Placebos can bring relief—even if you know they're drug-free.
When patients complain of certain difficult-to-confirm pains and problems, physicians face a paradox: They know that placebos can help, but passing off dummy drugs as medication is unethical, a breach of the patient's trust. A sugar pill's magic lies in deception—the patient must believe she's getting the real thing. Right?
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Wrong, according to a groundbreaking study published in PLoS One. Researchers asked patients suffering from irritable bowel syndrome (a common, hard-to-treat disorder with mostly subjective symptoms) to take placebo pills twice a day. They told participants that the pills had no active ingredients, but—this is key—they also explained that placebos can improve IBS symptoms "through mind-body self-healing processes."
By the end of the three-week trial, 59 percent of pill takers (vs. 35 percent of controls) reported adequate relief. The placebo also doubled the degree of symptom reduction and improvement in quality of life.
"People thought we were nuts for doing this study," says Ted Kaptchuk, a researcher at Harvard Medical School. "Everyone just assumed effective placebos require deception." But the findings suggest that knowing you're not getting any real medication won't automatically neutralize the benefits.
The exact mechanism of the placebo effect is unclear. Part of it is expectation: Tell yourself you're going to feel better, and subjective symptoms, at least, improve accordingly. Conditioning also plays a role—if your body has learned that the act of swallowing a capsule precedes relief, taking a few pills might bring on the physiological changes real drugs can yield. "We told participants they didn't have to believe in the placebo effect at all—but they had to take two pills a day," Kaptchuk points out.
Some experts argue that the placebo effect can be chalked up to special attention and care from a physician. "Our study shows that that isn't all there is to it," says Irving Kirsch, a researcher at the University of Hull in the U.K., who coauthored the study. The placebo and control groups had equal face time with health professionals, but the placebo group saw more dramatic improvement. "On the other hand, the control group also improved, and that indeed may have been attributable to the therapeutic relationship," he adds.
The next steps involve replicating the findings in larger populations and seeing whether the effect holds up for other medical conditions. "Our experiment is just a first step toward a whole new strategy," Kaptchuk says. "People need to understand they have this huge capacity for self-healing."