PLACEBO

EFFECT
~ SHREYASI PAWAR , 503
 INTRODUCTION
The effect of a treatment that arises from a patient’s expectations and response to
the treatment, excluding the treatment’s specific action .

In medicine, it typically refers to a response observed after inert or inactive

treatments.
Placebos do not cause anything because they’re inert.

It is the psychological/emotional meaning that defines the response

This response is elicited by far more than just inert pills

Must think about active agents as well

The meaning response goes well beyond psychological effects and results in
physiological changes as well.
 The term placebo is Latin and means ‘I shall please’. This reflects the historical

use of placebos to placate patients whose complaints could not otherwise be treated.

It also indicates a belief that while the placebos might please patients, they are not

likely to produce real benefits.

 INCIDENCE

15 studies, carried out by Beecher (1955) involving 1082 patients, the

average placebo response rate determined was 35.2%.When patients
do not know they are receiving placebos, high as 70-82%
 Placebos Can…
Constrict the pupils, alter blood pressure, change heart rate and respiration, influence
gastrointestinal secretions and peristalsis, change body temperature, produce
eosinophilia and leucocytosis, enhance corticosteroid reactions, and change blood levels
of creatine and lipoproteins (Perry 1981)
● Negatives: Cause dry mouth, nausea, heaviness, headache, difficulty
concentrating, drowsiness, sleep disturbance.
● Placebos are believed to be capable of altering a person's perception of pain.
● Analyzing data from the FDA, concluded that 82% of the response to
antidepressants was accounted for by placebos.
● Placebo morphine is considerably more effective than placebo Darvon, which in
turn is more effective than placebo aspirin.
 Placebo is of 2 types -
Inert or Pure Active or Impure
placebos placebo
Substances that could have no Have potential
conceivable pharmacologic effect pharmacological effects,
on the patient. though not necessarily any
specific activity for the
Examples: Dummy pills or condition under treatment.
capsules containing lactose
or chalk. Examples vitamin B12 or
iron in the absence of
Antibiotics in viral
infections
Factors influencing power of placebo effect
1. The administration of the placebos can determine the [Link] strength.
Studies have found that taking more pills would strengthen the effect. Besides,
capsules appear to be more influential than pills, and injections are even stronger
than capsules.

2. Children seem to have a greater response than adults to placebos.

3. If the person dispensing the placebo shows their care towards the patient, is friendly
and sympathetic, or has a high expectation of a treatment’s success, then the placebo
would be more effectual.

4. The colour of a placebo can influence its effects . When administered without
information about whether they are stimulants or depressives, blue placebo pills
produce depressant effects, whereas red placebos induce stimulant effects. Patients
report falling asleep significantly more quickly after taking a blue capsule than after
taking an orange capsule. Red placebos seem to be more effective pain relievers than
white, blue or green placebos.
Application
 Placebo in clinical trials
During the 1950s, the possibility that placebo treatment might have real effects

became more widely recognized, and the use of placebo controls in medical research

became common. In case after case, medicines and treatment procedures that had

been ‘proven’ effective in clinical trials were found to be no more effective than treatment by placebo.

It was suggested that placebos could reduce the frequency of asthma attacks, relieve hay fever,

suppress coughs, alleviate tension and anxiety, cure headaches, reduce pain, prevent colds and

alleviate cold symptoms, cure ulcers, inhibit symptoms of withdrawal from narcotics, alter

gastric function, control the blood sugar levels of diabetics, reduce enuresis, lessen

the severity of arthritis, reduce the frequency and severity of angina attacks and

reverse the growth of malignant tumours. These data led to the concept of ‘the

powerful placebo’ (Beecher, 1955).

 Placebo 1. Compare effects with those of the
active drug
Acceptance in
CT 2. Comparison of active drugs
validated by a placebo

3. Blind administration of two

drugs that cannot be made
indistinguishable (Double Dummy
technique) Wihdrawal period 4.

5. Toxicity

6. Placebo responders to be
excluded
 Psychological Perspective
● Currently, the two most popular explanations of the placebo effect are classical
conditioning and response expectancy.

In classical conditioning, a stimulus (called an unconditional

stimulus) that automatically elicits a response (called an unconditional response) is
paired repeatedly with a neutral stimulus (called a conditional stimulus). After a
number of such pairings, the conditional stimulus acquires the ability to evoke a
response (called a conditioned response).

Example – whenever you come home wearing a baseball cap, you take your child
to the park to play. So, whenever your child sees you come home with a baseball
cap, he is excited because he has associated your baseball cap with a trip to the
park.
Response Expectancy are anticipation of automatic subjective responses (e.g.

changes in pain, anxiety, depression). Response expectancies tend to elicit the

expected response. Thus, the anticipation of anxiety makes people anxious, the belief

than one will stay depressed forever is very depressing, and the anticipation of

changes in pain alters the perception of pain. More generally, subjective experience

appears to be due to a mix of external and internal factors. It is produced partially by

external stimuli and partially by the person’s beliefs, expectations and interpretations

of those stimuli. As applied to the placebo effect, expectancy theory asserts that

placebos produce their effects by changing people’s expectations.

Example – A placebo antidepressant leads people to expect a change in their depression, and

that expectation makes them feel less depressed. A shortcoming of expectancy theory

is that it does not easily account for the physical effects of placebos.
 Placebo psychotherapy
Given the importance of placebo effects in medical interventions, it was only

natural that researchers began to question the degree to which the effects of

psychological interventions might be placebo effects. To answer that question,

studies were designed to include placebo psychotherapies, the effects of which can be

compared to the genuine treatment. At first glance, this strategy seems reasonable,

but, in fact, it is very problematic. There are both practical and conceptual problems

with attempts to extend the placebo concept from the medical setting to the

psychotherapeutic setting. Practically, it cannot be done; conceptually, it makes no

sense to try.
 Conclusion
Placebo effects are not limited to drug treatments. Any medical procedure can

have effects due to the physical properties of the treatment and effects due to its

psychological properties. Just as the effects of the physical properties of a medication

can be tested by comparing its effects to those of a sham medication, so too the

physically produced effects of other medical procedures can be established by

comparison with sham procedures (e.g. sham surgery). For example, real and sham

surgery have been compared in the treatment of angina and osteoporosis of the knee.

In both cases, the effects appear to be due to the psychological properties of the

treatment, rather than to the surgical procedures themselves.

 References
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