Placebo and Nocebo Effect

Thought, health, belief, placebo, nocebo

Can You Think Yourself Healthy?

“If you believe you can or if you believe you can’t . . . you’re right.” Henry Ford

A UK construction worker stepped on a nail. It went right through his boot and came out the other side. The pain was excruciating to the point where he needed morphine just to remove the boot. Once the boot was removed it became clear that the nail had completely missed his foot and had gone in between his toes. [1]

Nocebo, nail through foot, construction worker

Subjects in a research trial had a stimulator put on their heads and were told that electrical pulses were being sent through their brains. No current was delivered but the subjects believed it was. When the stimulator dial was turned up in view of the subjects, the subjects reported increased head pain. [2]

Subjects were given sugar pills but told they were Amitriptyline with specific side effects. Many subjects developed the side effects despite them only ingesting sugar. [3]


This phenomenon is a regular sight in every day medicine. People expect something to happen – and it does. People believe something to be happening and it feels like it is.

 

Can our thoughts and beliefs really affect our health?

 The Healing Mind - the Placebo Effect

Healing Energy, Placebo, thoughts, health, beliefThe placebo effect is a well documented healing phenomena. When someone believes something will improve their health, an improvement is often seen.

There have been many studies proving the power of the placebo effect.

Placebo sugar pills are as effective as the six leading antidepressant tablets in more than half of clinical trials. [4]

People with arthritic knees are often given arthroscopies. The knee joint is cleaned of any loose debris from the worn joint and the worn, irregular joint is smoothed. In order to find out the most effective aspect of the surgery, subjects were divided into 3 groups [5]. One group had only debris removed, one group had only joint smoothing. The other group had “fake” surgery. The patient was sedated, three incisions were made and then the surgeon talked and acted just as he would have during real surgery. After forty minutes, the incisions were sewn up as if the surgery had been done. The results were quite remarkable. All 3 groups were pain free following surgery. This highlights two issues. Firstly, that arthritic pain can therefore not be caused by worn joints. Secondly, that thoughts and belief were able to stop the pain completely.

Cleaners, placebo, healthCleaning staff from a number of hotels were split into 2 groups. Researchers told group 1 that they were burning enough calories in their daily work, to fulfill recommendations for an active lifestyle. Group 2 were told nothing. After 4 weeks, group 1, who believed they were getting more exercise, lost weight and lowered their blood pressure, body fat, waist-to-hip ratio, and body mass index. Group 2 saw no changes [6]. Nothing had changed in group 1's lives except their belief that what they were doing was good for them.

 

The Placebo effect is a clear demonstration of our mind's power to make positive changes to our health. The question of how placebos work has generally been ignored by medicine. Often scientists seem defensive, as if the existence of the placebo effect undermines their more 'sophisticated' treatments such as medication and surgery.

Some researchers, however, have seen the huge potential for self healing that remains largely untapped, and are starting to look into its practical uses [7,8,9].

Destructive Thinking - the Nocebo Effect

This is the negative impact our thoughts can have on our bodies known as the Nocebo effect [10, 11].

Like the examples of the construction worker or the side effects from placebo pills - if we believe something will harm us, our bodies will react as if it has. If we expect to develop a bad chest/ heart/ knee as it runs in the family, we probably will.

Perception, thoughts, beliefs, health, healing, noceboBruce Lipton cites a case of 'a Nashville physician, Clifton Meador, who has been reflecting on the potential power of the nocebo effect for thirty years. In 1974 Meador had a patient, Sam Londe, a retired shoe salesman suffering from cancer of the oesophagus, a condition that was at the time considered 100 percent fatal. Londe was treated for that cancer, but everyone in the medical community “knew” that his oesophageal cancer would recur. So it was no surprise when Londe died a few weeks after his diagnosis.

'The surprise came after Londe’s death when an autopsy found very little cancer in his body, certainly not enough to kill him. There were a couple of spots in the liver and one in the lung, but there was no trace of the oesophageal cancer that everyone thought had killed him.

 

'Meador told the Discovery Health Channel: “He died with cancer, but not from cancer.” What did Londe die of if not oesophageal cancer? Had he died because he believed he was going to die? The case still haunts Meador three decades after Londe’s death: “I thought he had cancer. He thought he had cancer. Everybody around him thought he had cancer . . . did I remove hope in some way?”'

Lorimer Moseley, a leading pain researcher, tells a great story of his walk in the bush when he got a scratch from a stick and kept walking, not thinking anything of it. He'd spent lots of time playing in the bush as a child so wasn't alarmed.

When he got home, he saw fang marks and his left leg was very swollen and painful. He'd been bitten by a very poisonous snake. He spent several days in the hospital recovering from the bite and the left leg pain subsided.

Six months later, he was walking in the bush and felt a scratch on his leg. He immediately fell to the ground experiencing a great deal of pain. He was rushed to a hospital only to find that he simply had a scrape, not a snake bite. Despite this, his pain lasted several weeks.

Why all the pain? When he was a boy, his brain disregarded the mild pain from nicks and scrapes because they were interpreted as "not dangerous" and simply part of the enjoyment of walking in the country. However, because he believed the second scratch to be a life-threatening snakebite, his brain and body reacted accordingly, activating the same pain pathways that were learned six months earlier.

It makes me wonder on the nocebo impact of the graphic health warnings on cigarette packets. Whilst I in no way advocate smoking as it is clearly a significant factor in a multitude of health problems – will smoking related illness increase as a result of the fear and expectation instilled by the anti-smoking campaign?

Our minds have a powerful influence over our poor health – both in the development of disease and its exacerbation. Again, this is a key tool that could be used to the advantage of those suffering.

The Mind as a Treatment Option?

Surgery, placebo, nocebo, thoughts, healthThe powerful influence of our minds needs to be taken seriously as a tool of healing or destruction rather than something inferior to the power of chemicals or surgery.

Drugs and surgery have a huge cost every year, and this is not just a financial cost. More than 120,000 people die from adverse effects of prescribed medications just in America each year [12, 13]. Shockingly, the leading cause of death in America is medical treatment itself.

 

Treatment options that do not involve medications must therefore be explored to find safer alternatives. While it's correct that placebos do not work for everybody, we need to remember that standard medical treatments don't work for everybody either.
Understanding how our mind can influence our health is the first step in regaining a sense of control over our bodies, our health and our lives.

Hope, Faith, Belief, Thoughts, Placebo, Healing, Health

My next blog explains how our thoughts and beliefs are able to make real, physical changes in our bodies.

Chiron Fatigue TreatmentConnecting the Mind and Body for Health

References

[1] Fisher JP, Hassan DT, O'Connor N. Minerva. British Medical Journal. 1995; 310:70

[2] Bayer TL, Coverdale JH, Chiang E, Bangs M. The role of prior pain experience and expectancy in psychologically and physically induced pain. Pain. 1998;74(2-3):327-31.

[3] Sedgwick P. The Nocebo Effect. British Medical Journal. 2013; 347

[4] Parker G, Anderson IM, Haddad P. Clinical Trials of Antidepressant Medications are Producing Meaningless Results. The British Journal of Psychiatry. 2003; 183(2): 102-104

[5] Moseley JB, O'Malley K et al. A controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine. 2002; 347(2): 81-88

[6] Crum A, Langer E. Mind-set matters: Exercise and the Placebo Effect. Psychological Science. 2007; 18920: 165-171

[7] Erdmann J. Imagination Medicine. Science. 2008; 174: 26-30

[8] Price D, Finniss DG et al. A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought. Annual Review of Psychology. 2008; 59: 565-590

[9] Niemi, Maj-Britt. Placebo Effect: A Cure in the Mind. Scientific American Mind. 2009; 20: 42-49

[10] Colluca Luana, Miller, Franklin G. The Nocebo Effect and its Relevance for Clinical Practice. Psychosomatic Medicine. 2011; 73(7): 598-603

[11] Barksy Arthur J. Nonspecific Medication Side Effects and the Nocebo Phenomenon. JAMA. 2002; 287(5): 622

[12] Starfield B. Is US health really the best in the world? Journal of the American Medical Association. 2000; 284(4): 483-485

[13] Null G, Dean C et al. Death by Medicine. New York, Nutrition Institute of America. 2003

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