The Placebo and Nocebo effects

          When scientists perform studies that involve administering substances to patients, the latter are usually divided into groups, one of which is the ‘control group’. Instead of being provided the true chemical or medicine, this one is given a neutral ingredient which has no effects. For instance some pill made of sugar. Of course, individuals are not revealed that they are not being supplied the real substance. This allows controlling the non-specific psychological and social effects of a certain treatment.

          But some people in the control group truly experience benefits and remarkably heal with mere inert pills. This is the famous placebo effect. The matter has always been uncanny for the world of medicine, because those benefited by the placebo may vary between 30% and 60% of the patients. Let’s notice that these heal basically because they believe that they are receiving the original medicine!

          For skeptical medicine, placebo effects are considered in the best case irrelevant. Still… if we approach the issue in a serious manner, research involving placebos provides critical information about how mind, body and culture contribute to heal. We can assume placebo as a very useful tool: evaluating factors that enhance placebo may contribute to a science of healing.

          What does this have to do with emotions, anyway? To illustrate let’s face the very opposite phenomenon: What happens if the doctor supplies the medicine which is indeed effective –this time no sugar pills- but he suggests with a negative opinion that it won’t work? Although this might occur without bad intentions, in some patients it has such a negative impact that the term that best describes it is nocebo effect.

          The idea of nocebo has been validated in environments like surgery rooms. In spite of patients being under anesthesia and unconscious, if surgeons comment things such as ‘the odds of healing are low’ or ‘the situation is much more critical than expected’, the former are prone to undergo these prognoses and show no recovery. Then, habitual practices in operating rooms nowadays involve preventing any negative observations during the interventions.

          The famous self-help author and doctor Deepak Chopra has dived deeply into mind-body medicine. He concludes that the more positive the opinions expressed by the surgeon are, the more positive will be the result for the patient. He understands that the deepest matter is that anything can work as a placebo or as a nocebo, since the interpretation of the patient –whether about an innocuous medicine or about the doctor’s attitude- is strongly influential. Chopra has witnessed cases of spontaneous remissions in severe episodes, taking place within a framework of positive attitudes adopted by the sick person.

          Emotions derived from interpretations have a real effect on the immune and endocrine status of the body.

          In short, the context in which a treatment is offered changes the whole direction of the treatment itself and its effects. Neither interventions nor placebos are indifferent to the meaning assumed by the patient.

          Walach and Jonas researched how to maximize the factors that contribute to placebo. They identified, among others, the following ways of enhancing healing:

  • Relate the appearance of the pills (i.e.: color, size) with the desired effect.
  • Provide therapy in a warm and friendly manner.
  • Provide therapy with confidence and in a believable way.
  • Determine in which treatment the patient believes and in which one not.
  • Make sure –as therapist- that you believe in the treatment.
  • Add reassuring, relaxation and anxiety reduction methods.
  • Listen with empathy and understanding.
  • Touch the patient.

          I indicated certain words in the items above with italic font. Notice that they refer directly to emotional issues or are closely linked to them.

          The attitude of medicine professionals and the relationship between patients and doctors are essential to foster favorable emotional processes which can bring about benefits in the body. That is, enhance health by increasing immune defenses, regulating hormones and neurotransmitters as well.

          The patient’s certainty about his healing and about the positive results of a certain treatment is also fundamental. And this is related to hope, faith, and all emotions that anticipate a fortunate future.

 

 Ref.:

  • Chopra, Deepak (1989), La Curación Cuántica: Explorando las fronteras de la medicina mental y corporal; Grijalbo; México DF, 1998; (pp 173 a 179).
  • Walach, Harald and Jonas, Wayne B. (2004), <<Placebo Research: The evidence base for harnessing self-healing capacities>>; The Journal of Alternative and Complementary medicine, Vol. 10, Suppl. 1, 2004, pp S103-S112.
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One Response to The Placebo and Nocebo effects

  1. Mini says:

    Definitely food for thought…

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