The placebo effect is getting stronger—and nobody knows why


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Most people are familiar with the placebo effect, but less aware of a surprising development: It’s getting stronger, but nobody knows exactly why. Here, ahead of the publication of her new book Energy Medicine, acupuncturist Well+Good Council member Jill Blakeway, DACM, LAc, explains what’s happening.

In the world of medicine, a placebo is generally defined as a treatment—such as a pill or an injection or a procedure— that has a harmless effect and, usually, is proffered unbeknownst to the patient.

Interestingly, research has shown that even the appearance of a placebo can influence a patient’s reported reaction to it. For example, the larger the pill, the stronger the placebo effect, and two pills elicit a stronger effect than one. Patients have a more positive reaction to brand-name pills than generic ones, and the most powerful responses result from placebos administered by needle. Even the color of placebo pills can alter the outcome: Blue ones are more effective than red ones for helping people sleep and green pills are preferred for anxiety. These are just the kinds of capricious details that have historically made scientists and doctors scoff at the placebo, dismissing it as a trivial mind game.

Patients have a more positive reaction to brand-name pills than generic ones.

But placebos are far from trivial. Research clearly reveals that our subconscious expectations lead us to better health and that our interactions with doctors and health-care practitioners also improve our sense of well-being. The latter is known as the Hawthorne effect, or the observer effect, in which people modify an aspect of their behavior in response to their awareness of being watched. In a medical context, studies have shown that when a person feels that a doctor is particularly attentive, their health improves more quickly.

Energy Medicine, the new book by Dr. Jill Blakeway

In recent years, many groundbreaking studies on the placebo effect have been published, several of which suggest that the effectiveness of pain medications may be largely attributable to their value as placebos. A 2015 study published in the journal Pain concluded that over the course of seventeen years, the effectiveness of pain medications in clinical trials has declined sharply. In 1996, drugs relieved pain 27 percent more than a placebo in trials, whereas by 2013 that gap had shrunk to 9 percent. The placebo effect appears to be getting so much stronger and it is posing a problem for researchers trying to assess the effectiveness of new drugs.

Researchers are still seeking a coherent explanation as to why the placebo effect is so strong, and growing stronger. One theory draws on the Hawthorne Effect; the finding that the interaction between practitioner and patient creates its own placebo effect. Clinical trials in the US have grown longer and have included more participants in the nearly two decades between 1996 and 2013. In 1990, an average trial was four weeks long whereas by 2013, it was 12 weeks long; along the same lines, the average trial in 1990 included 50 people or fewer, but in 2013, trials included 700 participants, on average. As these trials have grown, researchers have added more personal elements to the process, such as hiring nurses to consult with the participants. (And it’s likely no coincidence that, in an era where the standard of care has been diminished by stringent HMO and insurance policies, patients are starved for this kind of reassuring attention.)

Researchers are still seeking a coherent explanation as to why the placebo effect is so strong, and growing stronger.

Another theory suggests that these trials have become more rigorously conducted and are simply revealing an outcome that was always there: Painkillers or antidepressants or even surgery may be less effective than we think.

Still others assert that the placebo effect is not psychological and chemical in nature but rather sociological and energetic. Dr. Bill Bengston, a professor at City University in New York, led a team of skeptical scientists who used “hands on” healing to repeatedly cure mammary cancer in mice in the lab (you can read more about him in my new book, Energy Medicine: The Science and Mystery of Healing). This in itself was a remarkable discovery, but even stranger was his finding that if the scientists assuming the role of healers for the study came into contact with a control group of mice, who had not received healing, these mice would also begin to recover.

Healing is an intertwining of a variety of elements that are not always quantifiable.

This seemingly inexplicable phenomenon led him to a radical hypothesis. A theory of resonant bonding—which suggests that an energetic bond created by the engagement between researcher and participant can extend outward to others within a “meaning field.” He believes that the two groups (control and not) of placebo effect studies are becoming entangled energetically, so that the real stimulus given to one group also affects the other. In other words, the control groups of these trials are similar to the control mice in his experiments—they are recovering because they become part of the meaning field, and they become part of that meaning field simply because the researchers focus on them.

We may never untangle the discrete threads that become braided in making up the placebo effect—our brains, our bodies, the method of placebo delivery, the physical environment, the manner of the doctor— but one thing is certain: Healing is an intertwining of a variety of elements that are not always quantifiable. And compassion and belief are powerful antidotes that should be harnessed in whatever form they come.

Dr. Jill Blakeway, DACM, is a practitioner and teacher of Chinese Medicine and the founder and clinic director of the YinOva Center in New York City.

Jill is the author of Making Babies: A Proven 3-Month Program for Maximum Fertility and Sex Again: Recharging Your Libido. Her third book, Energy Medicine, is available for pre-order now.

What should Jill write about next? Send your questions and suggestions to experts@wellandgood.com.

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