Placebo effect: does it really exist?

Still too often trivialized, the placebo effect, i.e. the benefit obtained from a preparation for the sole fact of being taken, is a reality supported by numerous scientific evidences.

“Placebo” comes from the Latin verb “placere” and literally means “I will like”. A certain promise and always confirmed when the term refers to a pharmacological preparation administered to alleviate the symptoms of a disease, even when the preparation in question is completely inert on the biological level, therefore ineffective.

Whether it is endowed with a real therapeutic activity or not, in fact, any tablet, solution, suppository, injection or cream proposed as “beneficial” really becomes so if the user is convinced of its favorable therapeutic action, even when it is a ball of sugar or a little water and salt.

But why does an inactive preparation without any appreciable organic effect make you feel better? Is it all suggestion?

What causes the placebo effect

Until not many years ago, the placebo effect was viewed with a certain distrust and a bit of annoyance on the part of doctors, who tended to attribute it to “imaginary” symptoms, linked to psychoemotional disorders of various kinds, in the absence of a real organic disease. In essence, the general idea was that, if a “fake drug” was effective and managed to make you feel better, the disorder for which it was taken had to be “fake” too.

The placebo effect, on the other hand, has always created many problems for researchers engaged in clinical trials aimed at verifying the efficacy and safety of new drugs. The placebo effect, in fact, also influences the response of patients towards real medicines, accounting for a variable, but never negligible, percentage of the overall therapeutic effect.

For this reason, in all scientifically proven clinical trials, the effectiveness of an active ingredient must be compared with that of an apparently identical inactive compound, without either the user or the doctors who administer them knowing which of the two has been given (double-blind study).

For a long time it was believed that the placebo effect depended exclusively on “suggestion”: in essence, it was believed that the simple fact of feeling “cured” and the expectation of obtaining a positive effect from a treatment predisposed the patient to really benefit and feel better, regardless of the real or presumed action of the treatment itself.

This interpretation of the placebo effect (also at the base of the success of many “alternative medicines” devoid of any scientific foundation, but defended by the sword of those who rely on them) is certainly true, but only partial. The most recent research has, in fact, indicated that taking a drug that you trust triggers a series of favorable biological reactions, which make the symptoms of the disease more tolerable.

In particular, it has been observed that the intake of a placebo preparation induces the release of endogenous opiates (endorphins) by the central nervous system and, probably, also of endogenous cannabinoids, hormones and neurotransmitters able to reduce the perception of pain and promote a state of well-being. In addition, there would seem to be a positive response from the immune system.

When the placebo effect works

Basically, to get benefits from the placebo effect “just believe it”, regardless of the disease you suffer from.

If it is true, in fact, that functional disorders benefit most from the “fake cures”, most influenced by stress or psychic discomfort (depressionanxiety, obsessive-compulsive traits, etc.), it is equally true that even patients with acute or severe chronic diseases can see their state improve with the addition of a mint lozenge or an injection of saline.

Typical examples of disorders that can be substantially alleviated by a placebo preparation, used alone or together with specific drugs that do not resolve results, are:

But there are indications that the placebo effect could also play a role in alleviating the severe malaise of cancer patients, if properly exploited in addition to active therapies of proven effectiveness.

So far, unfortunately, the placebo effect has been little used as an adjuvant of authorized treatments, partly because it is considered “unethical” towards the patient (since to work the inert preparation must be taken believing it an effective drug), but above all because it is not possible to establish precisely the extent of the benefit potentially obtainable by the patient, always very variable being on an individual basis.

What is the “nocebo” effect

The placebo effect shows that in some cases “trust is good”. Those who do not trust, on the other hand, risk feeling unnecessarily bad. It is now established that, in addition to the placebo effect, there is a diametrically opposite “nocebo effect” (“I will harm”) that leads those who have little confidence in a drug or much fear of its side effects to experience more the supposed adverse reactions than the therapeutic benefits demonstrated.

In this case, at the origin of the perceived organic discomforts there is mainly a negative psychological reaction to the fact of taking a preparation that is considered more harmful than useful, even when the usual sugary ball has been ingested.

The nocebo effect should not be underestimated because it can generate a serious psychophysical malaise and have a very negative impact on the availability to treatment and adherence to prescribed therapies by patients, inducing them not to treat a real disease on the basis of unfounded beliefs and fears.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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