Placebos, Suggestion, Faith and Health

A website selling placebo pills for kids has been receiving quite a lot of media attention, and stirred conversation on the topic.
Do sugar pills work? Is it a good idea to give your kids a placebo? Should doctors give placebos in some situations?

The body and mind are one

Our mental and emotional states influence our body. Try to recall the last time you were startled— you probably felt your heart beat faster, your breathing become rapid, your hair standing on edge, and all thoughts about food, or going to the bathroom evaporate. This is called a startle response, and we all know that in this case, our state of mind enacts a physical response. Another good example would be sexual arousal -- recall your reaction to a desired person -- again, physiologic response due to state of mind.

It should come as little surprise, after thinking about these common physiological response, that other thought processes can and do translate into changes in other organ systems. Our body secretes hormones, releases transmitters, gives electrical signals, activates immune cells and does an incredible array of actions in response to what our brain “feels” or perceives.

It is indeed wondrous, but if you think about it again, not that surprising, that there is healing power to our thoughts and our beliefs. This has been called by different names including the power of suggestion, the power of positive thinking, and the cure within. The phenomenon though is well known, and what it describes is that sometimes symptoms can be alleviated or worsened as a result of the individual expecting or believing that they will.

Placebos and the placebo effect

A placebo is a pill or procedure given to a patient as a medication or therapy which has no specific therapeutic activity for the condition. Generally, up to a third of patients will experience symptomatic and sometimes measurable responses to placebos. This effect is thought to be based on the power of suggestion. The patient’s expectation of feeling better generates subjective and sometimes also objective responses.

There’s always been a lot of interest in this kind of miracle cure without side effects, using the patient’s inner powers. Many in the scientific community attribute the positive effects seen by “alternative medicine” to the placebo effect.

Placebos sounds like a benign, inexpensive way to get results, especially for conditions which are chronic and difficult to treat (examples would be irritable bowel syndrome, chronic fatigue syndrome), or have no proven cure (like the common cold). Or are they?

Here are a few of the downsides:

• The placebo effect is usually transient, and the effect usually wears off (ok with the common cold- by the time it wears off the illness has run its course too)

• Some people don’t react to suggestion at all

• The patient has to believe he’s getting a real medication for it to work, therefore there has to be some deception involved from the side of the caregiver -- clearly an ethical dilemma

• Taking placebos may delay diagnosis and treatment with more effective therapies

The placebo effect though goes beyond giving dummy pills.

The quality contact with a caring knowledgeable clinician has its own healing power through suggestion. Have you ever experienced feeling terrible aches and pains, worrying about some grave illness you’re harboring, only to see your symptoms evaporate after a sympathetic doctor reassures you you’ll be fine?
Just being in a healing situation, getting attention, care and sympathy, and concentrating effort, time or money on getting help, can sometimes trigger physical reactions that promote recovery.

Placebo effect and evidence based medicine- the placebo effect is just an added bonus

One thing we need to remember when discussing placebos, suggestion, and alternative therapies is that evidence based medicine, or conventional medicine, is required to out-perform what can be done with placebos.
Without going into the various explanations of how placebos work, one has to admit that the placebo effect and the power of our mind are a fact -- an undeniable reality. Therefore to fairly assess if a new drug is effective and safe, most advanced drug trials conducted before the drug’s approval are designed as randomized (subjects are randomly assigned to receive either the study treatment or a placebo), double blind (subjects and researchers involved in the study do not know if they’re receiving the drug or the placebo), and placebo-controlled. A drug can be approved only if it’s significantly more effective than the placebo. Admittedly, not every treatment modality has been tested this way, as, for instance, it would be difficult and unethical to perform a double blind randomized placebo controlled trial of bypass surgery in cases of severe coronary artery disease, and subject half of the patients to mock surgery in which their chest is opened but their blocked coronary arteries are not bypassed, and they only think they were. Nevertheless this is the gold standard that modern medicine uses to assess efficacy whenever it’s feasible.

Granted, the visit with a caring doctor has potential for some healing through suggestion, and I think physicians and other medical professionals should develop skills to make every encounter one that improves the positive thinking of their patients and eases stress, but suggestion is just the bonus you may expect from your doctor. The diagnosis and treatment that he’s trained and vowed to give you is supposed to be evidence based, and work because it has specific therapeutic activity for your disease. It probably helps if you believe in the treatment, but it’s designed to work even if you don’t, and even if the patient’s unconscious.

I believe that doctors shouldn’t be engaged in giving placebos. The interaction and words of the doctor can instill hopefulness and relieve distress, but one has to trust that the doctor is practicing evidence based medicine, and fully informs the patient about every aspect of the treatment. If he recommends a medication, it’s because it has a good chance of treating the disease. Sometimes the doctor ends up treating unnecessarily, for example, if antibiotics are administered for what ends up to be a viral illness, the antibiotics had nothing to do with the resolution of the illness. But the reason to give antibiotics wasn’t for the placebo effect – it was to cover for the possibility that the illness was bacterial and treatable with antibiotics.

If an illness can be cured by the mind, is the illness real?

For this question I’d have to quote from Harry Potter and the Deathly Hallows (7th book in the series):

“Tell me one last thing,” said Harry. “Is this real? Or has this been happening inside my head?”

Dumbledore beamed at him, and his voice sounded loud and strong in Harry’s ears even though the bright mist was descending again, obscuring his figure.

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”

In the end, we all create our own reality in our head. No matter how intent we are on being factual, rational and logical (and I am), what’s real for us is what’s in our mind, and it’s probably something in between what the world is really like (way too depressing), and what we’d like the world to be (lovely, but not realistic at all). The reality in our minds is the only reality we have, so it’s as true as it’ll get for us, I believe.

Using suggestion in everyday life – without the pill

From the philosophical to the practical: We can all use suggestion. When you kiss your child’s scrapes and bruises better, or reassure them that they’ll feel much better tomorrow, or tuck them into bed and read to them a story with a happy ending when they’re feeling lousy, this is positive suggestion. This kind of suggestion needs no artifacts, involves no deception, and it really does work many times for many people. I’d rather encourage my kids to see health benefits in my kiss, love and reassurance, or power to their own positive thoughts than deceiving them into seeing magic in a sugar pill.

We shouldn’t believe blindly in pills, even real ones. Your doctor should weigh the evidence, and decide if the medication’s advertised effectiveness is supported by measured results for your specific condition. What we could believe in, is the power we all have to affect our health through the power of our mind. It’s very likely that a hopeful attitude and belief in our inner resources are important to our physical well-being and our ability to recover from illness or injury.

And above all, I really don’t think we should trick our kids or encourage gullibility. Kids prefer the truth.

Ayala