The Placebo effect

The Placebo effect

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Giving an unambiguous and satisfactory definition of the placebo effect is difficult: what is certain is that this phenomenon exists, is real and has been measured several times, not without difficulty. Let’s start with the definition of placebo. There are those who define a placebo as a starch or lactose pill that does not contain pharmacologically active substances, or a drip of physiological solution containing only water and salt, or even an ineffective drug to treat the condition for which it is used.

In reality, the placebo is all these things together, as can be understood by retracing the history of its definition. The first use of the term “placebo” is recorded in the fourteenth century, in particular in the Latin translation of the Bible: Placebo Domino in Regione vivorum (I will be pleasing to the Lord in the land of the living). Singing the placebo was a specific task of the “prefiche”, that is, of women who were paid to cry at funerals and praise the dead.

Later it took on a more secular and derogatory meaning: in the 15th century it therefore indicates a pimp, a disgusting person, a parasite. The first time that the term was used in medicine dates back to the eighteenth century, to mean any medicine suitable more to please the patient than to give him a real benefit. In fact, translated from Latin, “placebo” literally means “I will be liked”.

In 1945, placebo was defined as a “totally inert agent”, a definition that was outdated ten years later, on the discovery that it was not inert at all. The placebo, in fact, although it does not contain pharmacologically active substances, is not inactive from a therapeutic point of view, because it is able to provoke responses in humans.

In reality, the placebo, even if more frequently made up of a compound, can be any intervention, any therapy other than drug. This is why the most exhaustive description is probably the one that brings together different definitions given by the scholar of the phenomenon Howard Shapiro between 1964 and 1971: “Placebo is any procedure deliberately implemented to obtain an effect or which, even without having any notion of it, carries out an action on the patient or on the symptom or on the disease, but which objectively lacks any specific activity towards the condition being treated ”.

Relax with well-cell music

The placebo effect can only be recorded in the conscious man: in subjects in coma or under general anesthesia it does not evoke any response. Therefore, only in a vigilant subject can the placebo effect be recorded. But what are the responses evoked by the placebo? They can be subjective, that is, reported by patients taking the placebo, and objective, measurable or verifiable from the outside.

The subjective ones are the simplest to detect (for example, the patient is asked if, after taking the product or after surgery, his symptoms have improved, or he is asked to indicate, through a predisposed scale, the intensity of his pain), but they are also those most influenced by external variables and difficult to quantify. The objective responses are the most difficult to refute, as they are reproducible: for example, it is a question of the variation of biochemical or physiological parameters.

First placebo studies

A remedy used in the nineteenth century for many diseases were metal sticks applied to different points of the body (they were supposed to be able to reduce symptoms thanks to the electromagnetic properties of the metal): in 1801 John Haygarth treated five patients with similar sticks but made of wood and found symptom remission in four out of five patients. The next day he treated the five patients with metal sticks and got the same result. In a somewhat rudimentary way, the placebo effect had been measured: Haygarth defined the result as the wonderful power of the mind (and in particular of trust and hope) over the disorders of the body, something often overlooked in the treatment of diseases.

Other similar studies were carried out during the 19th century. In 1938, placebo was used to evaluate the efficacy of an oral flu vaccine. The placebo capsule was exactly the same as the vaccine, but it contained lactose. The results were the same: the reduction in colds was recorded both in the vaccine and in the placebo group and in an overlapping manner. Until about 1950, the placebo was used as a “humble scam”, that is, as an inert preparation that did not cause harm and could give comfort to the patient. In fact, by using it more and more in experimentation, researchers began to recognize its therapeutic value.

In Conclusion

Contributing to the placebo effect are: the placebo itself, the patient, the doctor and the doctor-patient relationship, in addition to the external context, each with its own characteristics, peculiarities, variability.

12 thoughts on “The Placebo effect

  1. Avatar
    Rylan Daly says:

    Precisely in order not to confuse the effectiveness due to the new molecule with the normal responses of the organism even in the absence of active substances.

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    Neil Guerra says:

    From a psychological point of view, when administering a substance that we consider “active”, our mind puts in place many mechanisms that allow a real effect (pain is better tolerated, stress is reduced …)

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    Caolan Huff says:

    It is called expectation, we expect a substance to do well and this happens, even if the substance does not have a beneficial effect….amazing human brain.

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    Brenden Frank says:

    It should be noted that it is also the physiology that responds to the effect, the expectation of an improvement causes the release in the body of substances that really have a positive action, first of all the endorphins but also very small amounts of adrenaline which allows to better resist stress.

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    Bruce Enriquez says:

    Not surprisingly, this also happens with “normal” drugs, many of their effects are enhanced by our belief in “doing us good”

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