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

Men's Health (Australia) - - Health - BY AARON SCOTT

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.

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