This article is taken from the Winter 2011 issue of I, Science.
Antonio Torrisi finds out why ‘never trusting a doctor’ could be a fatal mistake.
Since the case of Mr. Wright in 1957, whose cancer shrunk dramatically thanks only to his deep trust in a drug that was in reality ineffective, the world of medicine has become more and more aware of the placebo effect. The word placebo comes from the latin verb ‘placere’ which means ‘to please’. In clinical studies it embraces a complex unexplained phenomenon in which trust in a medicine seems to cause the medicine to have beneficial physiological effects, whether or not it is pharmacologically active.
Doctors and scientists have been investigating this effect in illnesses such as Parkinson’s disease and irritable bowel syndrome by using randomised controlled trials and ‘double blinding’, in which they separately treat two large groups of patients – one is given the standard pharmacological treatment (the control group) and the other is given inactive pills (the placebo group). Neither the patients nor the doctors in charge of the treatment know which group gets which pills.
Controversy and scepticism about the statistical significance of the effect are still present among scientists. Nevertheless, many experiments have shown that it is present and complex, depending on different psychological and cultural factors.
By using modern brain scanning techniques such as positron electron tomography, neuroscientists have observed important brain activity in patients experiencing the placebo effect, with release of endogenous opioids in the case of pain treatment or dopamine in the case of diseases affecting mobility such as Parkinson’s disease. Recently, scientists from Germany and Switzerland have also observed a partial activation of physiological mechanisms that promote the immune function in immunological diseases.
The placebo effect does not occur only within biomedical treatment, but also in surgical treatments and acupuncture.
A patient’s expectancy and trust in the medical treatment play an important role, but other factors seem to be important too, such as the patient’s psychology, interaction with the doctor, environmental conditions, as well as the care and assistance the patient receives. A study from Harvard Medical School compares Navajo healing rituals with ritual aspects in traditional acupuncture and biomedical treatment in the western world. Though there are many differences between all of these treatment methods, the common ritual component seems to be a very important factor in inducing a beneficial response in a patient. Like in Michael Cimino’s movie ‘Sunchaser’, believing in rituals can have a beneficial cathartic role in medicine as well as in life.
Image: flickr | sergis blog