“Most folks are about as happy as they make their minds up to be”
“The one thing of which we can be absolutely certain is that placebos do not cause placebo effects. Placebo’s are inert and don’t cause anything… ironically, although placebos cannot do anything themselves, their meaning can”
Daniel Moerman PhD anthropologist
There is meaning attached to the homeopathic process by the patient and this will have implications for the results of treatment. Patients may find the consultation meaningful and experience a placebo type effect from that alone but the actually taking of homeopathic remedies will hold significant meaning in itself. Daniel Moerman looked at the meanings that we attach to certain things in his research of placebo.
- Test 1
- Medical students asked to take part in a study of two new drugs, one a tranquiliser and the other a stimulant.
- Each student was given a package containing either one or two blue or red tablets
- All tablets were inert
- Response showed:
- The red tablets acted as stimulants while the blue ones acted as depressants
- Two tablets had more effect than one
- Test 2
- Women who used analgesics for headache were assigned to four groups
- Group one received aspirin labelled in a widely advertised brand name
- Group two received the same aspirin in a plain package
- Group three received placebo in the same widely advertised aspirin marked package
- Group four received placebo in a plain package
- Response showed:
- Branded Aspirin worked better than unbranded aspirin
- Unbranded aspirin worked better than branded placebo
- Branded placebo worked better than unbranded placebo
The question of homeopathy working as a placebo has caused controversy and outcry amongst the homeopathic community. To reduce homeopathy to a placebo response is felt to undermine it applicable effectiveness in the realm of recognised medical practice and can only serve to discredit the therapy further in the eyes of the medical profession. However Mayberg et al have looked at brain imaging in an attempt to see if placebo has a physiologically measurable effect which could point to it being more important in the field of medicine than is currently thought.
Placebo-controlled Positron Emission Tomography (PET) imaging study of the effects of the anti-depressant drug Fluoxetine was conducted. Researchers hypothesised that there would be a common pattern of regional metabolic changes with clinical response; independent of whether a patient was given active or inactive medication.
- 6 week study with 15 completers. Primary focus – 6 week response effect with placebo administration
- all patients received daily individual meetings with the treating physician, group therapy, and various ward activities
- 8 of the 15 study completers experienced symptom remission, 4 from placebo and 4 from the active drug – however the active drug receivers also experienced further developments shown through PET scanning
- placebo response was associated with regionally specific changes in brain function
- while comparable brain changes were seen with both drug and placebo administration, drug response was not merely the same as placebo effect, as active fluoxetine treatment was associated with additional and unique brain changes in cortical and paralimbic regions
- it is therefore emphasised that administration of placebo is not absence of treatment, just an absence of active medication
The research indicates that because all the patients received in-ward care this in itself constituted a therapeutic effect which may have been responsible for the seen PET results. The implications of this research for homeopathy point to the therapeutic effect of consultation having a measurable effect on brain function.
Mayberg suggests that had there been no active medication response at all, all results may have been due to the random chance that these people would have got better through the care they received alone. Mayberg does conclude however that placebo responders may be at greater risk for relapse and recurrence, suggesting that long term response to therapy is better maintained with active drugs than with placebo. He also concluded that symptom improvement requires changes in specific brain regions, regardless of the mode of treatment, indicating that placebo is able to produce these required changes. Therefore if homeopathy is a case of mere placebo it is still capable of providing the vehicle required to produce the changes in brain regions needed to bring about effective treatment.
The expectation of the patient in a homeopathic situation will have bearing on the effectiveness of the treatment received. In short if a patient expects homeopathy to fail the likelihood of recovery is limited. If on the other hand the expectation is positive the likelihood of recovery is greatly enhanced.
Amanzio and Benedetti researched expectation through the study of analgesic placebo and proposed two theories to explain the activation of placebo analgesia.
- Cognitive factors, like the expectation of pain relief, are supposed to trigger the release of opioids in the Central Nervous System (CNS)
- A classical conditioning mechanism has been proposed, in which repeated associations between active analgesics, pain relief, and therapeutic surroundings produce a conditioned placebo analgesic response.
- Cognitive factors like expectation appear to trigger endogenous opioid systems in all cases
- A complex cognitive function, like expected pain relief, is capable to interact with neurochemical systems and to produce a specific analgesic effect
- The placebo response depends on past experience, being mediated by specific subsystems that are likely to be activated during learning
- The understanding of the intricate mechanisms linking mental activity and pain will help in planning new therapeutic strategies.
This research implies that the patient’s expectation of a homeopathic treatment to help activates neurochemical systems in the brain to produce the desired/expected effect. This effect will be enhanced if the patient has had a previous positive experience with homeopathic treatment as their body will have learnt to expect a positive result. The belief of the patient is paramount in their healing and indicates that the homeopathic ritual of case and remedy taking acts as symbols which become more meaningful with a positive result.
Kaptchuk looked at the clinical significance of healing ritual regarding the placebo effect and noted that it concerns non-specific effects in patient physician relationships including attention, compassionate care, modulation of expectations, anxiety and self awareness. He looked at 5 components of the placebo effect.
- patient expectations
- patient practitioner interaction
- nature of the illness
- treatment and setting
The clinical repercussions of placebo are often tolerated by scientists as necessary nuisance noise but are otherwise considered inconsequential or treated with contempt. However kaptchuk asks whether alternative medicine can have an enhanced placebo effect with reliance on the power of belief, imagination, ritualistic symbols, meaning, expectation, persuasion and self relationship. He concluded that the role of the healer is a key aspect. The most important thing is enthusiasm, belief and commitment of the healer to what they are doing which if conveyed to their patients makes a huge difference to the healing outcome.
The studies show that we attach meaning to our healing desires through the power of positive thinking, positive past experience and affirmation which comes from ourselves and/or others. Therefore we fuel our desire for good health by the energy we give it. Scientific questioning of the placebo effect continues to argue back and forth regarding if the phenomena has a physiological or psychological explanation. But one fact comes through in all the studies shown, what one believes has an effect on the body. Expectation and belief, both psychological processes, are critical to healing no matter what is wrong with the individual and once expectation is there the brain causes other more specific physiological responses to be triggered as an effect. However as Nicholas Humphrey states, “the placebo is giving a message to the client but by whatever route the message comes, the patient must have the right mind set to receive it.”
Daniel E. Moerman, Wayne B Jonas (2002) deconstructing the placebo effect and finding the meaning response. Ann Intern Med
Mayberg H.S. & J.A. Silva; S.K. Brannan; J.L. Tekell; R.K. Mahurin; S. McGinnis; P.A. Jarabek (2002) the functional neuroanatomy of the placebo effect. The American Journal of Psychiatry
Amanzio M & F. Benedetti (1999) Neuropharmacological dissection of placebo analgesia: expectation activated opoid systems versus conditioning activated specific subsystems Journal of Neuroscience
T.J. Kaptchuk (2002) the placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance? In Complementary and alternative medicine series – academia and clinic
Nicholas Humphrey (2005) Oxford companion to the mind