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The Placebo Effect

Does the power of belief work for you or against you?

"So many of my friends have reported good results from that autism treatment/grapefruit diet/vitamin supplement/anti-aging cream -- it MUST work!"

How many times have we all heard statements like this one? It sounds so simple, yet the truth in these matters is usually anything but. When we hear such statements, we may unwittingly have entered the remarkable realm of the "placebo effect."

Placebo, Latin for "I shall please," refers to the positive result we get when our will to believe is combined with a treatment that alone does nothing. The placebo effect represents the most stunning example known of the power of mind over health. Though the precise workings of this process are poorly understood, there is a vast body of documentation concerning the circumstances under which belief and expectation can trigger powerful healing responses of a medical and psychological nature.

Standard figures for the effectiveness of placebos have suggested that about 40% of patients receiving a useless or inert remedy will experience relief from the targeted ailment. However, these figures may have to be revised upwards due to an analysis by psychologists at San Diego State University and the University of Michigan, and published in the July 1993 issue of Clinical Psychology. While it is generally held that about 40% of patients who believe in a treatment of no actual medical value will report that they "feel better," the new figures indicate that, in cases where both the patient and the physician or therapist believe in the ineffectual treatment, the placebo effect can soar as high as 70%. This new figure seems to bear out the famous remark of the late physicist Richard Feynman, who cautioned that "The first principle (of the scientific method) is that you must not fool yourself, and you're the easiest person to fool."

Contrary to common assumptions, placebos do not come only in the form of the proverbial "sugar pill": therapies and even surgical procedures may qualify. For example, in the 1950s surgeons routinely performed a now-questionable operation to relieve the pain of angina. While three-quarters of all patients reported benefits from this operation, it was later discovered that skin incisions alone, without any actual operation, produced reported improvements in nearly half of the patients!

The most important factors in the success of the placebo may be the setting and conditions under which it is administered. Research has shown that the wearing of a white coat by the doctor, therapist, or even skin care consultant, the "special" or "exclusive" character of the location at which people are treated (e.g. a hospital or treatment center reached by a long trip, rather than the local doctor's office reached by a short trip), the existence of special certifications for dispensing the treatment, plus the presence of medical equipment, special machines, impressive bottles and labels for the portions dispensed, and even appropriate "power colors" (red pills seem to work better than blue ones), are crucial in turning on the placebo response. Recent research even suggests that the presence of side-effects, such as discomfort or nausea, can trigger the placebo effect by causing patients to think something useful must be happening. Occasional reports of success from many an intrinsically worthless treatment can be explained by noting how many of these powerful cues were in place.

But of what does the placebo response consist? Experts agree that it is not "magic." Placebos seem to help patients turn on their own pain relief mechanisms, called endorphins, or simply to summon a more positive sense of themselves and their ability to take charge of their bodies. In the words of Richard Restak, M.D., "(Those) who can successfully elicit a placebo response tend to be optimistic and hopeful. In the face of uncertainty they emphasize affirmative emotions while encouraging confidence and expectations for recovery."

This sounds like a pretty good description of "Positive Approaches." If only we could release this positive attitude from its incidental, pseudo-medical trappings, imagine the effect of simply sharing with others -- especially our children and friends with disabilities -- a belief in their own competence and ability to triumph. Yet so often we choose to believe instead in gadgetry, technology, miracle treatments and formulas, and experts in white coats. The real story of the placebo effect may be the story of our failure to see where the power really lies.

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