How Placebos Work

You might find some of this material tough going, and if you are willing to take my word for the significance of these factors, you could just skip over these parts. But I thought it important to document my claims about how placebos work. Just as I have documented my claim that most of the antidepressant drug response is a placebo effect and that the remainder is in all likelihood an enhanced placebo effect, so here, too, I present the details of the research upon which my conclusions about the way placebos work are based. 

The FDA approval of citalopram (Cipramil) provides a convenient example of how this works. Seven placebo-controlled efficacy trials were conducted. Two showed small but significant differences between drug and placebo. Another two trials failed to show significant differences, but were deemed too small to count. Three other trials that were deemed... 

The evidence I have reviewed in this chapter indicates that placebos work for a wide variety of conditions. They can produce both positive and negative effects. They affect the body as well as the mind. They can be as strong as potent medications, and their effects can be lasting. We have also seen that placebos can produce negative effects. Furthermore, the nocebo effect maybe an important factor in clinical depression - at least for some depressed people. For this reason, understanding the placebo effect is essential to understanding how to treat depression effectively. How do inert substances produce both therapeutic and detrimental effects Chapter 6 provides an answer to this question. 

If we are to harness the placebo effect and make use of it in clinical practice, we first have to understand how it works. A number of factors have been proposed as explanations of the placebo effect. These include the relationship between doctors and patients, the patient s beliefs and expectations, the production of opiates in the brain, and a phenomenon called classical conditioning, in which people come to associate pills and injections with therapeutic effects, just as Pavlov s dogs came to associate the sound of a bell with the presentation of food. In this chapter we look at how all of these processes combine to produce placebo effects, and we consider their implications for the treatment of depression. 

How does physical exercise alleviate depression One possibility is that it increases the release of endorphins that produce a sense of well-being, sometimes referred to as the runner s high . Another possibility is that it is a placebo effect. But even if it is a placebo effect, consider the differences between exercise and antidepressants in side effects. Side effects of antidepressants include sexual dysfunction, nausea, vomiting, insomnia, drowsiness, seizures, diarrhoea and headaches. Side effects of physical exercise include enhanced libido, better sleep, decreased body fat, improved muscle tone, greater life expectancy, increased strength and endurance and improved cholesterol levels. So if both antidepressants and exercise work by means of the placebo effect, which placebo would you prefer ... 

How has deregulation worked A meta-analysis of the herb St John s wort (Hypericum perforatum) for mild and moderately severe depression, published in 1996 by German and American physicians, concluded that it was more effective than a placebo and was as effective as standard antidepressants but with fewer side effects. However, the authors of the analysis raised questions about the methods employed and cautioned about its efficacy in seriously depressed patients. The active chemical in the herb, they claimed, was not appropriately standardized. Furthermore, the study only compared St John s wort with antidepressant drugs that were given at or below their lowest level of efficacy. And, finally, patients were treated for only 6 weeks. An accompanying editorial concluded that longer term studies are needed before it can be recommended in major depression. ... 

So how can a homeopathic remedy work The answer is not in the medicine but in the lengthy diagnostic session with a sympathetic homeopath that precedes the treatment. It is this psychotherapy that benefits the worried patient. The homeopathic remedy then confers its benefits in the same way that a placebo often produces benefits in people when these are given in large scale trials of real drugs. Placebos are generally harmless and inactive substances such as cellulose, but they do produce positive results for around 30% of those who take them. And so it is with homeopathic medicines which do work for many people, but for unbelievers like myself they are a waste of time and money, because we realise that all we are drinking is water. 

Determining the molecular sites of action of bioactive medicinal plant constituents is clearly important for establishing the chemical and physiological basis for herbal medicinal efficacy, for quality control of commercial herbal preparations and for the discovery of lead compounds for synthetic (or semi-synthetic) pharmaceutical development. Of course, it must be recognized that medicinal plant efficacy may derive from complex synergistic effects or even from quasi-placebo effects connected with the taste, mild effects and appearance of the preparation. While recognizing these possible holistic complications, in order to find out how such preparations work, it is clearly important to initially isolate, structurally characterize and define the biochemical targets of plant bioactive substances. 

In medical research studies, the "sugar pill" is usually the so-called placebo a "dummy" pill that scientists administer to half of a test group of patients to evaluate how well the real pill works. In an interesting twist, biochemist Hudson Freeze of the Burnham Institute in La... 

How well does it work, and what are the common side effects Evaluation in 1,000 or more patients with the target disease or dysfunction in comparison with a placebo and a positive control—usually double blind. 

The preponderance of inconclusive studies has led some practitioners to ascribe a psychological diagnosis to PMS without giving consideration to other factors. The psychological aspects of the patient are more clearly understood when looking at the psyche s impact on the limbic system. This is especially so when considering how well placebos have worked in some studies. Treatment of limbic system influences is more clearly defined in the psychiatric literature with respect to the anxiety and depression symptoms that are commonly associated with PMS. 

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