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The Placebo Effect & The Future of Medicine

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The placebo effect has been known for a long time, and doctors and medical practitioners have been exploiting its efficacy for a number of ailments.  Whether it is sugar pills, a fake surgery, or even prayer, the power of belief and the psychological effect on our physiology is real and undeniable.  While the placebo effect may have its roots (or been most thoroughly exploited) in various religions, through the power of belief, it has been used by non-religious medical practitioners for quite some time now, and it is starting to be investigated much more thoroughly in cognitive neuroscience, and psychology.  Scientists are beginning to design and implement new techniques that take advantage of this effect of the mind helping to heal the body.  It’s become a fascinating area of research with some potentially huge benefits that may prompt a significant paradigm shift in the future of medicine.

A major advantage of placebos (at least those in the form of a pill or injection) is that they don’t require the expensive R&D and drug-synthesis manufacturing processes that traditional treatments do, which means that there are likely billions of dollars that can be saved in the future, as well as the very important benefit of greater environmental sustainability, by consuming less energy and creating less hazardous waste in the pharmaceutical manufacturing process.  In the case of placebic-surgeries (which have been successfully performed), if surgeons simply have to make a far less complicated incision or two, along with some other protocol and ambiance considerations and requirements to produce the desired effect, then the costs of the far simpler operation are drastically reduced, as well as any chances of malpractice or other long-term complications resulting from the surgery.

One thing that will have to be considered as we start making greater use of these placebic treatments (specifically “drugs” and surgeries), is how the pricing and costs associated with placebo options will be decided for a patient.  Will placebos be as expensive as normal drugs (if they are comparably effective), or will the decreased cost of placebo manufacturing offset/reduce the cost of other drugs so that the average trip to the doctor will be cheaper for everyone?  As always, we will likely have to continue battling with pharmaceutical companies and or medical practitioners that take advantage of the cost savings just to increase their own profit margins while giving no trickle-down savings to the patient.  In the grander scheme of things, having healthier people at the same cost that we currently have is still better, but nevertheless, we can only hope that these discoveries will continue to reduce the costs for the patient as well.

As for other types of placebos, such as meditation, prayer, various rituals, etc., since these placebos do not require any physical mediums or materials per se (or at least not in many cases), they are relatively inexpensive, if not entirely free in some cases.  Modern medicine, however, is also making more use of similar placebo methods, that is, placebos that don’t require the intake of a chemical nor require any surgery.  In fact, one can certainly argue that modern medicine has been utilizing these “non-material” placebos for quite some time already.  For example, various psychological treatments have been used to help heal people with all kinds of ailments, many of which are psycho-somatically induced, and all of which can be exacerbated by hypochondria, pessimism, and other causes of stress — and the placebo effect is certainly a likely contributing factor in many of these successful treatments.  These kinds of treatments could very well be applied in many (if not all) other cases that aren’t currently considered “psychological” ailments.  Putting this all together, I think we are going to start seeing a shift in medicine where psychology, cognitive and neuroscience are going to combine with modern “material” medicine to form a more obvious hybrid.  This integration will be significant, as currently many medical practitioners or schools of thought within medicine have a large divide between what are believed to be either psychological or physical ailments.  In reality though, it appears that every ailment is actually a combination of the two that can be more effectively treated, when both aspects are treated rather than merely one or the other.  After all, the brain and the rest of the body operate as a single unit, and so they should be treated as such.

Another positive discovery relating to the placebo effect is the fact that even if people know that they are being given a placebo, it is still effective, as long as they believe that the placebo is effective.  A more common concern regarding the placebo effect is that it will lose all efficacy if patients are informed that they are receiving some kind of placebo, however it turns out that this isn’t the case at all.  To give an example, in a recent study at the Harvard Medical School, people with irritable bowel syndrome were given a placebo and they were informed that the pills were “made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes.”  Then the researchers found that despite being aware that they were taking placebos, the participants rated their symptoms as “moderately improved” on average.  This seems to imply that it is the belief in efficacy of a particular treatment that houses the placebic potential for healing, regardless of the substrate used to implement it, and this solves a lot of ethical complications regarding the desired disclosure that a patient is receiving a placebo.

If the belief in the efficacy of a placebo is the primary factor for the placebo’s effectiveness, this would imply that stronger belief will produce a stronger placebo effect.  So it appears that one of the most major challenges in producing ever-more effective treatments within this domain, is going to be finding ways to increase the belief in a treatment’s effectiveness (as well as other psychologically beneficial factors including being generally optimistic, reducing stress, and other factors that haven’t yet been discovered).  It may even be possible one day for this “belief” maximization (or the neurological effect that it causes) to be accomplished by physically altering the brain through various types of electrical stimulation or other neurologically-based treatments, so a person wouldn’t need to be convinced of anything at all.  On a related note, I’d like to mention that we also need to consider that the opposite effect, that is, the “nocebo” effect, also exists and presumably for the same psychological reasons.  That is, by a person believing that something will harm them or that they are getting sick, even if there is no actual pathogen or physical medium to produce the illness, they can actually get sick and make things much worse.  For a powerful example, there were chemo-therapy participants in a certain study, some of which only got a placebo, and they still developed nausea and had their hair fall out (alopecia) because of their expectations of the treatment.  So the placebo effect works both ways, and this means that medical treatment will also likely change with regard to finding new ways of countering the “bad news” of a diagnosis, etc., possibly through the same kinds of psychological and neurological techniques.

Nobody is sure exactly when the placebo effect was first discovered, but it was likely unknowingly discovered many thousands of years ago in various cultures with particular religious beliefs, including those that involved prayer and faith healing, shamans and other medicine men, etc.  Without seeing any material cause or knowing what was causing its efficacy (i.e. dynamics in the brain), people no doubt chalked up many positive effects to the supernatural, whether by the interventions of some god or a number of gods, magic, etc.  So this appears to be one of many examples of how natural selection favors not only certain genes, but also certain memes.  If people began to spread certain religious memes (ideas) that promoted self-healing by utilizing the power of belief, they would be more likely to survive, and this would be yet another factor in explaining why religions formed, why they’ve been as ubiquitous as they have, and why they’ve propagated for so long throughout human history.  To be sure, it could have been the case that humans long ago experienced the placebo effect (without knowing it) and this led to the development of certain religious rituals or beliefs (because the cause was mis-attributed or unknown), or it could be that certain religious beliefs that were formed for other reasons happened to produce a placebo effect (and/or to strengthen it by other psychological factors).  Either way, it was a very valuable discovery indeed.  Now that we are starting to better understand the real physiological/neurological/psychological factors that produce the placebo (and nocebo) effect, we can continue advancing a scientific world-view and continue to increase our well being in the process.