What does placebo mean? Placebo, what is it in simple words. Interesting facts about the placebo effect

In medicine, cases have been recorded when patients recovered due to taking drugs whose effectiveness has not been proven. Moreover, clinical studies confirm that the medicinal value is approaching zero. In this case, there is a placebo effect - curing yourself with almost the power of thought.

Placebo: what is it

Almost two hundred and fifty years ago, doctors described the facts of the recovery of patients after taking substances that are not drugs, but passed off as such.

In simple words, we can say that the patient receives a "dummy" that imitates a tablet, capsule, injection. There are no medicinal components in its composition and, logically, it should not “work”. But in reality, it turns out that the patient receives “treatment” and recovers.

The phenomenon was called "placebo" and was subjected to repeated study by psychologists and physicians.

For the purity of the experiment, double-blind studies are often carried out. In the experimental group, the experiment is controlled by neutral scientists. At the same time, neither the patients nor the doctors treating them know which of the patients receives drugs, and which - their imitation.

Example 1 Psychiatry

A doctor in a psychiatric clinic located in one of the cities of the United States treated patients suffering from violent attacks. Their behavior was aggressive, threatening the life and health of others.

At the initial stages, most patients of the clinic were kept in conditions of deprivation of activity - in straitjackets.

The management of the clinic went on an experiment in which, by prior arrangement, Dr. Medel's patients began to receive a new, hitherto unknown, but very effective medicine. This medicine allowed to stabilize and socialize violent crazy and mentally deranged patients.

Even the doctor himself didn't know who was getting the pills and who was getting the placebo. After some time, the doctor began to notice that the patients became calmer. They show adequate behavior, make contact and violent attacks become rare.

Patients talked, smiled, and the doctor was able to abandon the guard, which he had not parted with before.

Imagine his surprise when he learned the results of the test treatment. None of the insane asylum patients received medication, all took a placebo.

The therapy paid off because neither side of the experiment (neither the doctor nor the patients) knew who was receiving the medicine. Patients believed that a drug had been found that would help overcome their problems. And so it happened.

The doctor wanted with all his might to see the results, changes in the behavior and consciousness of his wards. He really "saw" them, thereby unwittingly influencing the sick.

A drug reserpine entered the history of psychiatry as the most effective placebo capable of treating people with mental disorders.

Example 2 Tuberculosis

At the turn of the 19th and 20th centuries, patients with pulmonary tuberculosis were observed in one of the German clinics. Scientists have not yet invented a medicine capable of defeating the disease, and mortality was extremely high.

Taking a risk, the medical staff informed the patients about the admission to the hospital of a rare, very effective and equally expensive drug that could overcome the disease within a month. The mentioned characteristics of the drug were important: new, effective, expensive.

Under the guise of know-how, patients received acetylsalicylic acid. But the belief in the effectiveness of a new drug delivered to the hospital specifically for them, potential suicide bombers, made it possible to cure 80% of patients.

Example 3 Pediatrics

In the United States, placebo drugs are widely used in pediatrics. American doctors are deeply and unshakably convinced that children should not be stuffed with medicines unless absolutely necessary.

Not only children, but also their parents often need a "magic" pill. Therefore, drugs of this kind are sold in pharmacies and consist of safe components that are allowed even for small children.

Pills "from laziness", "from fear", from diseases developing against a background of uncertainty, phobias are very popular. What is most surprising is that they bear fruit.

List of drugs considered placebo

The list of drugs marked as "dummy" is quite large. According to the Russian Academy of Medical Sciences, about a third of drugs on the modern pharmacological market are “dummy”. Many of them have a high cost and are popular with both doctors and patients.

1. Medicines to improve blood circulation, microcirculation - actovegin, cerebrolysin, solcoseryl;
2. Immunomodulatory drugs;
3. "Heart" drugs - ATP, cocarboxylase, riboxin;
4. and (linex, bifidumbacterin, bifidoc, hilak forte and others);
5. Means for improving cerebral circulation - piracetam, nootropil, tenoten, phenibut, pantogam, aminalon, tanakan, preductal;
6. Mildronate, mexidol;
7. Bioparox;
8. Polyoxidonium, grippol, gromecin;
9. Chondroprotectors - chondrosamine, glucosamine, chondroitin;
10. Valocordin, valoserdin, novopassitis;
11. Antithrombotic drug thrombovazim;
12. Essentiale N, mezim forte.

What enhances the placebo effect

Pharmaceutical companies that produce certain groups of drugs know the marketing moves. These methods increase not only the popularity (and hence the level of sales) of dummy drugs. They also help patients, despite the absence of the active substance in the composition of the drug:

• Patients like large, brightly colored tablets more than small, faded, colorless ones. Patients subconsciously develop confidence in outwardly visible drugs;
• A pronounced therapeutic effect is manifested in patients after taking drugs from well-known manufacturers compared to modest competitors, even if the composition contains the same active substance;
• Expensive medicines “treat” faster, more efficiently, and there is more confidence in them than in cheap analogues;
• After the end or interruption of the placebo "treatment" course, 5% of patients experience a withdrawal syndrome with pronounced symptoms;
• From 5 to 10% of patients experience the declared side symptoms, although there are no substances that can cause them in the medicine;

Placebo has a better effect on people with a labile psyche, anxious, gullible. They consider the doctor to be the last resort and trust him. Such people, extroverts, are easily suggestible. Low self-esteem and secret readiness for a miracle allow the placebo to "work" in full force.

Patients who are suspicious, suspicious, checking any information “by the tooth”, are less amenable to the influence of a placebo. They do not trust miracles and the charlatans who propagate them. After all, it is the subconscious and the willingness to believe that play a key role in the treatment with pacifiers.

Types of placebo

Placebo treatment is not limited to banal pills with a magical effect. There are several types of placebo:

Preparations

The most popular and extensive group. Under the influence of "powerful" pacifiers, migraines disappear, blood pressure normalizes, bleeding stops, even tumors, including malignant ones, dissolve.

There are many such examples described in the medical literature. In each case, the effectiveness is recorded and cannot be explained only by the impact on the consciousness and subconsciousness.

Imaginary surgical interventions

Surgeons use the placebo effect, replacing the real operation with a sham one, and achieve the same result as with a real intervention.

Surgeon David Callmes has been practicing spinal surgery for many years after severe injuries and fractures. He decided on an experiment, during which some of the patients were actually operated on. The other part was informed about the operation, although in fact there was none.

But what really happened was the reliable preparatory work with patients, the identical surroundings in the operating room.

As a result of a well-played performance, the well-being of patients improved. At the same time, pain disappeared and functions were restored. This means that somewhat different regeneration mechanisms come into play.

Placebo - acupuncture and homeopathy

Inspiring the patient to believe in the possibility of getting rid of a serious illness by inserting needles into the skin and taking homeopathic medicines makes it possible to achieve tremendous success in the treatment of mental and somatic diseases.

And yet, how does it work?

In psychology, the placebo effect is used not only to correct personal qualities, but also for training and education, development, and stabilization at any age. Placebo is based on suggestion. Properly executed suggestion triggers hidden mechanisms in the human body. This allows you to mobilize your own resources and defeat the disease.

Every doctor knows that there are patients for whom the attention of a medical worker is already a treatment. Suspicious, suggestible people, ready to believe in a magic pill, a unique procedure, rejuvenating apples and living-dead water, easily succumb to the temptation to be cured with the help of a miracle remedy.

Their body produces substances necessary for treatment, rejects pathological cells, promotes tissue regeneration, because the brain, confident in the effectiveness of treatment, gives the necessary commands.

For this category of patients, a good doctor is the one who prescribes drugs, will treat, and will not explain how to do without them. Just in such cases, the placebo contributes to the treatment, does not harm the body, causing, most likely, damage only to the wallet.

It has long been known that faith works miracles. Placebo - belief in the possibility of becoming healthy again despite predictions and possible negative options.

Information from Encyclopatia

Placebo - faith hidden under a thin shell of a pill / ampoule.

Comes from lat. placebo- please, satisfy("placere" - like).

History

The inventor of the phenomenon is the American anesthesiologist Beecher, who described it in 1955 after analyzing 15 studies, according to which 35% of patients out of more than a thousand felt improvement after using pacifiers. Even during the war, he drew attention to how the wounded, when morphine ran out, were injected with saline for pain relief (telling them that it was morphine), and they still felt how the pain passed.

In the not so distant 2008, there was a big scandal from Irving Kirsch, who, after analyzing a bunch of FDA studies, came to the conclusion that 82% of the effect of antidepressants is placebo. Srach does not subside to this day, posters are drawn “Depression does not exist!” and insane films like Psychiatry: An Industry of Death are being made, although due to gross violations of the calculations and methods of analysis, denials have long been published that tell us that patients on pacifiers fall back into depression much more often than on joyful pills.

However, the question of the strength of the placebo effect still remains open, because all the studies that have been conducted give conflicting data and are criticized from different angles, in light of which a second control group has been introduced into some clinical trials, which receives nothing at all.

What is this

The placebo effect is one of the subspecies of opium for the people: it is a subjective improvement in the patient's well-being, based on the belief in the effectiveness of the drug / method, in fact, not burdened with a real effect. The phenomenon is based on the natural suggestibility of each of us, fueled by external factors such as massive advertising, high prices or the authority of the specialist who prescribes / conducts this “treatment”. The placebo industry is incredibly developed due to the fact that where there is no effect, there are (mostly) no negative consequences either. Frightened by the side effects of real drugs, the masses are looking for painless methods of taking their banknotes from them and, of course, find them in the cozy arms of charlatans.

One of the highest quality pacifiers is popularly loved valerian, although glucose / lactose, calcium, saline, vitamins, olive / corn oil are more commonly used; also suitable are any colorful solutions, turned off devices (the main thing is that the bulbs are bewitchingly lit) and hypnosis: chilling stories about successful operations “under hypnosis” and without anesthesia are explained precisely by self-hypnosis.

Nocebo

The opposite effect, observed in fierce hypochondriacs and suspicious personalities: the pacifier causes pseudo-side effects from mild discomfort to panic attacks. However, nocebo also appears on normal drugs, when a person is very afraid of side effects and they appear all at once, regardless of the dose. Actually, by replacing the active drug with a pacifier, you can reliably find out whether these were real side effects, or nocebo.

How it works

Suggestibility, coupled with the expectations and hopes of a person, leads to considerable changes, because experiences, emotions and thoughts affect the biochemical processes in the brain. The latter, controlling the rest of the body, with its positive attitude and attitudes, can have a measurable effect on improving the condition. Complementing all this with immersion in the [comfortable] treatment process, attention and care from the doctor, we will get almost a panacea, although not all people are susceptible to it.

But there is a suspicion that the action of the pacifier relates more to the effect of the brain not on the body, but primarily on human behavior: from the point of view of psychology, a role-playing game is clearly seen in the behavior of the patient, since the status of the sufferer is based on specific socio-cultural stereotypes. In this case, placebo makes it possible to measure the degree of change in behavior from sick to healthy, taking into account the person's attitude to his actions and statements about his own state. This helps to explain the fact that most of those who received effective pseudo-treatment become discouraged when they find out about it, realizing the doubts that arise in the head about the seriousness of their symptoms.

It is interesting that endorphins are involved in the implementation of the placebo effect, which is associated with the body's ability to reflex (including under the influence of higher nervous activity) secrete endogenous opiates, catecholamines and corticosteroids into the blood,. This explains the apparent effectiveness of any acupuncture and the frequent satisfaction of patients with them.
In addition, the conditioned reflex mechanism of the effect was confirmed in mice: rodents were given syrup with an immunosuppressant, which objectively suppressed immunity, and after some time they were given just syrup, and it also led to immunosuppression.

At large specialists in quack placebo therapy, people queue for their opium, which they are promised by homeopaths, hirudotherapists, osteopaths and other magicians. According to various sources, the placebo effect is usually realized in 10–35% of cases, or even more, which, with the due artistry and persuasiveness of the “specialist”, can inspire faith in the kind of assistance rendered to many thousands of gullible people, including various intellectual level. Moreover, even when a person is aware that he is taking a pacifier, he may be subject to a placebo effect - a phenomenon called "meta-placebo".

In official Russian medicine, the effect is brazenly exploited by narcologists for the treatment of alcoholism with all sorts of “suturing” and “coding” that grossly contradict world practice (see links at the bottom of the page).

In normal medicine

The placebo effect has three rational applications:

1. As an object of comparison for this drug/method in efficacy studies (RCTs);
2. As a means of antihypochondriacal therapy in obese cretins of absolutely unconvincing patients with screams “Doctor, give me something!”. According to research in Denmark, up to 50% of doctors use pacifiers when treating patients at least 10 times a year (only these are not shit medicines, but antibiotics for viral infections). However, it must be remembered that it will not work to reproduce the placebo effect cited in the studies for a five-minute intake and administration of fuflomycin “to get rid of it”, this can only be done with a competent approach, normal interaction with the patient, care for him and only in addition to basic medical recommendations.
3. As a diagnostic method to separate real from imagined symptoms: 25% of those mentioned above used a placebo for just that.

Doctor, what will happen to me?

You will feel the unspeakable joy of experimenting on yourself if you find yourself in a research group. After signing a voluntary consent to participate in the experiment, you will get a huge set of attractions, where it is not known what exactly is the attraction, and what is just a sofa:

• Wart Removal: Patients are daubed with bright, inactive paints with the ardent promise of the disappearance of the warts as the paint fades. Someone's going down.
• For asthmatics, it is enough to say that they are taking bronchodilator drugs, so that in some of them the bronchi objectively expand (remember that asthma is partly psychosomatic).
• The pain after the extraction of the wisdom tooth goes away with both real and imaginary use of ultrasound (the main thing is that the device is turned on).
• Colitis is relieved by a pacifier in 52% of patients.
• Pain: Three groups of patients with severe pain receive different (without knowing it) dosages of the painkiller Buprenorphine (1 - 11.55; 2 - 9.15; 3 - 7.65) with appropriate instructions: 1 - you are not given pain medication; 2 - you are given either pain medication or a placebo; 3 - they give you one of the coolest painkillers. The result is the same reduction in pain in all three groups.
• Migraine: As a psychosomatic illness, it has a response to pacifiers. Moreover, when they are administered by injection, and not by tablet, the effect is 7% higher.
• Some surgeries: Those who have just had an incision and stitched back up sometimes do just as well as those who have had a normal operation (do not repeat with appendicitis!).

However, even without such troubles in the harsh reality, you may encounter:

• Drugs without proven efficacy: used as widely as one can imagine;
• homeopathy: sugar balls without active ingredient - a reference placebo worthy of the Chamber of Weights and Measures;
• acupuncture: another standard, only procedural - they poke with needles, some endorphins are produced - and voila! relief;
• osteopathy: these eccentrics crumple the external genitalia of the integument of the human body, promising to cure the internal organs;
• spa treatment: relaxation with a set of spa treatments, physiotherapy and climate has a beneficial effect even on a healthy person, but objectively only patients with tuberculosis and a couple of other severe illnesses need it.

The list of other attractions of all colors and sizes is endless.

More

• The scale of the Russian pharmacological placebo can be estimated;

A placebo (from the Latin Placebo, “I will please, please,” from placeō, “please”) is a medically ineffective treatment for a disease. A patient receiving a placebo believes in its effectiveness. In a person with such ineffective treatment, there is often a subjectively perceived or real improvement in the condition. This phenomenon is commonly referred to as the placebo effect or placebo reaction. Several different elements contribute to the placebo effect, and the way the placebo is administered can be as important as the use itself.

Placebo is an important methodological tool in medical research. Inert pills (such as sugar pills), infusions of inactive ingredients, sham surgery, and other procedures based on false information are often used as placebos. However, in a 2010 study, patients who knew they were receiving placebo pills showed greater improvement compared to those who did not know they were receiving placebo. In addition, the use of treatments that patients do not know about has been shown to be less effective than the use of treatments that patients have been informed about. The placebo effect is the subject of scientific research to understand the underlying neurobiological mechanisms in pain relief, immune suppression, Parkinson's disease and depression. Brain imaging studies by Emeran Mayer, Joanna Zharko, and Matt Lieberman have shown that placebos can have real, measurable effects on physiological changes in the brain. A placebo can produce some objective physiological changes, such as changes in heart rate, blood pressure, and brain chemistry, in cases associated with pain, depression, anxiety, fatigue, and some symptoms of Parkinson's disease. In other cases, such as asthma, the effect is purely subjective, with the patient reporting improvement despite no objective change in the underlying condition. The placebo effect is very common. In fact, it is part of the response to any active medical intervention. The placebo effect points to the importance of perception and the influence of the brain on physical health. The use of placebo as a treatment modality in clinical medicine (as opposed to laboratory testing) is ethically problematic because it involves the deliberate misleading of the patient. The Parliamentary Committee on Science and Technology of the United Kingdom stated that "prescribing a placebo ... usually involves some degree of patient deception" and "prescribing a pure placebo is a bad practice. The effect will be unreliable and unpredictable and cannot serve as the sole basis of treatment in the National Health System.” In 1955, Henry C. Beecher suggested that placebo use might have clinically important effects. This view was particularly challenged when a 2001 systematic review of clinical trials concluded that placebo showed no clinically important effects, except perhaps for pain management and efficacy in observing subjective treatment outcomes. The paper faced a flurry of criticism, but the authors later published a review of the Cochrane Collaboration with similar findings (updated as of 2010). In most studies, the difference from baseline until the end of the trial was attributed to the placebo effect, but reviewers examined studies that included both placebo and the untreated group in order to separate the placebo effect from the natural progression of the disease.

Types of placebo

Placebo is defined as "substances or procedures ... that do not objectively have a specific effect on the condition being treated." According to this definition, a wide variety of things can be called a placebo, and many things can have a placebo effect. However, the placebo effect may be part of true pharmacological therapy: the infusion of painkillers and anti-anxiety drugs surreptitiously, without the patient's knowledge, is less effective than if the patient knows he is receiving them. In addition, the effects of stimulation from implanted electrodes in the brains of Parkinson's patients are more pronounced if the patients know they are receiving the stimulation. Sometimes giving or prescribing a placebo turns into a medical scam. Usually, “sugar pills” or saline injections are used as placebo. Sometimes fake transactions are also carried out. An example is the Finish Meniscal Legion Study Group trial published in the New England Journal of Medicine, which found that sham meniscal surgery is as effective as the actual procedure. While examples of placebo treatments can be found, the definition of the placebo concept remains imprecise.

effects

The placebo effect is sometimes defined as a physiological effect caused by a placebo, but Morman and Jonas note that this seems counterintuitive since the placebo is an inert substance that does not directly cause any effects. Instead, they coined the term “significant response,” the response that the brain associates with placebo, which is what causes the physiological placebo effect. They suggested that placebo use, which may be unethical, could be avoided entirely if doctors were more supportive and encouraging of their patients. Ernst and Resch also attempted to distinguish between "true" and "perceived" placebo effects, as they argued that some of the effects attributed to the placebo effect may be due to other factors. Studies have shown that, for psychological reasons, some placebos are more effective than others. Big pills are more effective than small pills, colored pills are more effective than white pills, injections are more effective than pills, and surgery has a stronger placebo effect than injections.

Ethics

The placebo effect has always been considered a controversial issue. Prominent medical organizations endorsed the use of placebos, however, in 1903 Richard Cabot stated that the use of placebos in medicine should be avoided, as this method was associated with deception. Newman points to the "placebo paradox": it may be unethical to use a placebo, but it is also unethical to "not use something that cures." He proposes to solve this dilemma by introducing the notion of a "meaningful effect", that is, the judicious use of the placebo effect, as long as "the patient ... accepts the placebo honestly, openly, and believes in its potential healing power."

placebo mechanism of action

Because the placebo response is simply a patient response that cannot be explained by the action of the pill, there are numerous possible components of the placebo effect being measured. These components have different significance depending on the type of study and types of observations. While there is some evidence that placebo can alter hormone, endocannabinoid, or endogenous opioid levels, other known components of the placebo effect measurement include mean duration of exposure, regression to the mean, and imperfect study methodologies.

Expectation and conditioned reflex

The placebo effect is related to the patient's perceptions and expectations; if a substance is seen as beneficial, it can have a curative effect, if it is seen as harmful, it can cause negative effects, which is known as the "nocebo effect". In 1985, Irving Kirsch hypothesized that placebo effects are produced by self-perpetuating response-expectation effects, in which the patient's belief that they will feel differently leads the person to actually feel differently. According to this theory, the belief that the patient has received the active drug can produce subjective changes in his state of health. The placebo can act in a similar way with the classic conditioned response, in which the placebo and the actual stimulus are used simultaneously until the placebo becomes associated with the effect of the actual stimulus. Both conditioning and expectation play a role in the placebo effect. The conditioned reflex has a longer lasting effect and may affect earlier stages of information processing. Patients who are confident that the treatment will work show a stronger placebo effect than patients who do not believe the treatment will work, as evidenced by studies using acupuncture. A placebo disguised as a stimulant will have a stimulating effect on heart rate and blood pressure, while a placebo disguised as a depressant will have the opposite effect. If a person believes they are taking an ergogenic drug, their endurance, speed, and ability to lift heavy weights may increase. All of this leads to the question of whether placebos should be allowed in competitive sports. Because placebos are dependent on perception and expectation, various factors that alter perception can increase the placebo response. For example, studies have shown that the color and size of a placebo pill matters. Pills of "warm" colors are more effective as stimulants, while pills of "cold" colors are more effective as depressants. Capsules are more effective than tablets. Size can also matter. One of the researchers found that large pills increased the effect, while another argued that the effect depends on the cultural background of the patient. Motivation can contribute to the placebo effect. An individual's active goals change his somatic experience by changing the detection and interpretation of symptoms congruent with expectations, and by changing the strategy of the person's behavior. Motivation can be related to the meaning of how people experience illness and treatment. This meaning is derived from the culture in which a person lives and which informs him about the nature of the disease and how it responds to treatment. Placebo studies in the treatment of gastric and duodenal ulcers show that the effect varies widely across societies. The placebo effect in the treatment of gastric ulcers is low in Brazil, higher in Northern Europe (Denmark, Netherlands), and extremely high in Germany. However, the placebo effect in the treatment of hypertension in Germany is lower than in other countries. Although the placebo effect is generally associated with deception associated with positive expectations, studies conducted by Harvard Medical School have shown that placebos can work even without deception. In an attempt to use placebo fairly, 80 patients suffering from IBS (irritable bowel syndrome) were divided into two groups, one of which received no treatment, while the other was given placebo pills. Although patients were told that the tablets did not contain the active ingredient, patients reported relief of symptoms. Another similar study in which migraine patients were given pills labeled "placebo" found that patients reported improvements in their symptoms.

The placebo effect and the brain

Functional imaging in placebo analgesia shows that it is associated with activation and increased functional correlation between this activation in the anterior cingulate gyrus, prefrontal, orbitofrontal and insular cortices, nucleus accumbens, amygdala, central gray matter of the brain and spinal cord. The higher brain center regulates subcortical processes. A high placebo response is associated with an increase in dopamine and mu-opioid activity in the process of reward and motivated behavior responses in the nucleus accumbens, and, in contrast, anti-pain responses to nocebo were associated with deactivation of dopamine and opioid release in this part of the brain. (It has been known since 1978 that placebo pain relief depends on the release of endogenous opioids in the brain.) Such placebo analgesia alters information processing downstream in the brain by increasing downstream inhibition through the periaqueductal gray matter in the brain on spinal nociceptive reflexes, while anti-pain nocebo expectations act in the opposite direction. The brain is also involved in less-understood ways in non-analgesic placebo effects: Parkinson's disease: Relief from a placebo is associated with the release of dopamine in the brain. Depression: Depression-reducing placebos affect many of the areas that are activated by antidepressants supplemented with the prefrontal cortex. Caffeine: Decaffeinated coffee, if users are unaware of its lack of caffeine, results in an increase in the two-way release of dopamine in the thalamus. Glucose: Waiting for an intravenous glucose injection increases dopamine release in the basal ganglia in men (but not women). Methylphenidate: Anticipation of intravenous administration of this drug in inexperienced users increases dopamine release in the ventral cingulate gyrus and nucleus accumbens, and this effect is most pronounced in patients with no previous experience with the drug. Placebo functional imaging shows that the placebo response is “mediated by top-down processes dependent on the frontal cortex that create and maintain cognitive expectations. These expectations may be based on dopaminergic reward pathways.” "Diseases that lack this top-down or cortical regulation may be less associated with improvement with placebo."

brain and body

The brain controls the processes of the body that are affected by the placebo. When creating a conditioned response, a neutral saccharin stimulus is introduced into the drink with an agent that produces an unconditioned response. For example, this agent may be cyclophosphamide, which causes immunosuppression. After that, the taste of saccharin itself will induce immunosuppression as a new conditioned reflex through neural control from top to bottom. Such a conditioned reflex affects a wide range of not only the basic physiological processes of the immune system, but also processes such as serum iron levels, levels of oxidative DNA damage, and insulin secretion. Recent reviews state that the placebo effect is associated with top-down control of immunity and pain. Pacheco-López and colleagues raised the possibility of a "neocortex-sympathetic immune axis providing neuroanatomical substrates that could explain the association between placebo/conditioned reflexes and placebo/expectancy responses". A recent MRI study showed that a placebo can reduce pain associated with neural activity in the spinal cord, suggesting that placebo effects may extend beyond the brain. Dopaminergic pathways are involved in the placebo response in pain and depression.

Evolutionary regulation of health

Evolutionary medicine defines many symptoms, such as fever, pain, and illness behavior, as an evolved response to protect or enhance recovery from infection and injury. Fever, for example, is an evolved self-medication that allows bacteria or viruses to be killed by elevated body temperature. These evolved responses, however, also have a cost that, depending on the circumstances, may outweigh the benefit (due to this, for example, there is a decrease in temperature during malnutrition or at the end of pregnancy). According to Nicholas Humphrey's health management theory, the brain serves to provide responses only when the cost-benefit ratio is biologically beneficial. To do this, brain factors use a variety of information sources, including but not limited to the probabilities derived from the belief that the body will recover without deploying its costly evolutionary responses. One such source of information is the knowledge that the body is receiving care and treatment. The placebo effect in this sense occurs when false drug information misleads the health management system about the likelihood of recovery so that the body chooses not to deploy evolutionary self-medication.

Clinical utility

Clinical relevance

Asbjørn Hróbjartsson and Peter Gotzsche published a study in 2001, and subsequent studies in 2004, which questioned the nature of the placebo effect. The studies were conducted in two meta-analyses. They found that in studies with a binary outcome, that is, when an outcome was classified as improvement or no improvement, there was no statistically significant improvement in the placebo group compared to the untreated group. Similarly, no significant placebo effect was observed in studies in which objective data (such as blood pressure) were measured by an independent observer. The placebo effect can only be documented in studies where the results (improvement or non-improvement) are self-reported by the subjects. The authors concluded that the placebo effect did not have "powerful clinical effects" (objective effects) and that the improvements reported by patients (subjective effects) with respect to pain were small and could not be clearly distinguished from reporting bias. Other investigators (Wampold et al.) reanalyzed the data from the 2001 meta-analysis and concluded that the placebo effect on objective symptom scores is comparable to the placebo effect on subjective scores and that the placebo effect may exceed the effect of active treatment by up to 20% in disease states. susceptible to the placebo effect. Another group of researchers noted the strikingly different conclusions between the two groups of authors, despite nearly identical meta-analytic results, and suggested that the placebo effect is indeed significant but small in magnitude. The conclusion of Hróbjartsson and Gotzsche has been criticized on several grounds. Their meta-analysis covered studies in a highly mixed group of conditions. It has been reported that for measurements in peripheral organs, the placebo effect appears to be more effective in achieving improvement in physical parameters (such as reduction in hypertension, improvement in FEV1 in patients with bronchial asthma, or reduction in prostatic hyperplasia or anal fissure) than in improving biochemical parameters ( such as cholesterol or cortisol) in various diseases such as venous leg ulcers, Crohn's disease, urinary tract infections, and chronic heart failure. Placebos also don't work as well in clinical trials because patients don't know if they're getting real treatment or sham. When placebo studies are done in which people think they are getting the actual treatment (and not just the possibility of it), there is a placebo effect. Other authors argue that the placebo effect can be reliably demonstrated under appropriate conditions. Another publication by Hróbjartsson and Gotzsche, published in 2010 as a systematic review of the Cochrane Collaboration, confirms and modifies their previous work. More than 200 trials investigating 60 clinical diseases were included in the meta-analysis. Placebo interventions again did not show important clinical effects overall, but could affect patient-reported outcomes in some settings, especially for pain and nausea, although it was "difficult to distinguish patient-reported placebo effects from response error." The pooled relative risk they calculated for placebo was 0.93 (only a 7% effect), but significant. Effects were also found for phobia and asthma, but were inaccurate due to the high risk of error. In other settings involving three or more trials, there was no statistically significant effect for smoking, dementia, depression, obesity, hypertension, insomnia, and anxiety, although the confidence intervals were wide. Several clinical (physical placebo, patient outcomes, false information to patients that there was no placebo) and methodological (small sample size, explicit purpose of studying the placebo effect) factors were associated with higher placebo effects. Despite the low overall effects and the risk of error, the authors acknowledged that in certain situations, a strong placebo effect can be observed. In 2013, Jeremy Howick and colleagues used data from Hróbjartsson and Gotzsche to compare placebo effect size with treatment effect size. They found a statistically significant difference between the size of the placebo effect and the treatment effect in the binary trials but not in the subjective trials.

Negative Effects

Like the placebo effect, inert substances have the potential to cause negative effects through the "nocebo effect" (Latin Nocebo: "I will harm"). In this case, the intake of an inert substance will have negative consequences. Another negative consequence is that placebos can cause side effects associated with real treatment. One example of this is administering to people who have already been injected with an opiate, administering it as a placebo, and seeing them develop respiratory depression. Withdrawal symptoms may also occur after placebo treatment. This was discovered, for example, following the discontinuation of menopausal hormone replacement therapy by the Women's Health Initiative. The women used the placebo for an average of 5.7 years. Moderate or severe withdrawal symptoms were reported by 4.8% of patients in the placebo group compared with 21.3% of those on hormone replacement therapy. In addition, the use of placebo as a form of treatment is often difficult to practice ethically.

doctor-patient relationship

A study by Danish general practitioners found that 48% of doctors prescribed a placebo at least 10 times in the past year. The most commonly prescribed placebos were pacifiers disguised as antibiotics used for viral infections, and vitamins for fatigue. Specialists and hospital physicians reported much lower rates of placebo use. A 2004 study in the British Medical Journal of physicians in Israel found that 60% of physicians used placebos in their medical practice, most often to "fend off" requests for inappropriate prescriptions or to calm the patient. The accompanying editorial states, "We can't afford to do without any treatment that works, even if we're not sure exactly how it works." Other researchers argue that the open provision of placebo for the treatment of ADHD in children may be effective in keeping children with ADHD on lower doses of stimulants in the short term. Critics of this practice respond that it is unethical to prescribe a treatment that does not work, and that telling a patient (as opposed to the research subject) that a placebo is the real treatment is deceptive and harms the doctor-patient relationship in the long run. Critics also argue that the use of placebos can delay the correct diagnosis and treatment of serious illnesses. Physicians and pharmacists may face charges of fraud or malpractice when using a placebo. About 25% of physicians in studies in Denmark and Israel used a placebo as a diagnostic tool to determine if a patient's symptoms are real or if the patient is faking them. Both critics and advocates of the medical use of placebos agreed that it was unethical. The editors of the British Medical Journal stated: "Just because a patient experiences pain relief from a placebo does not mean that the pain is not of real or organic origin... Using a placebo to 'diagnose' whether or not pain is real is misleading." The use of a placebo may be a useful treatment in some specific cases where the recommended drugs cannot be used. For example, burn patients who experience breathing problems often cannot be prescribed opioids (morphine) or opioid derivatives (pethidine), as this can cause further respiratory depression. In such cases, placebo injections (normal saline, etc.) ) are useful in providing real pain relief in burn patients if non-delirious patients are told they are being given a powerful dose of painkiller. With regard to homeopathy specifically, the United Kingdom House of Commons Committee on Science and Technology stated: In the opinion of the Committee, homeopathy is a placebo treatment and the government should have a placebo policy. The government is reluctant to address the question of the appropriateness and ethics of prescribing placebos to patients, which is usually associated to some degree with patient deception. Prescribing a placebo is inconsistent with informed patient choice, which the government considers very important because it means patients do not have all the information they need to make a choice. Aside from ethical concerns and the integrity of the doctor-patient relationship, prescribing pure placebos is bad practice. Their effect is unreliable and unpredictable and cannot be the sole basis of any treatment in the National Health System. A study in the United States of more than 10,000 physicians found that while 24% of physicians prescribe a placebo treatment simply because the patient wants the treatment, 58% do not, and for the remaining 18%, it depends circumstances.

Changes in time

A review published in JAMA Psychiatry found that in antipsychotic drug trials, change in placebo response increased significantly between 1960 and 2013. The Review authors identified several factors that may be driving this change, including baseline inflation and fewer severely ill patients. Another analysis published in Pain in 2015 found that placebo responses increased significantly in neuropathic pain clinical trials conducted in the United States from 1990 to 2013. The researchers speculated that this might be because such trials "increased in study size and duration" during that time period.

Patients

Who is subject to the placebo effect

Placebos don't work for everyone. Henry C. Beecher, in a paper published in 1955, suggested that placebo effects occur in about 35% of people. However, this article has been criticized for failing to distinguish the placebo effect from other factors, and thus encouraging an inflated understanding of the placebo effect.

individual differences

Significant research was done in the 1950s to determine whether a particular personality type responded to placebo treatment. The received data cannot be replayed and this is now considered to have no effect. The desire for pain relief, "goal motivation", and how much pain relief is expected increases placebo pain relief. Another factor in the effectiveness of a placebo is the degree to which a person pays attention to symptoms, "somatic focus". Individual differences in response to placebo analgesics have been associated with regional neurochemical differences in the internal affective state of individuals experiencing pain. Patients with Alzheimer's disease lose the ability to perceive placebo, and this is due to the loss of the ability to have expectations, dependent on the prefrontal cortex. Children show a greater response to placebo than adults.

Genes

In social anxiety disorder (SAD), an inherited gene variant for tryptophan hydroxylase 2 (the enzyme that synthesizes the neurotransmitter serotonin) is associated with reduced amygdala activity and greater sensitivity to the placebo effect. The authors note that "more work is needed to clarify the generalizability of the findings." In a 2012 study, variations in the COMT (catechol-O-methyltransferase) genes associated with dopamine release played a crucial role in the placebo effect in patients with irritable bowel syndrome participating in the study, according to a research team at Harvard Medical School. Patients with the met/met variant, having two copies of the methionine allele, showed a greater likelihood of responding to placebo treatment, while the val/val variant, due to two copies of the valine allele, showed the least likelihood. The response of patients with one copy of methionine and valine was moderate. Dopamine release in met/met patients is thought to be associated with reward and "confirmation bias" that reinforce the feeling that the treatment is working. The role of COMT gene variations is expected to be more prominent in studies in which patients report more subjective conditions such as pain and fatigue rather than objective physiological measurements.

Symptoms and conditions

The placebo effect is stronger in some conditions than in others. Dylan Evans suggested that placebos are most effective for conditions such as pain, edema, stomach ulcers, depression, and anxiety, which have been associated with activation of the acute phase response.

Pain

The placebo effect is thought to reduce pain - a phenomenon known as placebo analgesia - in two different ways. One way is that the placebo triggers the release of endorphins, which are natural painkillers produced by the brain. Another way is that the placebo changes the patient's perception of pain. "A person may reinterpret sharp pain as an uncomfortable tingle." One way in which the magnitude of placebo analgesia can be measured is by conducting "open/covert" studies, in which some patients receive pain medication and report that they will receive it (open study), while others are given the same drug. without their notification (hidden research). Such studies have shown that analgesics are significantly more effective when the patient knows they are receiving them. When administered orally, placebos have clinically significant effects in reducing back pain.

Depression

In 2008, a controversial meta-analysis by psychologist Irving Kirsch in analyzing FDA data found that 82% of the response to antidepressants was placebo. However, there are serious doubts about the methods used and the interpretation of the results, in particular the use of an effect size of 0.5 as a cutoff point. A complete reanalysis and recalculation based on the same data from the FDA found that the Kirsch study had important calculation flaws. The authors concluded that while a large placebo response rate was due to expectations, this was not true for the active drug. In addition to confirming the effectiveness of the drugs, they found that the effect of the drug was not associated with the severity of the depression. Another meta-analysis showed that 79% of patients with depression who received placebo felt well (within 12 weeks of an initial 6-8 weeks of successful therapy), compared with 93% of patients who took antidepressants. In the continuation phase, however, placebo patients relapsed significantly more frequently than patients on antidepressants. A 2009 meta-analysis found that in 2005, 68% of antidepressant effects were due to placebo, more than double the placebo response rate in 1980. While some argue that it is ethical for a patient to give general consent to an unspecified treatment in advance, others argue that patients should always be given specific information about the name of the drug they are receiving, its side effects, and other treatment options. Although some patients do not want to be informed, healthcare professionals have an ethical obligation to provide proper information about a given treatment. There is such debate about the use of placebos because while placebos are used for the benefit of society to test the effectiveness of drugs, some argue that it is unethical to deprive individual patients of effective drugs.

chronic fatigue syndrome

It has previously been suggested that the placebo response rate in patients with chronic fatigue syndrome (CFS) is unusually high, "at least 30% to 50%", due to the subjective presentation of symptoms and the fluctuating nature of the condition. According to a meta-analysis and contrary to conventional wisdom, the overall response rate in the placebo group was 19.6%, which is even lower than for some other medical conditions. The authors suggest possible explanations for this result: CFS is widely understood as a difficult-to-treat condition, which will lead to lower expectations of improvement. In the context of the evidence showing that placebo has no powerful clinical effects compared to no treatment, the low rate of spontaneous remission in CFS may contribute to a slower rate of improvement in the placebo group. The type of intervention also contributed to the heterogeneity of the response. Low patient and physician expectations for psychological treatment may explain the particularly low placebo responses in psychiatric treatment.

List of medical conditions

The effect of placebo treatment (inert tablets unless otherwise indicated) has been studied for the treatment of the following conditions. Many of these quotes refer to studies showing that active therapies are effective, but placebo effects also exist.

Anxiety disorders

Autism: language and behavioral problems

Benign prostate enlargement

Compulsive overeating

bipolar mania

burning mouth syndrome

• Crohn's disease

  Depression

  Dyspepsia and gastric motility

  Epilepsy

  erectile disfunction

  food allergy

  Ulcer of the stomach and duodenum

  Headache

  Heart failure, congestive

  Mental retardation

  irritable bowel syndrome

  Lower urinary tract symptoms

  Migraine Prevention

  Multiple sclerosis

  Nausea: stomach activity

  Nausea: chemotherapy

  Nausea and vomiting: postoperative (sham acupuncture)

  Osteoarthritis

  Bladder overactivity

  Panic Disorders

  Parkinson's disease

  Psoriatic arthritis

  Reflux esophagitis

  restless leg syndrome

  Rheumatic diseases

  Sexual dysfunction: women

  social phobia

  Ulcerative colitis

Story

The word "placebo", which in Latin means "I will be pleased", goes back to the Latin translations of the Bible made by St. Jerome. In Hooper's 1811 Lexicon-Medicum, placebo is defined as "[any remedy] more adapted to please, rather than benefit, the patient." Early implementations of placebo control groups date back to the 16th century in Europe, when Catholic efforts were made to discredit exorcism. Individuals who claimed to be possessed by demonic powers were given false shrines. If the person reacted with violent convulsions, it was concluded that the possession was purely a figment of the imagination. John Haygarth was the first person to investigate the efficacy of the placebo effect in the 18th century. He tested a popular medical treatment of his time called "Perkins sticks" and concluded that the remedy was ineffective, demonstrating that the results of treatment with fake Perkins sticks were the same as with the original sticks. Émile Coué, a French pharmacist, while working as an apothecary in Troyes between 1882 and 1910, also argued for the effectiveness of the "placebo effect". He became known for reassuring his customers by praising the effectiveness of every drug and leaving a small positive notice for every drug sold. His book Self-Control Through Conscious Auto-Suggestion was published in England (1920) and in the USA (1922). The placebo remained a widespread medical practice until the 20th century, and the use of the placebo was sometimes commended as a necessary deception. In 1903, Richard Cabot said that he had been taught to use a placebo, but he eventually came to the conclusion, saying that "I have not yet come across a single case in which a lie did not do more harm than good." In modern times, T. C. Graves first identified the "placebo effect" in a published article in The Lancet in 1920. He spoke of the "placebo effect of drugs", which occurs when "it looks like there is a real psychotherapeutic effect." In 1961, Henry C. Beecher concluded that surgeons, whom he classified as enthusiastic, relieved their patients' chest pain and heart problems more effectively than skeptical surgeons. Beginning in the 1960s, the placebo effect became widely recognized and placebo-controlled trials became the norm for new drug approvals.

Placebo Controlled Studies

The placebo effect makes it difficult to evaluate new treatments. Clinical trials are testing this effect by including a group of patients receiving sham treatments. Patients in such studies do not know whether they are receiving treatment or placebo. If a person receives a placebo under one name, and if there is a positive effect, the person will respond in the same way later to that placebo under the same name, but not under another. Clinical trials are often double-blind, with researchers also not knowing which subjects are receiving active treatment and which are receiving placebo. The placebo effect in these clinical trials is weaker than in conventional therapy because patients do not know if the drug they are receiving is active. Knowingly giving a person a placebo if there is an effective treatment available is an ethically difficult issue. While placebo-controlled trials may provide information about the effectiveness of treatment, they do not provide some study patients with the best (possibly) available treatment. As a rule, informed consent should be obtained from patients, including informing patients that some subjects will receive placebo treatment. The ethics of placebo-controlled trials have been discussed in the process of revising the Declaration of Helsinki. Of particular concern is the difference between studies comparing inert placebo versus experimental treatment versus best available versus experimental treatment, as well as differences between trials in developed sponsoring countries and those in targeted developing countries.

Nocebo

A nocebo is the opposite of a placebo effect, where the patient believes that the treatment will cause the symptoms to worsen. This effect, which is now named after the nocebo analogy (Latin nocebo - "I will hurt"), can be measured in the same way as the placebo effect, for example, when members of a control group receiving an inert substance report worsening symptoms. Recipients of an inert substance can negate the placebo effect simply by having a negative attitude towards the effectiveness of the substance, which often results in a nocebo effect that is not caused by the substance but is due to other factors such as the patient's attitude towards their ability to recover, or even purely random. worsening symptoms.

Placebo Ingredients

Placebos used in clinical trials sometimes have unintended effects. A report in the Annals of Internal Medicine reviewing 150 clinical trials found that some of the placebos used in the trials affected the results. For example, one study of cholesterol-lowering substances used olive oil and corn oil in placebo tablets. However, according to the report, this "may cause the active drug to look less advantageous than placebo: the monounsaturated and polyunsaturated fatty acids from these 'placebos' and their antioxidant and anti-inflammatory effects can cause lipid-lowering and risk of cardiovascular disease. Another example reported by researchers is a clinical trial of a new treatment for cancer patients suffering from anorexia. The placebo that was used included lactose. However, since cancer patients tend to be at higher risk of lactose intolerance, the placebo pills may actually have caused unintended side effects that made the experimental drug look better.

Hello dear readers! Today we will talk about what the placebo effect is, its examples and possibilities of application in medicine, psychology, sports and self-improvement. Remember learning to ride a bike as a child? Do you remember how at that moment you fell and broke your knees, and how then your mother kissed your bruise, said that everything would pass now, and the pain subsided? Why is that? The healing properties of a kiss or self-hypnosis? This placebo effect is amazing! But what is this effect? And in general, is it really possible to be cured by the power of thought?

This term was discovered at the beginning of the 18th century. But interest in such a phenomenon was really shown during the Second World War, when an American anesthesiologist saw that an ordinary saline solution (roughly speaking, water with salt) had an effect as an anesthetic and subsequently conducted empirical studies and even wrote papers about it. - Powerful Placebo.

Tell me, have you ever turned to folk healers? Or did you even think about how homeopathy and other alternative medicine work, which promises miracle healing in one session? It's all the same effect! This is an amazing ability given to a person for self-healing. I would call it our super power. Thought is material and capable of miracles!

One of the most obvious examples of this effect has been familiar to us since childhood. Although the example is from a fairy tale, it illustrates life very well. Have you read The Wizard of Oz? So there Goodwin gave the Scarecrow stuffed with needles straw, and the scarecrow immediately felt sentient. The Tin Woodman was able to love with a piece of silk. And Leo became fearless, thanks to the smelling liquid. Classic placebo effect!

Studies proving placebo efficacy

One such example proving the effectiveness of a placebo: an experiment that was carried out in Germany at the end of the 19th century. In a clinic where tuberculosis patients were treated, doctors made announcements that scientists had found a cure for the disease and promised to provide it within 30 days. It is worth noting that the case was 2 centuries ago and of course, there was no drug then. Within two months, patients were stuffed with stories about this miracle drug, but in fact they were given ordinary aspirin, and surprisingly, during this study, 80% were completely cured.

In general, it was previously believed that a placebo removes only the symptoms, but does not cure the disease. But it is not so! In the placebo effect, the same parts of the brain that would have been affected by the drug are triggered. For example, when a painkiller is replaced with a “pacifier,” a patient who is convinced of the effect of the drug begins to produce endorphin, our natural pain reliever.

And in the United States, in general, Obestalp tablets have recently been released, containing only sugar glucose in their composition and intended to “treat children from laziness”. But how the medicine works becomes immediately clear if you read the English name of the drug in reverse (platsebo).

Who does placebo work on?

Unfortunately, placebos work differently for everyone. The effectiveness of such treatment is influenced by many facts, such as the patient's self-hypnosis, his character, faith in medicine. Suspicious people are much more prone to self-hypnosis. But even if a person has such a strong suggestibility that even a simple kiss on the knee can cure him, then this can also do harm. The placebo has the opposite effect and is called Nocebo.

If a doctor, for example, says that a rash may pop up when taking a medicine, then it will definitely pop up in a suggestible person. Therefore, physicians should consider these factors also for patients who are subject to such a mood of choosing the right words so as not to harm them even more.

One day, a friend of mine told me a story about how her classmate was bitten by a dog, and after reading information on the Internet, she came to the conclusion that she had rabies, just a couple of hours after the bite. Of course, in the clinic it turned out that she had no obvious symptoms, but injections into her stomach were still injected for prevention. This is how the reverse effect of suggestion works - the nocebo.

Taking advantage of the placebo effect

placebo in sports

Have you ever noticed that by believing in victory you achieved really grandiose successes for yourself? Of course, the opposite happens, but the mood is very important.

In any case, almost everyone has experienced this effect! Think not? Do you believe in omens? In sports, in work, in life in the end. Still think not? Often in the same sport there is a sign of wearing happy things - this is the same placebo effect. Wearing some happy thing, a person inspires himself that he will certainly win.

Sometimes coaches give dummy pills to athletes, and they say that this is doping. Indeed, athletes show much better results.

All experiments show not only the effectiveness of placebos, but also the fact that the human mind is capable of amazing things. Thanks to the possibility of consciousness, people can control their lives.

Placebo in psychology

One experiment made it possible to use the placebo effect in psychology. Doctors gathered one hundred and twenty people, one of them was given an orange pill, which supposedly was supposed to give them a surge of strength, energy and good mood. And for others, on the contrary, blue, which will give them drowsiness, bad mood and depression. And when patients began to be asked how they were feeling, almost everyone felt what they were told.

This allowed the use of placebos in psychiatry, often doctors instead of antidepressants give patients just ordinary yellow vitamins. Since the placebo subconsciously manifests itself in us not only from the type of pill (what color and shape it is), did you notice? And yet, it turns out that the higher the price of the drug, the more we tend to believe in its effect. This has been proven by experiment. Two different groups of people (who had previously been safely electrocuted) were given identical "pacifiers". Only one group was told that the pill cost ten cents, and the others that it cost two and a half dollars. And people who drank expensive drugs noticed an improvement faster than in the other group.

But what makes this effect unique is that even believing in the placebo effect itself leads to the manifestation of the effect itself. Even if the patient is told that he is being given some kind of ascorbic acid, faith in the power of autosuggestion leads to amazing results. This conclusion was reached after studies conducted at Harvard on 15 patients in 1966.

Placebo in psychosomatics

Many do not know, but psychosomatics studies the occurrence of diseases due to the influence of the human psyche. Indeed, many diseases are due to psychological factors. For example, sometimes chronic back pain is just the effect of suggestion of the psyche. Everything has been fine with the back for a long time, but the pain still lives in the human mind and he feels it physically. This is where a placebo can help! Sometimes in this case, if you convince a person, anything can help him, like a conspiracy, or some ordinary badger fat ointment, for example. The main thing is to convince him of his effectiveness.

How the placebo effect affects people's lives outside of medicine

Have you already realized that your brain is capable of much? He can heal our body, influence the fate and fulfillment of your desires. No wonder many people say that thoughts materialize, if you strongly desire something and think about it, you will get it. But also, if you set yourself up for the bad, then this will most likely become a reality.

Many people think that intuition and placebo are one and the same. The definition of intuition is the feeling of something. I do not believe that intuition is a placebo. Rather, sometimes they can be confused. For example, if you inspired yourself that your wife no longer loves you, and for a long time inspired yourself with this, and then once she stopped loving you, and you decided that it was your intuition that told you, and I am inclined to believe that this is a placebo. You made up your mind and it happened.

The placebo effect can help a person in self-education based on positive self-suggestion. Many believe that it not only has a beneficial effect on health, but also on the course of your life as a whole.

You need to act like this: make a list of positive attitudes that will help you in life and regularly reflect on them. The main thing is to believe that all the things from the list will come true.

If this phenomenon has become interesting to you, then on my own I recommend watching the film "Secret" of 2006 release. The question of the power of human self-conviction is also raised there, but it should be understood that self-hypnosis also has its limits, and the law of karma (the laws of nature and the laws of God) operates in the life of any person. Therefore, a person should not rely on self-hypnosis alone. - dedicated to a separate article on my blog.

This is where I want to end the article, I hope you learned something new and interesting about our capabilities. The main thing is not to allow bad thoughts into your life, only positive ones, and you will immediately notice how your life has improved. Remember that your mind can do more than you imagined. If you liked this article, then subscribe to my updates so that you don’t miss anything, and also recommend my blog to your friends. I would be glad if in the comments below you tell me about how the placebo effect has affected your life.

The placebo effect has been known since ancient times. Doctors resorted to it long before the advent of scientific approaches in medicine, and some resort to this day. A placebo is not a drug per se, it does not contain substances that can have a pharmacological effect. However, it is noted that the patient's condition after taking a placebo may improve. What is the secret of this effect? Let's try to answer this question in this article.

What is placebo

The term "placebo" should be understood as a certain drug that does not have active medicinal properties, but is used for medicinal purposes. The actual therapeutic effect in this case will be based on the patient's belief in the effectiveness of the drug. From a pharmacological point of view, a placebo is a neutral drug and has neither therapeutic nor side effects. Lactose, chalk, starch, sugar or any other substances without pharmacological effect are used as the basis. The actual composition of the placebo tablet does not matter, the main thing is that it is safe for the patient and does not have significant pharmacological effects. However, placebo is not only a pill, the term has a broader meaning and application. So, let's analyze everything in more detail.

The actual effect on the human body, based on self-hypnosis, has been known since ancient times. It was noted that for some patients it was especially important to gain confidence in their own recovery. However, in those distant times, medicine was still far from scientific methods and was based more on the personal experience and worldview of the doctor. Only in the 19th century did scientists try to define the placebo effect and describe its properties. With the development of pharmacology as a science, the placebo effect has been replaced by effective drugs that have proven their effectiveness. The placebo method has already lost its original significance, but in some cases it is used. The placebo effect is primarily used in the testing of new drugs. Also, the placebo effect is used in some areas of medicine (psychiatry, narcology). Many aspects of traditional medicine are based on the placebo effect.

Types of placebo

A placebo can be presented in the form of any form of drugs, be it tablets, solutions, powders, potions, etc. Only under the guise of a tablet, the patient receives starch or sugar, and under the guise of a solution, distilled water. A placebo can mimic any known drug, or it can be a "dosage form" in its own right. Also, the placebo effect can be used in the form of direct verbal suggestion. Regardless of the type of placebo, the patient must be convinced of the medicinal power of the drug. Whatever the type of placebo, verbal suggestion is best supported by some action, such as the issuance of a miracle pill.

In addition to the therapeutic effect, suggestion can also have a negative character. If a negative reaction develops to a harmless drug through suggestion, then this situation is called "nocebo". The nocebo effect is identical to the placebo effect, the difference is only in the expected final result after the procedure. Nocebo is used in narcology, suggesting that the most terrible complications will develop when taking alcohol.

The degree and ability to suggestion varies from person to person. The placebo effect does not appear in all the examined patients. However, there are some ways that increase the healing power of a placebo:

• Before taking a placebo, the patient must be informed in detail about the unsurpassed healing effect of this drug.
• The placebo pill should be bright, large, in a beautiful package.
• The inscriptions on the packaging should be bright and large, preferably in a foreign language.
• The price of a placebo also affects the effect, respectively, the more expensive, the more effective.
• The patient should not know that he is receiving a pacifier and not a real drug.

Having carefully read the factors that enhance the placebo effect, one can immediately recall the many advertised remedies “for all diseases”, which, when tested, turn out to be not drugs, but dummies, or placebos. Many of the treatments traditional healers and healers are basically nothing more than a placebo effect, presented in all sorts of forms.

Summing up the power of placebo, one cannot fail to mention homeopathic remedies. The essence of homeopathy is the use of herbal preparations at a dosage significantly lower than required for the pharmacological effect. Based on the data of modern scientific works, it can be argued that the effect of homeopathic medicines is entirely based on the placebo effect.

Self-hypnosis, of course, can alleviate the subjective state of the patient, especially with psychosomatic diseases. However, when it comes to organic pathology, diseases requiring targeted drug therapy or surgical treatment, it is unacceptable to use the placebo effect. A placebo can calm the patient, but not cure the real disease.

The placebo method is based on suggestion (or self-hypnosis) to the patient of faith in the medicinal qualities of the proposed medicine. The end result is explained to the patient, convincing him of the undoubted effectiveness of the drug, and in some cases he notes an improvement in well-being or a decrease in the symptoms of the disease. Strange as it may sound, but such a scheme works and is used quite widely. The placebo method itself has now acquired all sorts of masks. Never and nowhere will you be told that this treatment is based on the placebo effect. Thus, all kinds of healers, adherents of alternative medicine, magicians, etc. use the placebo method. It can sometimes be quite difficult to distinguish an effective method from the placebo method, but there are several rules that can be proposed to do this.

• Placebo is used for profit, treatment in this case will always be paid and expensive
• The interior design of the clinic will meet your expectations. If this is “oriental medicine”, then the employees will look like the Chinese, if you came to the healer, then the surroundings will be in the appropriate style
• Promises to heal the most severe ailments or diagnosing a non-existent pathology. Treatment will again be staged and lengthy (indefinitely long)
• The use of words such as: new, alternative, traditional, etc. Prevalence of foreign words, reference to authoritative surnames (previously unknown for some reason)

These circumstances should lead you to a critical assessment of the situation in which you find yourself. Ask such a doctor about the scientific publications describing his method, were there studies on his drug, where, when? Do not rush to take the word of such people, especially if you are an easily suggestible person.

The appearance of the placebo is very important, it should not cause doubts in the patient. A suspicious-looking placebo may cause the patient to doubt the therapeutic effect of the drug. A placebo must always be indistinguishable from the original drug if you want to get the maximum effect.

There is also the possibility that under the guise of a drug, you can sometimes buy a fake or a placebo. Suspicious drugs can be not only ineffective, but also harm the body. Always be careful when buying medicines. Here are some simple rules that will help you avoid buying counterfeit medicines:

• Make purchases only in large and well-known licensed pharmacies
• The packaging of the drug must not be damaged
• Don't buy prescription drugs
• Always check the expiration date of the medicinal product (after the expiration date, the medicinal product may not have a therapeutic effect, moreover, it may not be safe for health)
• Before going to the pharmacy, you should consult with your doctor. The doctor will help you choose the optimal drug in the required dosage.
• You should not save too much on medicines, especially you should not replace a drug prescribed by a doctor with a cheaper analogue

Every drug has a placebo effect to some extent. The suspicious appearance of some drugs may raise questions in the patient. Always ask your doctor about the effect of this drug before taking any medicine.

placebo drugs

As such, there is no "placebo drug" and cannot exist. A placebo is not a drug, it does not contain active substances. This circumstance is the whole point of using a placebo. However, placebos are still used in medical science, not as a medicine, but as a way to test other drugs for effectiveness. You should not assume that a placebo drug works for everyone to whom it was given. Some people do not notice the placebo effect at all, for someone the placebo has an effect only under certain conditions. A direct relationship was noted between trust in the doctor, the desire to be healed, and the placebo effect.

Let's look at what a placebo tablet consists of and what is its main difference from a drug. The placebo tablet is 100% neutral substance that does not have any pharmacological effects on the human body. Such substances include lactose, chalk, starch, etc. nothing else is contained in the placebo tablet. A drug tablet consists of a substance that has a pharmacological effect on the body. Such a tablet either consists entirely of a medicinal substance, or contains a neutral component in its basis. For example, a digoxin tablet contains only 250 micrograms of the active ingredient, and its bulk is represented by starch and lactose. This dosage of digoxin is sufficient to obtain the desired pharmacological effect. The placebo tablet consists entirely of starch or lactose and has no pharmacological effect.

Placebo

To get the maximum effect, taking a placebo must follow a number of rules:

• The patient should not know that he is being offered a dummy.
• The doctor should be as convincing and consistent as possible, explaining to the patient the medicinal qualities of this medicine.
• The placebo pill should not cause suspicion in the patient
• Placebo should be taken in a calm environment

It is unacceptable to treat diseases by prescribing a placebo. If the pathological process is based on organic pathology, then taking a placebo will not only not alleviate the patient's condition, but will also aggravate the severity of his condition. The use of a placebo is allowed only during clinical trials and only with the consent of the subject.

In order to confirm the effectiveness of a drug, it is necessary to conduct clinical trials. These kinds of clinical trials require the use of a placebo. The method for evaluating the effectiveness of an investigational drug is based on a comparison of indicators among 2 groups of people: those who took a placebo and those who took the original drug. Such placebo studies require extensive financial outlays, but eventually an evidence base for a particular drug can be obtained. Clinical trials of a new drug in general are reduced to the following algorithm:

• Form 2 equivalent samples of the examined persons
• One sample of individuals receives a new drug, the second receives a placebo
• After some time, significant clinical indicators are assessed, for example, blood pressure, severity of pain syndrome, body temperature, etc. The clinical indicator depends on the type of study and the characteristics of the pharmacological drug
• Carry out a comparative analysis between two groups of examined persons
• If the pharmacological effect of the new drug in the main group exceeds the pharmacological effect of the placebo in the comparison group, then such a study confirms the effectiveness of the test substance. If the pharmacological effect in both groups is the same, then the study drug is considered ineffective.

Such studies may differ in terms of sample size, conditions, quality of control, and the set of effects studied. However, the comparison of two (or more) groups without taking into account the placebo effect is considered unacceptable.

Placebo treatment

The first thing to remember is that a placebo is not a drug. Treatment of somatic pathology with a placebo is considered unacceptable. However, there are still a number of psychiatric diseases where the placebo method remains in demand. These areas include psychiatry and narcology. We will talk more about the use of placebo in narcology and psychiatry later.

There are also a number of diseases, united under the general name "psychosomatic diseases". The essence of psychosomatic pathology is the primary psychological factor that provokes (or exacerbates) somatic pathology. There are many theories and opinions about psychosomatic pathology, a special place is given to the stressful effect on the body of such a patient. The problem of psychosomatics is that a patient with a psychiatric pathology may suffer from a somatic disorder and vice versa - a patient with an obvious somatic pathology may have a psychiatric disorder. There is no clear boundary separating psychosomatic pathology into a separate nosological group. In this regard, such patients, who have already undergone full treatment, with satisfactory indicators of clinical tests, may still actively complain. A placebo may have a positive effect on such patients. It is noted that the authoritative and convincing statement of the doctor that the patient is healthy had a positive effect. A well-known aphorism says: “After talking with a doctor, the patient should feel better.”

Placebo is not used in the treatment of organic pathology. It is unacceptable to treat a disease based on metabolic disorders, inflammation, oncology, etc. with the help of a placebo. In such a situation, the disease can only worsen. Of course, there are situations when an inflammatory disease is resolved on its own. However, such an outcome is possible due to the body's own immune and regenerative capabilities, and placebo does not play a role here. Still continue to meet alternative medicine centers, where they successfully use the placebo effect. Always ask about new therapies that are being proposed to you, what they are based on, and whether they have passed clinical trials. If the specialist cannot adequately explain the method of treatment and scientific clinical trials of the method have not been conducted, then most likely they are trying to offer you a treatment based on the placebo method.

How fast does the placebo effect come on? It was found that the placebo effect occurs earlier than the action of many pharmacological drugs. Of course, there are drugs whose action occurs very quickly (novocaine, nitroglycerin, etc.), but for a better understanding of the speed of the onset of the placebo effect, let's take the following example. The headache patient took an aspirin tablet and the pain was significantly reduced after 5 minutes. Here we see a typical example of the placebo effect, since the effect of aspirin occurs only after half an hour. This circumstance also applies to other drugs of delayed action. Taking a pill, we are focused on the result, and sometimes we feel a quick relief of symptoms. However, it takes time for the active drug to enter the bloodstream, thus the effect of the drug does not occur immediately.

Placebo in pharmacotherapy

In pharmacotherapy, in some cases, the placebo effect is used. This method is used in those exceptional situations when the use of drugs does not bring the desired result. Placebo is used in pharmacotherapy in the treatment of diseases for which drugs have not yet been developed. Pharmacotherapy of clinical conditions using placebo is used in psychiatry and in the treatment of psychosomatic disorders.

Also, the use of a placebo is justified if the patient simulates the symptoms of the underlying disease. If suddenly a patient comes to the doctor who complains, deliberately misleading the doctor, then the appointment of a placebo in this situation may be justified. Relief of symptoms in response to placebo in this case contributes to the exposure of the simulator. A similar practice is found, for example, in the draft departments of the military registration and enlistment office, where the conscript is trying to get a deferral for health reasons, or in penitentiary medicine.

The placebo effect also develops in healthy individuals. It is very important what expectations precede taking a placebo. If the person being examined takes a placebo with positive motivation, he is sure of a beneficial effect and fully wants to get the result, then with a high degree of probability the placebo effect will be positive. On the contrary, in case of excessive focus on side effects, lack of motivation and purpose after taking the drug, the onset of a placebo effect is unlikely. In some cases, the nocebo effect develops when patients report complaints after taking a placebo pill.

Placebo in pharmacology is used to test new drugs in practice. The task of pharmacology is to develop new, more effective and safest drugs. The patient receives a drug for the purpose of stopping any disease. Find out how effective the new drug will be, how it will affect the human body, what side effects may occur, a placebo will help. If we compare 2 study groups, where one group of individuals receives a new drug, and the other remains without it, then the placebo effect is not taken into account during the experiment. If in both groups patients receive a tablet that is outwardly identical, but different in composition (i.e. one of the groups receives a placebo), then such an experiment takes into account the influence of the placebo effect and is more informative.

Placebo in psychiatry

The use of placebo in psychiatry is possible and in some cases quite justified. In psychiatry, recommendations for prescribing placebo therapy are followed:

• Placebo is used only after verification of the main diagnosis.
• The doctor monitors the effectiveness of such treatment
• Placebo is not used if there are effective drugs for the treatment of this disease.
• Placebo is given when the effectiveness of such therapy has been described in the scientific literature

Also placebo in psychiatry can be used to optimize treatment in psychiatric patients who are positive about medication. In this case, with the help of placebo, the main psychotherapy is supplemented.

There are scientific publications that describe the use of placebo in various diseases, including psychiatric. Let's talk about some of them:

In 1995, a team of scientists led by Dr. Sierra evaluated the placebo effect on sleep disorders. They noted the positive effect of using a placebo as a sleeping pill. By doing the ritual of taking a placebo pill every night before bed, some insomniacs fell asleep more easily. Episodes of their daytime sleepiness were also noted. However, not all patients noted a hypnotic effect and scientists did not find a strict pattern between taking a placebo and insomnia. Among the reasons for the effectiveness of the placebo, doctors noted the authority of the attending physician, the patient's desire to cooperate with the doctor.

In the Anxiety Disorders Study, the placebo effect was highly variable. A number of studies have noted a high placebo effect, however, in some publications, the placebo effect has not been found at all. Some people in the studies noted an aggravation of anxiety symptoms after taking a placebo, i.e. the nocebo effect was noted. Patients with panic attacks responded favorably to placebo. This circumstance was explained by the special personal qualities of patients suffering from panic attacks. In studies of depressive disorders, the placebo effect was observed in 30-40% of cases. The milder the case of depressive disorder, the more pronounced was the placebo effect. The manic patients also responded favorably to the placebo. The more confident the patient was in contact with the attending physician, the more often a positive placebo effect was detected. In all the clinical conditions described above, the effect of the placebo developed relatively quickly, within 3 days. However, in the treatment of schizophrenia, the effectiveness of placebo administration was extremely low, and the effect developed 10 or more days after placebo administration and developed gradually. The thing is that in schizophrenia, the patient's contact with the attending physician and the surrounding reality as a whole is especially acutely disturbed. The personality with this disease undergoes significant disturbances, the patient is not able to perceive reality sensibly, criticism of his own condition is rudely reduced and there is no desire to recover. The whole complex of psychiatric pathology in schizophrenia changes the personality type of such patients, preventing the effective use of placebo among them.

Placebo in narcology is used in the treatment of alcoholism. According to the results of research in this area, extreme instability was noted. Patients suffering from alcoholism showed different results on placebo. The same patient on one day of taking a placebo could notice a change in his condition, on the other day he could not notice any changes at all. It was noted that in the treatment of alcoholism, along with pharmacotherapy, the main role is played by the orientation towards a sober lifestyle, support from the close environment, and individual motivation. Some experts note the low effect of pharmacotherapy in the treatment of alcoholism. Attempts to get in touch with the patient, to identify the causes of alcoholism and resolve them, brought more significant results. In the treatment of drug addiction, a result comparable to that of alcoholism was obtained. Placebo pills did not cause a stable remission of the disease. However, the support of family, friends, a trusting relationship with the attending physician brought results.