The Placebo Effect: What You Should Know

By Marisa Ramiccio. May 7th 2016

When you feel under the weather, you probably take some sort of medicine to help yourself feel better. But what if the medicine you took was really nothing more than a hard candy? You couldn’t possibly feel better, could you? Thanks to the placebo effect, you actually could. You may be familiar with the term “placebo” and its connotations within clinical trials, but you may not know that doctors are prescribing placebos as they would any other pill. While in some cases this is beneficial, in others it’s causing controversy.

What Are Placebos?

Placebos are faux treatments that are meant to look like real treatments. You may think of placebos as pills, but placebos can also be liquids, injections or procedures. The common denominator among all of these forms is the fact that they are always inert, which means that they contain no active ingredients. For instance, if a placebo pill is given to a patient, it may be a “sugar pill” or a vitamin.

The most common use of placebos is in clinical trials. In order to prove that a new drug therapy actually works, it must be tested against a placebo to ensure that it is the drug and not some other factor that is causing the improvement. During a clinical trial, patients receive either a placebo or the real medication. The process for determining who receives what is randomized and the studies are double-blind, which means that neither the patient nor the doctor knows who receives a placebo. The goal is to find out how effective the treatment is; if the group that receives the real medication reports a much better outcome than the placebo group, the medication is considered effective.

The Placebo Effect

So what is the placebo effect? Well, when the placebo group reports a change in outcome, the placebo effect has taken place. In other words, when patients report a decrease in symptoms after receiving a placebo, they have experienced the placebo effect. The effects only last for a short period of time and the placebo has no actual effect on a person’s disease or illness, but the person believes that it does. That belief plays a role in the theories of how placebos work. Those theories include:

  • The subject-expectancy theory – This theory states that people who expect a certain outcome from a medication will bring about that outcome by unconsciously changing their reaction. They may also report the expected outcome of that medication even if they didn’t experience it.
  • The classically conditioned theory – This theory is similar to the subject-expectancy theory and it should ring a bell if you’re familiar with the experiment involving Pavlov’s dogs. Those who believe this theory suppose that people who expect relief from medication will receive that relief.
  • The endorphin theory – Some people believe that the placebo effect is caused by endorphins, chemicals in the brain that relive the feeling of pain. A study conducted at the University of Michigan shows subjects who were given a placebo experienced pain relief, which corresponded to the area of the brain that received endorphins. This means their expectation of pain relief most likely caused the brain’s endorphins to react.
  • The remembered wellness theory – Some researchers think placebos may work because they help people recall a time when they were healthy. This is often referred to as remembered wellness.

Although many other studies have been conducted on placebos and many other theories have been formed as to why and how they work, for the most part, placebos are still a mystery. Some researchers say there may be a genetic component to it; others say it further confirms the mind-body connection.

But what if people knew they were receiving a placebo pill? Would it still work then? The answer is yes. A study conducted at Harvard Medical School showed that patients who took a placebo pill and were informed that the pill was inactive still experienced significantly greater improvement in their symptoms.

Prescribing Placebos

Aside from their use in clinical trials, placebos are also often prescribed to patients as a therapeutic treatment. In a study from the Journal of General Internal Medicine, 45 percent of Chicago internists reported using a placebo during their clinical practice. It’s a common practice that has gone on for years, but it’s conjured up quite a bit of controversy.

On the one hand, doctors feel that they should prescribe a placebo in cases where they can’t offer any alternative, perhaps because the real medication would cause unwanted side effects in the patient. In other cases, the patient may insist on taking some kind of medication, so the doctor prescribes a placebo.

But in these cases, some doctors prescribe aspirin or vitamins, which some people argue aren’t technically placebos since they both have active ingredients. In worse cases, doctors prescribe antibiotics. Now that we know about antibiotic-resistant strains of bacteria such as MRSA, the practice of prescribing antibiotics when not absolutely needed is frowned upon.

Another problem with prescribing placebos is the fact that many patients don’t know they are taking placebos. Although it is unethical to not tell a patient that he or she is taking placebos, some doctors still keep the real identity of their patient’s medication a secret.

What You Should Know

If you’ve learned nothing else about the placebo effect, at least you know it’s a fascinating effect that still remains a mystery in a lot of ways. It does demonstrate the power of our minds and how we could use it to help heal ourselves. However, some doctors choose to use placebos in the wrong manner, so be aware of how open and communicative your physician is when it comes to your medication. You never know when you may be popping a placebo.


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