The Placebo Effect, Nocebo Effect and Belief
This is a transcript of podcast EP007. If you like, you may listen here. (I get small commissions for purchases made through the Amazon affiliate links on this post.)
In this article, I'll be talking about:
- The placebo effect, which you probably heard of, but I'll be going deeper.
- The nocebo effect, which you may not have heard of.
- And the thing that they both have in common: BELIEF.
The word placebo was first used in the late 18th century. It comes from the Latin word placere, meaning to please.
In the dictionary, placebo is defined as a substance that has no therapeutic effect that is used as a control and testing new drugs. The placebo effect is a beneficial effect that's produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself and must there for be due to the patient's belief in the treatment. So you probably heard of the placebo being the sugar pill which it can be, but it can also be a surgery or any other treatment.
I want to talk a bit about how the placebo effect changed a career. I talked about Dr. David Hamilton in the last episode, but he's going to come up again today. He earned his PhD in organic chemistry and worked for four years in the pharmaceutical industry. While in that capacity, he worked creating drugs primarily for cardiovascular disease.
Once they've created a drug, they have to test it. You test it using both the drug itself and a sugar pill that is manufacturer to look exactly like the pill. The researchers know who gets which pill but the patients don't.
And they would give each of those 100 people and then follow the results. A good result would be if the drug had a 75% rate of improvement. While that would be good, sometimes they will find that a placebo can have an effect as high as from 50 to 80%!
He worked specifically on a cholesterol lowering drug that, in the trials, the five year survival rate on that drug was 80%. However, the survival rate for those on the placebo was 79.1%.
In a Hay House World Summit 2018 interview Dr. Hamilton said,
“But what was amazing is believing in the drug or believing in a doctor or believing in something was actually producing — you're producing your own biology and your own biology produced by your mind was what was carrying out the healing and overruling the effect of the drug. And I thought this was ridiculously fascinating.
So I resigned after four years because I thought, wouldn't it be great if people could learn how to harness this ability for themselves? And that would give people a sense of hope and power. Something perhaps they could do in their thinking adjustments to their thinking that could perhaps make them healthier.”
So the placebo effect — the idea that believing you're getting a real drug could produce the same result as the drug itself — it took everyone by surprise in his book how the mind can heal the body.
Dr. Hamilton says: “The placebo effect has evolved from being thought of as a nuisance in clinical pharmacological research to a biological phenomenon worthy of scientific investigation in its own right.”
The placebo effect is an interesting phenomenon too, sometimes having unexpected results:
- The color of a pill can make a difference. There were some studies where a blue pill performed better than a pink pill.
- In some studies, people were given an inhaler and told it would relax their airways. And it did.
- People also respond to brand name drugs, more so than generic. Somehow that name or maybe the more expensive they feel like it should be more effective.
- Even the name of a drug can impact its effectiveness. He talks about the drug Viagra and suggested in part it could be effective because its name is similar to Niagara, as in Niagara Falls, which is considered a powerful force in nature.
The nocebo effect though, the term nocebo is fairly new. It was coined by Walter Kennedy in 1961. It comes from the Latin word, nocere, meaning to harm.
According to Dr. Hamilton, the nocebo effect results when a patient develops negative symptoms. When they gave people an inhaler and told them it contained allergens, their airways would constrict, even though the inhaler contain only water,
“With nocebo, you give a viable drug, but the patient doesn't respond, because the doctor has signaled that the drug isn't going to work." He goes on to say anything can function as a nocebo just as anything can function as a placebo. It is not the dummy drug, the doctors bedside manner or the antiseptic smells of a hospital that does harm or good. It's the patient’s interpretation of it.”
Dr. Chopra tells of findings related to surgery the validate the idea of nocebo. For decades, doctors believed that anesthesized patients were unconscious and therefore not influenced by what was said and what happened during their surgery. But it has since been discovered that people undergoing surgery could hear every word. They may not remember it consciously, but post surgical hypnosis has shown that they do hear and remember what goes on during surgery. Which means that a negative prognosis mentioned during surgery could impact the outcome for the patient.
Dr. Chopra says: “As a result of these findings, which validate the idea of nocebo, it is now standard practice not to make negative remarks during surgery. The more positive the surgeon’s expressed opinions, in fact, the more positive the outcome for the patient.”
It's obvious that belief is a large part of both the placebo and the nocebo effect. What we choose to believe can be powerful. It can have either a positive or negative effect.
Like the people who visit the church into Chimayo, New Mexico — El Santuario de Chimayo. There's a holy dirt there that is believed to have healing powers. My husband and I visited the church a few years back on our way to Taos. There was something very spiritual and moving about the church and the grounds. You could actually buy some of that holy dirt there. My husband suggested the holy dirt could not have come from the pit where people were taking it, simply because it would have been emptied years ago. Yet there were testimonials of healings and abandoned crutches in the prayer room, at the church.
Belief, alone, can be a powerful healer. I've heard stories of people in their beliefs. Like the woman who upon receiving a diagnosis of multiple sclerosis, remodeled her home to make it wheelchair accessible. She no doubt eventually needed that wheelchair.
Meanwhile, Dr. Terry Wahls was in a wheelchair at one point with her MS and healed herself by changing her diet.
What we believe can be powerful, much more powerful than we can even imagine.
I've read studies where they had one group actually practice throwing a ball for so many minutes each day, and another group to just practice throwing the ball in their mind. To just sit and think about the motion of throwing the ball, But for the same amount of time. The throwing ability of both groups improved almost equally.
The brain really can't distinguish real from imaginary. So what you're imagining happening on some level, to the brain, is actually occurring, taking place. If your belief in a doctor or a drug can change your biology, then perhaps we don't even need those drugs to effect change. That would be a powerful belief.
You probably won't be surprised to learn that the pharmaceutical industry wants to weed out from their trials, anyone that has a positive reaction to a placebo. In fact, according to Dr. Hamilton, some of the world's best selling antidepressant drugs are sometimes thought to be relatively ineffective, because evidence has shown that the placebo effect accounts for most of the antidepressant effect. Seriously, who's to say that the people in trials that get the actual drug and respond in the way the drug is designed aren't also exhibiting a placebo effect? Believing that the drug is supposed to help them so it does. As long as a placebo effect is a real thing we may never know