TRICK AND TREAT
Discover how you can psych out sickness, deceive depression, dupe pain and fool your way to fitness with the help of one magic little pill
I KNEW I shouldn’t have uncorked the second bottle of red. But when you’re already three glasses in and the conversation’s flowing and the mains are yet to arrive, what’s a man to do?
And so it is that, at 9 o’clock on a Thursday morning, I find myself staring at my computer screen with dull, lobotomised eyes; my hair uncombed, my mouth ajar, a rusty drill-bit working its way deeper and deeper into my frontal lobe.
Next to my computer is a small, brown bottle filled with tiny, white pills. I pick it up and unscrew the lid. The instructions on the back advise taking three pills once a day. I double the dose and drop six into my mouth. They dissolve quickly, leaving a faintly sweet taste on my tongue. I close my eyes and wait. I know these pills have the power to make me whole again. They can ease my throbbing head and soothe the roiling nausea in my stomach. And this is just the start. They can make me run faster, sleep better, lift heavier, think sharper. If I was depressed, these pills could be my saviour. If I was laid out with back pain, they could get me up and walking. If I was wracked with Parkinson’s disease, they could restore some kind of normality to my life. Put simply, these pills might be the most exciting therapeutic and performance-enhancing phenomenon in modern medicine.
The ingredient list on the side of the bottle: 100 per cent sucrose.
placebo.> The label on the front of the bottle:
IMAGE OVERHAUL The most cursory of Google searches will reveal a motherlode of placebo studies boasting astonishing results. A study published in the New England Journal of Medicine, for example, tracked two groups of people suffering from osteoarthritis. One group underwent arthroscopic surgery; the other group thought they were going under the knife – they were anaesthetised and small nicks were put in their knee – but no instruments were inserted and no cartilage was removed. Both groups reported similar levels of pain relief.
Another study published in the Journal of Experimental Psychology hooked subjects up to a machine that purportedly measured how much REM sleep they’d registered during the night. Subjects who were informed they had clocked above-average shut-eye performed significantly better in a cognitive test than those who were told they hadn’t logged enough. The machine was, of course, a sham – there’s no device that can measure REM sleep.
A study published in Medicine and Science in Sports and Exercise, meanwhile, injected a group of recreational runners with a substance they were told was a safe and legal version of EPO. Not only did the majority of the runners report feeling stronger, more energised and more motivated with the substance coursing through their veins, they also clocked significantly faster times over a 3km race. The “EPO” was nothing more than salt water.
What can we make of such studies? Exciting scientific breakthroughs that point to a brave new world of performance enhancement and pain relief? Or crafty researchers playing games with naive subjects? Historically, it’s been the latter. For most of the past 250 years, placebos have been characterised as everything medicine was not – inert substances that deceive gullible patients to produce phantom results that rapidly fade.
The first recorded placebo study took
‘‘It wasn’t just the pill at work – it was also the patient’s expectation that the pill would work’’
place in the court of King Louis XVI, back in 1784. The target of the trial was a German physician called Franz Anton Mesmer, who had gained notoriety in Europe for “mesmerising” patients via a new treatment he called “animal magnetism”. The King’s wife was a disciple; the King was not. He decided to test one of Mesmer’s sessions. A boy was directed to hug an ostensibly “magnetised” tree infused with Mesmer’s healing powers. The boy dropped to the ground convulsing, the tree was revealed to be an ordinary tree, Mesmer was declared a charlatan, and placebos became inextricably linked with deception and quackery.
So things remained until World War II, when US anaesthetist Dr Henry Beecher encountered wounded soldiers who, despite suffering horrendous injuries, declined morphine injections. Beecher knew that civilians who’d suffered similar insults would have been pleading for pain relief. So what allowed these soldiers to show inhuman powers of fortitude? He guessed that the answer lay in the mind. A civilian crossing a road expected to get to the other side safely, so the impact of a car was a stunning assault. A soldier facing an artillery barrage expected to die, so a bullet in the leg didn’t seem all that bad. This observation led Beecher to a groundbreaking conclusion: our expectations and emotions have a dramatic impact on how our bodies function.
This concept lit a fire in Beecher’s mind. In 1955, he published an article in the Journal of the American Medical Association entitled The Powerful Placebo. He argued that placebos weren’t snake oil but legitimate therapeutic tools that could produce real effects. Indeed, he suggested that the placebo effect already played a role in almost every medical interaction: patient sees doctor, doctor prescribes pill, patient expects pill to work, patient gets better.
For Beecher, it wasn’t just the pill at work – it was also the patient’s expectation that the pill would work. Simply trusting in a treatment could be as effective as the treatment itself.
For a time, Beecher’s hypothesis remained just that – an unproven theory sitting close to the lunatic fringe. But with the onset of neuroimaging, researchers were suddenly able to see exactly what was happening in the brains of people who had been given a sugar pill or injected with a saline solution. And they didn’t just prove Beecher correct – if anything, they showed that he had been underselling the power of our emotions and expectations when it comes to healing and performance enhancement. LOOK WITHIN What did the neuroimaging show? That placebos work by triggering our body’s internal healing mechanisms, prompting our brains to release cascades of neurochemicals >
‘‘When it comes to getting bang from your placebo buck, a big pill trumps a small pill and two pills trump one pill’’
that have a profound effect on how we experience pain or nausea, depression or anxiety, mental weariness or physical fatigue.
“So, there’s no one placebo effect,” explains Dr Damien Finniss. “There are many effects. If you’ve been taking morphine, then I give you a sugar pill and tell you it’s a powerful opioid medication that’s going to reduce pain your brain will turn on its own internal morphine-like response. If you’ve been taking an anti-inflammatory drug, then I give you the same sugar pill, your brain will turn on an entirely different biological mechanism, your endogenous canabanoid system . . .”
The list of neurochemicals than can be activated by a simple sugar pill rolls on and on. And their capacity is stunning – they can improve motor function in Parkinson’s patients, alleviate gut disorders, relieve insomnia, halt the secretion of stress hormones and boost mood in depression sufferers. How potent are they? Well, a 2014 Harvard meta-analysis concluded that a full 82 per cent of the effect of antidepressants can be slated back to the placebo effect.
True, our internal healing mechanisms have their limits. They can’t, say, halt the growth of a brain tumour or mend a broken femur. But they can ease the agony of chemotherapy or the irritation of wearing a cast on your leg. The crucial point, according to Finnis, is that the effect placebos produce isn’t a phantom feel-good reaction. “These are very real, discrete, biological effects.”
Based at the University of Sydney Pain Management Research Institute, Finniss is Australia’s leading researcher when it comes to placebos. In his mind, the effect doesn’t revolve around the sugar pill or the saline injection – instead, it revolves around “simulating the treatment ritual”.
Crushing migraine? The antiseptic smell of your GP’S surgery, the confident tone of your GP’S voice, the scratch of the pen on the prescription pad and, yes, the taste of the pill on your tongue – all of these are part of the placebo effect. They’re cues that affect you emotionally, bumping up your expectation that relief is at hand, triggering your body’s internal healing mechanisms – in this case a blissful squirt of pain-relieving endorphins.
Maximising the treatment ritual lies at the heart of the placebo effect. Studies show that, when it comes to getting bang from your placebo buck, a big pill trumps a small pill and two pills trump one pill. A capsule outperforms a pill and an injection outperforms a capsule. Coloured pills are more likely to relieve pain than white pills and expensive brand-name pills illicit a stronger response than cheaper no-name pills. In short, the more impressive the ritual, the stronger the effect.
Similarly, the friendlier and more attentive the person administering the placebo, the greater the effect. A recent Harvard study, for example, found that when people suffering from irritable bowel disease received sham acupuncture from a therapist who was friendly and listened to their complaints, they described significantly more pain relief than when they were treated by a therapist who was curt and closed.
Indeed, so powerful is the treatment ritual that a series of recent studies has shown placebos have a significant pain-relieving effect even when subjects are well aware the pill they’re downing is nothing more than sugar. One study tracked a group of migraine sufferers, concluding that openly labelled placebos were nearly half as effective as Maxalt, a common pain-relief drug, at easing the ache. Studies tracking subjects with lower-back pain or irritable bowel syndrome reached similar conclusions. The placebo effect, it seems, doesn’t require deception if the ritual is convincing enough.
And this, for Finniss, is where placebo science starts to intersect in a meaningful way with modern health. It’s not about sugar pills and clever studies. It’s about maximising the ritual of standing in front of someone – be it a doctor, a physiotherapist, a personal trainer. It’s about getting the most out of that interaction; describing your problems, agreeing on a solution, committing to a treatment. For Finniss, this entire process – not just the pills or the massage – is crucial to healing and performance enhancement. Dial up the placebo effects of this therapeutic ritual and we can dial down our reliance on pills, potions and powders. Maximise our own internal healing mechanisms and we can minimise medications, with all their attendant costs and side effects.
“So should we just take sugar pills and tell ourselves we’ll get better?” asks Finniss. “No. It’s far more complex than that. The great power of the placebo lies in that therapeutic ritual.” JUST DO SOMETHING Little surprise, then that the six sugar pills I dumped did nothing to blunt the brutal progress of my hangover. Sitting at my office desk, staring at my computer, surrounded by the sound of fingers on keyboards, the act of downing sugar pills was too disconnected from any healing ritual I’d ever encountered. Despite knowing the science, my expectations were low – and so they were fulfilled. The drill-bit kept burrowing relentlessly into my brain.
So what’s the take-home? Can you knowingly harness the placebo effect and tap into your body’s miraculous internal healing mechanisms without signing on to some concocted study?
According to Dr Daniel Harvie, a pain researcher at Griffith University, the crucial step is recognising that, as humans, we’re mind-body connected. Emotions impact healing; expectations impact performance. “And that’s not some kind of hippy saying,” he says, “it’s a scientific fact. What you think and what you feel has hormonal and immune-system consequences that affect your body. And what’s happening in your body affects what you think and feel emotionally.” Facing a slipped disc in your back? Don’t slide into despair. Feel the black dog padding closer? Don’t cancel your gym membership. “Health is a two-way street,” says Harvie. “For me, this is the major takeaway from placebo science.”
Finniss, however, has a more practical take. In his estimation, every single one of us is a placebo responder. Our emotions and expectations impact our bodies on a daily basis, from the sniff of roasting coffee beans that perks our alertness, to the bump in heart rate when we lace on a pair of runners, to the headache relief when we merely reach for a packet of aspirin.
His message? Do something. Anything. Just act. “Whether you see a doctor or a physiotherapist or a personal trainer or whoever, part of the reason you improve is because of that interaction and the subsequent triggering of your own internal healing mechanisms. That’s important to realise: you are part of the process of getting better. It’s not just about someone doing something to you – you need to take an active role.”
It’s an empowering message. When it comes to beating pain, sharpening cognition and pumping up performance, the pill’s in your hand.