The placebo effect has a positive effect on recovery
Empathy and trust help patients cope, research shows
E ALL know a kind word or supportive arm around the shoulder can make a world of difference when you’re ill. But emerging research suggests that not only does having a compassionate doctor make illness more bearable, it can help patients to recover quicker and even make medication more effective.
The findings come from researchers looking at the ‘placebo effect’ – where a dummy treatment produces a similar effect in the body to actual medication.
That people can respond to a “fake” treatment is why any new drug has to be tested against a dummy version in clinical trials – to make sure it is having a real effect. Hundreds of studies have shown that when people are told, for instance, that an injection they have been given reduces pain, they report feeling better – even though the syringe contained salt water.
Similar benefits can come from telling people that their condition, perhaps depression or asthma, will start to improve after they take a pill consisting of inert powder.
Now scientists are looking at whether it’s possible to boost this effect in patients.
A research unit at Harvard University, set up specifically to investigate the placebo response, has found that simple things such as using positive words, creating a reassuring environment and – crucially – ensuring that a patient trusts the doctor, can all improve the response to treatment.
“We’ve built up enough evidence to start training doctors in how to improve the effectiveness of their treatment by making use of the placebo effect,” says psychologist Professor Irving Kirsch, associate director of the Harvard Programme in Placebo Studies.
But how can something as basic as a doctor’s kindly face have such a powerful effect? “The mind and body are influencing each other all the time. When your blood sugar drops, so does your mood, and when you are stressed or frightened your heart beats faster and your blood pressure goes up.
“We’ve scanned the brains of people who believe they have taken an antidepressant. Some got the real thing and others a placebo. What’s fascinating is that both have activity in the same area of the
Wbrain that controls mood.’
Writing in the journal Physiological Review last year, Fabrizio Benedetti, a professor of physiology and neuroscience at the University of Turin, echoed Kirsch’s view. “We should have courses to improve doctors’ empathetic and compassionate behaviour.”
Benedetti’s research has dramatically illustrated what a powerful placebo generator the mere arrival of a doctor can be. In one small study he ran, it was found that hospital patients receiving the tranquilliser Valium via a drip benefited only when a doctor administered it. Other patients given the same drug but who didn’t receive a doctor’s visit said it had no effect.
Other studies have confirmed that sympathetic doctors can boost patient health. In US research, it was found that those treated by doctors rated high for empathy had better blood sugar control and lower cholesterol levels than those treated by doctors low on empathy.
Professor of Medicine at Harvard Medical School and researcher Ted Kaptchuk said: “It is the care, the ritual, the interaction that can change the way people feel about their disease. “We give empathy and warmth. We offer a little confidence, a little hope, a little listening. We give some clear statement that the doctor is in this with you, not just ‘I am going to try’ but ‘I am really in your camp and I’m going to do everything possible to make this work’.”
Research is revealing that even if patients know they are taking a dummy, they still show improvement. In one study, patients with irritable bowel syndrome were told that the drug they were getting was a placebo. The pill bottle had “Placebo” written on it. Even so, they reported feeling twice as much benefit as if they were given nothing.
A possible reason is positive thinking – if a patient believes a treatment will have an effect, they may improve.
One patient who understands the power of positive thinking is Tessa Guy. The 50-year-old fitness trainer had breast cancer diagnosed in 2010, and reached a stage where she felt she couldn’t go on.
“I was into my fourth round of chemotherapy in three months, I had no hair, one breast had been removed, I was missing nails and ached everywhere.”
But instead of sinking into despair, she did the opposite – and is convinced it made a difference. “I chose to believe that I could create a better future.” She tried to trigger her own placebo response and, after changing her mental attitude, found the rest of the treatment much easier than expected.
“I still had radiation therapy and another two rounds of chemo to come, but it suddenly struck me that concentrating on all the bad and frightening things about it were likely to make it worse.”
Tessa focused on surviving for the sake of her sons – Charlie, 19, William, 17, and Peter, 10 – and set a routine: “First thing in the morning and last thing at night I’d visualise getting better, making change in my life and helping others.”
Tessa’s cancer has been in remission for four years and she believes positive thinking made her treatment easier to bear. She has since set up a website (inmindinbody.com) to help other cancer patients practise positive thinking.
Kirsch agrees it may have had some effect. “You can do all sorts of things to boost the placebo response. Our research has concentrated on doctors and I don’t see why visualisation by the patient shouldn’t help – but it needs studies to prove it.” – Daily Mail