Placebo: In Hopeful Anticipation

At Christman, wishes come true. The children are convinced: one only has to believe strong enough. The power of imagination is indeed strong – it can even cure diseases and ease pain. Thanks to the placebo effect that – if taken seriously – requires changes in the health care system. 01/12/2009

Wishing - at least in medicines
it can help; © SXC

At Christmas Eve, the greatest healer of the whole Christendom was born: it is written in the bible that Jesus helped a lame, a blind as well as an obsessed man. For many Christians, the saying “faith can move mountains” is the key to these miraculous healings. Scientists in the 21st century, however, find more and more hints that the saying is not necessarily related to religion. Neurologists and psychologists examine how strong imaginations and expectations can influence diseases and sicknesses. They come to the conclusion that high expectations can in fact cure asthma and that a strong imagination can ease pain – if the patient is supported in a certain way by someone from the outside. Even Jesus could have been a placebo healer.

“Already Plato has spoken about the charme of medics”, explains Manfred Schedlowski. If the treating physician did not dispose of a positive charisma, then the pills and elixirs were of none or only of little help. The ancient Greek philosopher observed a phenomenon that attracts fewer and fewer interest in the modern German health care system. Yet: “The relationship between physician and patient plays a major role regarding the treatment of illnesses”, says the director of the Institute of Medical Psychology and Behavioral Immunobiology at the university hospital in Essen. Recently, researchers of the Harvard Medical School proved exactly that by letting physicians treat patients in two different ways. One group of patients was treated with a standard acupuncture. The others were pierced just the same with a needle but, additionally, the doctor held a long and intensive conversation with them. After some weeks, the researchers observed that the patients that were intensively looked after by their physician performed much better in terms of quality of life and relief of pain than the other group.

Placebo effect alleviated pain during the Second World War

“The effect is most-likely linked to the expectations”, says Schedlowski. The better a patient feels cared for by a physician the more confident he is about his cure and the healthier he feels. Similarly placebos are working when it comes to easing pain, as a U.S. American military surgeon first found out: Henry Beecher accompanied soldiers during the Second World War at the Allied invasion of the Normandy. When morphine became scarce, he injected the wounded a common salt solution out of desperation. Surprisingly, the majority of the injured sensed a relief of pain – just because they expected it, clueless as they were.

The placebo effect is a bond between body and mind and is suited well as a model to find out more about this mysterious transition. Researchers at the University Medical Center Hamburg-Eppendorf therefore try to measure the placebo effect inside the brain. They treated test persons with an ineffective ointment that allegedly alleviates pain and, in doing so, looked into the patients’ brain with the help of a magnetic resonance tomography. They saw that certain regions that are important for handling pain were extremely active. Placebo pain killers stimulate the production of endorphins, a morphine produced by the body itself that blocks the pain perception in the affected brain areas. “An increased expectation indeed changes the brain’s chemistry”, explains Schedlowski. “Messenger substances are released and these changes are transmitted to the body via the nervous system.” The thought virtually passes over to the flesh.

Only in the past 15 to 20 years, the power of imagination achieved recognition among medics. “During this time it was started that medicines in clinical trials were compared to placebos”, says the professor of Essen. Researchers found out astonishing things: nearly in all cases, the effectiveness of a pill can be ascribed to the placebo effect. That means that patients swallow a well-known medicine that does relieve them – yet partly just because they believe in its success. Sometimes this pseudo drug effect ranks between five to ten per cent. “On other occasions, it accounts for up to 60 per cent”, the psychologist emphasises. With this knowledge, researchers now start to deal with the phenomenon much more intensively – full of hope to be able to use it in medical science.

Training the immune system like Pavlov’s dog

The research at the university hospital in Essen centres the placebo conditioning effect. “That is comparable to Pavlov’s dog.” Yet instead of coupling the salivation of a dog with a ring tone, Schedlowski would rather like to train the human immune system to adapt certain behaviour: in a trial, he gave test persons immunosuppressive pills that they had to take in combination with a green drink. „A fluid with a truly novel taste.“ Four times consecutively, the immune system was suppressed by the drug. When the trial was repeated after some weeks with a placebo mixed in the drink instead of effective medicines, the immune system was weakened anyway. „Not as much as beforehand with the real pill yet still clearly observable.”

The immune system had been conditioned to react to the green drink by the combination of taste and pill. A fact that could help with transplantations: after the surgery, the immune system of the patient has to be suppressed in order to prevent the rejection of the organ of a foreign person. In future, the dosage of the medicines with many side effects could be reduced by giving the patients a placebo every now and then. This effect could also reduce costs as expensive pills could partly be exchanged against sugar pills that – in combination with the same taste – are as effective as the original.

For the placebo effect, the faith in a drug, a treatment, a physician is pivotal. “It will be getting really exciting in case we take the results truly serious – since this would have consequences.” Schedlowski calls for a change of thinking in health policies. „The high-tech and three-minute medicine has to be reconsidered.” The fact that half an hour of conversation with the patient is more salutary than talking just five minutes should be mirrored in the compensation system, he argues. So far it works in a way that a patient intensive care is not more profitable than a quick check – no matter how much the physicians wish for a change. And no matter that it is Christmas season.

MEDICA.de