The placebo effect comes from the brain, quite simply. Our nervous system has the ability, under certain circumstances, to secrete endorphins (natural morphine) that numb the pain, at least temporarily. This is why an injured person may not start to feel pain until half an hour after breaking their leg. Other substances naturally present in the brain have similar effects.
The intensity of the placebo effect is favored by two types of circumstances: on the one hand, the trust and expectations that the patient has towards the caregiver (regardless of their specialty or status), and on the other hand, the caring attitude of caregivers towards patients.
The placebo effect is therefore defined as a modification of the body resulting from the symbolic meaning that the patient attributes to an event or object in the care environment. In other words: the placebo effect is directly linked to the patient’s perception of the circumstances and the way in which they are being treated.
It is the placebo effect that explains, for example, why many patients suffer less when leaving the doctor’s office than when entering, even though the doctor has not done anything specifically therapeutic. (The nocebo effect explains why some doctors, through their attitude, aggravate the symptoms of the people who consult them…)
The placebo effect also explains why a child who has hurt themselves can quickly find relief from a kiss on the forehead. Or why taking an aspirin tablet relieves a headache 5 minutes after swallowing it, even though the active substance has not yet been absorbed by the intestine.
In this placebo effect, the relational part is the determining element: in operated patients, postoperative pain is less, with the same quantity of analgesics, for patients to whom the anesthesiologist has explained the painful phenomena and the treatment, than for patients to whom nothing has been said. Thus, an experiment has shown that openly administering physiological serum to a patient (in an automatic syringe placed near the bed) is as effective on pain as an injection of morphine given without the patient’s knowledge!
Similarly, the words a doctor uses to accompany an effective treatment alter its effectiveness. Prescribing a painkiller by saying “it’s very effective” produces better results than saying “it might be
After discussing the placebo effect in a book of the same name (The Placebo Effects), Fabrizio Benedetti recently published another astonishing book entitled The Patient’s Brain. In it, he explains, thanks to advances in neuroscience and brain imaging, which neurological circuits mediate the beneficial effects of the caregiver-patient relationship. This important book, which has just been published, should be read by all doctors. I therefore recommend that you recommend it to those you know – because ALL doctors use the placebo effect, sometimes without knowing it, but also, often, without using it to the best benefit of patients.
Ethical problem?
Even more importantly, the use of a placebo poses a major ethical problem: can we treat someone’s symptoms by making them believe that the inert tablet we are giving them is an effective molecule – in other words, by lying to them?
Well, a recent study shows that there’s absolutely no need to lie. In December 2010, an Anglo-American team published a therapeutic trial on patients suffering from irritable bowel syndrome. This chronic illness is one of the 10 most common reasons for consulting a family doctor, with symptoms including abdominal pain and constant discomfort related to intestinal problems (alternating gas, diarrhea, and constipation).