The Power of Placebos

One of the things that I have never understood, and may never understand, about modern medicine is its relentless refusal to accept and take advantage of the power of the placebo, a therapy prescribed for the psychological effect rather than the physiological effect that has been shown to work in randomized controlled trials (the supposed “gold standard” of proof in “laboratory medicine”).

This article in the May 2017 issue of the Smithsonian Magazine therefore piqued my interest. It focuses on “open label” placebos, substances that are explicitly prescribed as placebos and that evidently work well even when a patient knows that they are not real.

I was pleased to find that the driving force behind this research is Ted Kaptchuk, whose forays into placebo world I have eagerly followed for decades. Hired by Harvard Medical School originally to do research in Chinese medicine, he shifted his attention after one day asking himself, “If the medical community assumes that Chinese medicine is “just” a placebo, why don’t we examine this phenomenon more deeply?”

Among the results: in experiments with postoperative patients prescription pain medications lost half their effectiveness when the patient did not know that he or she had just been given a painkiller; and a study of the migraine drug rizatriptan found no statistical difference between a placebo labeled rizatriptan and actual rizatriptan labeled placebo.

One of my favorite of his investigations was a “placebo face-off” study that compared fake acupuncture (performed with retractable needles or when the pricks are made in the wrong spots) with sham pills. Both treatments worked (though fake acupuncture did slightly outperform sham pills), and via the so-called “nocebo” effect (in which a placebo creates a negative result instead of a positive one) both groups of test subjects suffered some of the potential side effects that researchers had predicted. A few of the pill-takers actually had to stop treatment because the side effects of their “medication” became so severe.

Perhaps mainstream doctors may start to realize that placebos actually “do” something, as functional MRI and other new technologies demonstrate that they, like real pharmaceuticals, actually trigger neurochemicals such as endorphins and dopamine, and activate areas of the brain associated with analgesia and other forms of symptomatic relief.

Perhaps modern medicine requires to be administered a placebo in order to become willing to accept the placebo?

Or maybe the problem is something much deeper: a loss of faith in faith as healer. Early in my own life my father recounted to me that one of his doctors had told him that faith is really what sets people right when their systems have gone wrong, and I have found in my own experience that this is absolutely correct. The placebo works because of faith. It does not matter much in what you have faith – in the physician, the medicine, a deity, a concept, your own organism’s healing powers – so long as you have it; if you sincerely believe that you can get well you (not always but very frequently) can get well.

Ayurveda explains this with the help of the two most common Sanskrit words for faith: vishvasa, which literally means “a special form of breath” – i.e. prana – and shraddha, which is derived from a root that means “heart”. When you can realign yourself properly with prana, and connect it to your heart so that fresh prana circulates to all parts of your organism, you will return to being the healthiest you can be for who you are at that moment.

May we all keep the faith!