familiar with the concept of a placebo, this is an inert treatment, which can non the less produce an improvement in the person being treated. When drugs are tested in clinical trials, they are compared to placebo or dummy pills. Both the drug and the placebo have a placebo effect, but only the drug has an active effect. How much better (or worse!) the drug performs, is a measure of its’ therapeutic effect.

Often people think of the placebo response as an imagined or sham effect, as it results from a dummy treatment, but this is not the case. All treatments owe part of their success to the patients’ placebo response, and the degree can be dramatic. In a review of twenty six studies on pain relief, placebo was more than half as effective as morphine.

But it’s not just subjective factors such as pain that can be altered by placebo response; objective changes that have been measured include lowered blood fats, increased exercise tolerance of the heart, decreased swelling after facial surgery and improved healing of duodenal ulcers.

The power of placebo lies within the patient, not the medicine. It is based on the power of belief or expectation, even though the belief or expectation may be completely unconscious.

Nocebo

But what happens if a negative or limiting belief or expectation is planted in our mind? The effects can be just as powerful, and this is then referred to as a nocebo response. In other words, negative beliefs or expectations can create disease effects that would not otherwise be there, or exaggerate ones that are there. Comments like “There is no treatment for this and it will probably get worse” or “What do you expect at your age” can damage the health of those receiving them.

So be careful about the comments you take to heart, especially if they come from an “expert.” A few years ago I was running a training session for some GP registrars, I remember their GP trainer saying that ‘any doctor who says “there is nothing that can be done” should be struck off!’ I agree with him, people and their ability to recover are nothing short of miraculous; anyone who claims to be so sure of anything is in my opinion rather too arrogant to work in healthcare.