Steve Silberman’s Wired feature on the placebo effect is drawing deserved praise today.
Its chief contribution may be in highlighting the work of Fabrizio Benedetti (right, from the Swiss Federal Institute of Technology), who has been getting inside the chemistry of placebos for years.
In a 2006 paper he describes how opioids, chemicals produced by the body under stress, have a real impact in reducing symptoms.
The best known is dopamine, but the key point is these chemicals are released on orders from the brain as it tries to predict the future, and they work.
In other words the ritual of taking medicine, and the marketing of medicine, can both have a positive impact on our reaction to even a simple sugar pill.
This also works in reverse, and is called the nocebo effect. We go to the doctor to have our blood pressure checked and “white coat syndrome” causes our blood pressure to rise. If you expect chemotherapy to be painful, it will be more painful.
Thus the better U.S. drug makers get in convincing people that their products are good for them, the more difficult it is to get new drugs approved, thanks to the placebo effect. We get better in part because we believe we will, especially if we are participating in a clinical trial.
The result could be hybrid therapies in which placebo effects are harnessed to reduce the nocebo impact of chemotherapy or other painful procedures. It could also transform the world of mental illness, where placebo effects are most pronounced, and where drugs have been rapidly replacing talk therapy.
If talk therapists can harness the placebo effect, they may not need to routinely prescribe antidepressants that have trouble beating the placebo effect in trials.
