The Placebo Effect: Mind over Biochemistry

The problem gets your attention. Pharmaceutical researchers are facing a new and puzzling phenomenon: as medicines become more effective, so do the placebos that they use in clinical trials.

Wired magazine has published an excellent report on this. Link here. I am indebted to Neo-neocon for having brought it to our attention.

How is it possible to have more effective placebos? They are still the same sugar pills, innocuous substances that patients are induced into believing are the real thing. Yet, researchers at Merck had to stop tests on a new anti-depressant because, however much it was an improvement over current treatments, the placebos were just as effective.

In itself the placebo effect is not especially mysterious. If you believe that a treatment will cure you, your mind will trigger certain biochemical processes that will either aid or abet the therapeutic properties of the medicine. But the mind will trigger a similar reaction even when the medicine is a fake, a placebo.

Placebos only work if you believe in a lie, if you allow yourself to be tricked. When the subject is disabused of his credulity, the placebo will not be effective.

But then, you might imagine an experiment where a subject was taking a biochemically active substance but was allowed to discover-- by accident-- that he was really taking a placebo.

For some medicines disillusionment would make no difference, but for some it would.

Now, what produces the state of belief that will allow the placebo to work? What makes you take the word of a physician or a clinician for the absolute truth?

Perhaps the reason lies in the fact that you have a vested interest in believing it. You gain no real benefit for believing that the physician is lying to you.

In his Wired article Steve Silberman outlines several factors that enhance the placebo effect.

First, physician empathy counts. If your physician believes in the clinical effectiveness of the treatment he is prescribing, if he cares about whether or not you will get better, and if you trust him... then you will feel a therapeutic benefit, even if you are swallowing a placebo.

Perhaps your reaction is purely self-interested. You would rather feel better than lose faith in your physician.

Second, clinical trials are social rituals. We are more likely to believe in something if that belief makes us members in good standing of a social group.

Active participation in a group means performing rituals. Surely this isan effective therapeutic agent for people who are depressed, thus, suffering from isolation.

Third, and perhaps paradoxically, placebos work better because the latest treatments work so well. All the hype and hoopla, all the media stories and advertising campaigns... the more the culture touts the great cures for depression the more likely they are to work.

If they also work for you, you feel like you are part of the culture. And this will make you feel better, even before your body has built up therapeutically beneficial levels of the chemical.

The corollary here is that if you do not live in a culture where people believe in the miracles of modern biochemistry, and where this belief enhances your social status, the placebos will not work as well, if at all.

As I was reading Silberman's article I had a strange thought. The placebo effect involves mistaken beliefs coupled with participation in a social ritual that affirms your membership in a group. But doesn't this sound a little like religious practice?

Perhaps this is the reason why recent research has shown that people who believe in religion are likely to be healthier than those who do not. Link here.

Obviously, clinical trials are not quite the same as religious rituals. The placebo effect is based on an outright lie, a statement contrary to fact. Belief in the Supreme Being is not a statement contrary to fact since it can neither be proven nor disproved by observing physical objects.

Like the human mind and like ideas, the Supreme Being is a metaphysical entity. Strictly speaking you cannot see, hear, taste, touch, or smell God. Nor will there ever by a microscope or a telescope sufficiently powerful for you to do so.

Of course, many of us believe that physical events, even the physical world itself, was produced or ordered by the mind of God. Otherwise, how would it be intelligible to a human mind.

And this is not inconsistent with Darwin or Newton or Galileo or Newton or Kepler. As Jacques Lacane once argued, we know that the planets were orbiting the sun according to Kepler's formula well before Kepler wrote it down. But if planetary orbits were following this law or this idea before any human mind thought it, was there another mind, the mind of a Supreme Being, that had been thinking it.

In other terms, if we assume that it was actively functioning before Kepler wrote it down, where exactly was it?

At the least this line of reasoning is worthy of respect. Even without referring to miracle cures.

If you do not believe that a metaphysical entity like the mind can trigger a physiological process of cure then you cannot believe in the placebo effect. Whatever you think about God, the placebo effect is demonstrably real.