Placebos also work without deception
Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.Sham drugs also work if the patient is informed. So it is not a belief in an active ingredient that helps. But what is it then?
It is common practice in hospitals and medical practices: In order not to burden the body of their patients too much with a pain reliever or sedative, doctors often prescribe drugs that do not contain any active substance. Nevertheless, they alleviate pain or let people slumber blissfully.
Placebos are what medicine calls these dummy drugs. At first glance, their use is a win-win situation. But he plunges medicine into a moral dilemma: after all, the doctor deceives the people entrusted to him with a dummy drug.
A recent study by Harvard Medical School shows that this may not be necessary at all. Openly used placebos could therefore have as great an effect as those secretly hyped. The study thus challenges the long-established view that patient deception is a key element of the placebo effect.
Open placebos seem like secret ones
"The effect of open placebos has shaken the belief that the effect of placebos is based solely on positive thinking," explains study leader Ted Kaptchuk to There is a widespread belief that the placebo effect is based on the patient's belief that he is receiving a drug that contains active ingredients. Kaptchuk has been researching the effects of placebos for over 20 years. Today he heads the Placebo Studies and the Therapeutic Encounter (PiPS) at the Beth Israel Deaconess Medical Center.
Placebos for irritable bowel syndrome
For their current study, the researcher and his colleagues had won a total of 270 irritable bowel patients as participants. Irritable bowel syndrome is associated with excruciating abdominal pain, diarrhea and flatulence and can severely impair the quality of life. Its causes are not yet known, and treatment options are limited.
The scientists informed some of the participants that they were receiving a placebo. But they were also told that the placebo effect could improve their symptoms. Another group was treated "double-blind": Neither the doctors nor the patients knew who was receiving a placebo and who was receiving a dragee with mint oil. The latter is said to be able to relieve irritable bowel symptoms.
There was also a control group that received no medication. This is important because in diseases such as irritable bowel syndrome, the condition can change quickly on its own even without medical intervention.
Open placebo as effective as mint oil
The result: In participants who had received openly a placebo, the irritable bowel symptoms improved on average just as well as in the “double-blind” group - and even just as well as in the group with the mint oil therapy. Conclusion: In the end, all three groups had benefited equally - all showed, on average, significantly greater improvements than in the control group, which had neither received a dummy drug nor the mint oil.
In the open placebo group, almost 70 percent of the participants responded to the treatment. 30 percent of the open and double-blind placebo recipients reported an improvement in their symptoms of 150 points or more on a 500-point scale. In the control group it was only 12 percent.
"If the assumption that deception is necessary for placebos to work is wrong, then many theories about the mechanisms that trigger placebo effects may need to be changed," says Kaptchuk.
Effective even with skeptics
“We don't really know how it works,” says the researcher. The conscious conviction of the effect does not seem to be the sticking point: "The condition of patients who have higher expectations of the effectiveness of the treatment does not improve more clearly than that of patients who are skeptical about the effect," reports Kaptchuk. "In fact, most of our patients are very skeptical."
Unconscious reaction to known rituals?
The scientists' hypothesis is that unconscious physical reactions to medical rituals that one has internalized play a role in the placebo. If you have already experienced several times that you feel better after swallowing a tablet, your body will also react to a drug-free preparation. And apparently even if it is an openly administered placebo.
Basically, it is a phenomenon that the Russian Nobel Prize winner Ivan Petrovich Pavlov described for the first time in his famous dog experiment: classical conditioning. Dogs that kept hearing a bell shortly before eating began to secrete saliva at some point when the bell rang, even if there was no food.
"Placebos cannot shrink tumors"
A total of twelve studies are known that have proven the effectiveness of openly administered dummy drugs, reports Kaptchuk. But they are not miracle cures. “Placebos cannot shrink tumors or correct pathological organic changes,” says the researcher.
They worked best for symptoms such as chronic lower back pain, migraines, cancer-related fatigue, or hot flashes during menopause. Parkinson's patients and people with depression have also been shown to benefit from the placebo effect.
Neurobiological basis
“The placebo effect undoubtedly has a neurobiological basis,” says Kaptchuk. However, the fact that the nervous system plays a role does not mean that the effect is pure imagination: For example, researchers have been able to prove that the body releases its own opioids when given placebos, which reduce pain.
Neurological circuits can also be positively influenced by the administration of placebo. This could, for example, affect the complex nerve network that controls bowel activity - and thus also affects irritable bowel symptoms. Even changes in heart rate and blood pressure were found after the placebo was administered.
Saline solution instead of morphine
Field hospital doctor Henry Beecher discovered how great the power of placebos can be in World War II. When he ran out of the highly pain-relieving morphine, in his desperation he injected severely injured soldiers with pure saline. It helped. His book "The Powerful Placebo" was published in 1955 as the first scientific treatise on the subject.
Today, every drug that comes onto the market has to assert itself in a double-blind study against the placebo effect - that is, work better than the dummy medication.
Targeted use of the placebo effect
With his research, Ted Kaptchuk also wants to ensure that the placebo effect is used more specifically in medicine in the future. Instead of always hunting for better active ingredients, it would be just as important to decipher how to achieve an optimal placebo effect. This could then be an essential part of medical care.
Because there is much more to it than administering drug-free pills. In addition to the power of the medical ritual, the treatment situation, the relationship between doctor and patient, and feelings of trust and hope also play an essential role in the healing process.
Obfuscation is unnecessary
Deception doesn't fit into the picture. A patient who learns that they have been secretly given a dummy drug will lose trust in the doctor. Kaptchuk's current and previous studies show that you can have both - placebo effect and sincerity.
“The ethical aspect is why I started researching open placebos,” says Kaptchuk. “We need to rid placebos of the stigma of deception. This is unimportant for the clinical effect.
