Placebos are often associated with deception, even gullibility, but this is misleading.

“I said that the cure itself is a certain leaf, but in addition to the drug there is a certain charm, which if someone chants when he makes use of it, the medicine altogether restores him to health, but without the charm there is no profit from the leaf.”

–Plato (Charmides, 155-6).

The truth about placebos is much more complicated and interesting.

Pharmaceutical companies are required by the FDA to prove that their medicines can drive greater improvement in patients’ wellness than a placebo. This has resulted in reams of research accumulated over decades. This research was designed to prove the efficacy of the drugs being studied, but it has also proven something unintended – the power of the placebo and our own expectations to make us well.

A drug may be only 5% more effective than a placebo and still be approved to go to market. Recent research suggests that many anti-anxiety and anti-depression medicines would not hold up to that standard if they were tested today.*

That’s because another trend that has surfaced through this research – our collective placebo response is getting stronger over time. A 2015 study* examined the impact of the placebo effect in 84 trials of nerve pain treatments that took place over the prior 23 years. Researchers found that the placebo effect has grown remarkably stronger, primarily in U.S. studies.

No deception required, placebos work, even when you know.

“Our hope is that in conditions where the open-label placebo might be valuable, instead of putting people on drugs immediately — for depression, chronic pain, fatigue — that people would be put on placebo,…

If it works, great. If not, then go on to drugs.”

–Ted Kaptchuk, Harvard Medical School

Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies at Beth Israel Deaconess Medical Center in Boston, conducted a study* to see if giving patients open-label placebos would improve their condition. In other words, the patients who took the placebo were fully aware they were taking inactive pills.

A significant portion of the patients showed clear improvement, sometimes despite their own predictions going into the trial.

Not everyone has a strong therapeutic response to a placebo.

If that were the case, we wouldn’t need medications at all. Expectation plays a key role in triggering the right response, as do a number of genetic and social factors, including your personal history and experiences.

Understanding who responds to placebos, when and why is a subject of high interest for pharmaceutical researchers. That’s because high placebo responsiveness can interfere with drug trials, or to put it another way, study subjects who are high placebo responders may not need the medicine being studied to improve. Meanwhile, low placebo responders often do need active medicine to get better, and medicines tailored to them would be more effective.

Placebo responders aren’t gullible, they have a superpower.

Pla·ce·bo

/pləˈsēbō/

noun

1. a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect.

2. a treatment which is not effective through its direct action on the body, but works because of its effect on the patient's expectations and previous experiences. 

3. a trigger used to signal to the body that it is a good time to heal.

If we can be trained to reduce our placebo response, we can also train to improve it.

From an evolutionary perspective,* the placebo response at first appears to make no sense, until you dig a little deeper. Something similar to the placebo effect occurs in many animals as well.* Siberian hamsters do little to fight an infection if the lights above their lab cage mimic the short days and long nights of winter. But changing the lighting pattern to mimic summer triggers a full immune response.

The immune system is costly to run – a strong and sustained response could dangerously drain energy reserves. So it would make sense that we have developed triggers that signal to our bodies when it is safe to heal, or even grow more muscle.

It’s possible that high responders have stronger communication pathways between the brain and body, resulting in more powerful, balanced systems, stronger immunity and survival instincts.

The placebo response can be trained.

Fortunately for those who have a milder placebo response, it can be trained and strengthened over time.

Pharmaceutical companies have already launched efforts in the opposite direction, through something called PRR. Placebo response reduction training* is a strategy intended to reduce the placebo response. To date, it’s been used in at least 19 clinical trials. It focuses on neutralizing expectations of benefit in the patient.

This leaves us with several important questions:

1. Why take drugs if you can get better with a placebo?

2. Is it ethical to prescribe active medicine to a patient when a placebo will do?

3. Instead of trying to eliminate it, why not work to improve the placebo response?

If we can be trained to reduce our placebo response, we can intentionally train to improve it. Perhaps if we shift our perspective, we can achieve better more sustainable wellness, and truly own and understand how we get well.