18 November 2009

My Placebo

The effects of placebo are fascinating. But are they really that surprising?

If we accept the highly plastic properties of the brain then it seems to follow that a patient's brain structure can be physically altered by the perception that they are taking something that is good for them. The effect is heightened by the fact that the pill is being prescribed by a professional in the field of medicine, who must know what he/she is doing.

The placebo effect gets a bad press. The beneficial effects of placebo appear to be treated as a negative because the patient was 'fooled' into getting better. Does this actually matter? This is just semantics. If it is the case that your mind 'fools' your body into getting better then there must be a myriad ways in which your mind does this all the time without placebo. Is this 'conned' wellness inferior to 'real' wellness?

I have also come across this attitude from people who have used placebo-centred treatment such as homeopathy. Obviously they think that homeopathy is not placebo but when I explain that it is, and why it is, they can feel embarrassed. Why should they feel that way? If they went to see a nice person who listened to them and who spoke sympathetically about their condition, then gave them some harmless pills, and then they got better, surely they should be delighted. I would be. This is a wonderful beneficial effect of neurobiological processes, not a cause for embarrassment.

I have read that the placebo effect can work even in cases where the patient is told that he/she is being given a placebo in the form of a sugar pill. The doctor speaks calmly and sympathetically to the patient, explaining that there is scientific evidence which shows that these pills can have a beneficial effect in some cases. Why would this work? How can the patient be fooled if the sham is revealed to them before they even start the treatment? Well, all the other elements of the system are still in place - the sympathetic health professional, the thrice daily pill-taking ritual, the follow-up visits to the professional to talk about the condition, and so on. I would venture that, as a result of this, other crucial 'hidden' elements are still in place - the health professional as de-facto psychotherapist, the pill ritual as regular trigger for mood, appetite and sleep-affecting neurotransmitters such as serotonin, the ongoing care as a longer-term enabler/consolidator of neuroplastic change via increased levels of plastic change associated (speculative) neuromodulators such as oxytocin.

Maybe we should be more positive and up-front about the placebo effect. Towards this end I have made up my own placebo, Abcepol (made by Hedmed), and put it up for sale on Ebay. It's just a bit of fun really but there is a serious point. I want to see if people are prepared to pay for a placebo when it clearly states that that's exactly what it is. If anyone buys it I'll give the proceeds to a neuroscience-related charity.


nuncio said...

Quick update. Just sold my Hedmed Abcepl placebo pills on Ebay for a grand total of 99p. Not my most profitable transaction. It cost me £3.00 for the pills and £1.50 to post. Have made a small donation to the Walton Neuroscience Fund.

nuncio said...

Anti-homeopathy demos around the UK this weekend. Story on the bbc news website at http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8488286.stm