Welcome everyone to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. As a doctor for many years, I’ve always been fascinated by the placebo effect and how suggestion and expectation can lead to healing. 

Placebos have shown to be most effective for chronic pain, stress related insomnia, and maybe even cancer treatment side effects, such as fatigue and nausea. It’s an amazing, yet baffling phenomenon. The Power of PLACEBO. 

Let’s get started. 


What Is A Placebo Controlled Trial? 


The gold standard of any drug trial is called a Double-Blind, Placebo Controlled Trial. This is where both the researcher and the patient don’t know if they’re getting the real drug or a sugar pill. Thus, the term “blinded”. In most trials the placebo works at least one third of the time, and sometimes even as high as 60%. 

The Placebo Effect suggests that your mind can be as powerful as some of the treatments themselves. I’m a strong believer in the Placebo Effect. It encompasses so many different ways of thinking about healthcare. These drug trials are usually placebo controlled, blinded studies. Most of the time placebo works. You have to think about why this is happening and incorporate it into the way you think about your own health (or your way of practicing medicine).  


Why Do Placebos Work? 


Most likely, there’s a non-pharmacologic mechanism that’s in play here. It’s a complex neuro biological phenomenon. It includes everything from an increase in the “feel good” neurotransmitters (endorphins and dopamine) to greater activity in the brain regions that are linked to mood, emotional reactions, and self awareness. In other words, your brain is telling your body what it needs to do, to feel better. There is tremendous power in this! 

In a lot of cases, a placebo will work even if the patient knows they’re getting a placebo. To me, that is fascinating! The very act of taking a pill itself can catalyze the body’s own capacity for healing. It may simply be the ritual of taking the pill, but it definitely sets off processes in your brain that have been shown through MRIs and PET scans to light up and show enhanced activity in certain parts of the brain. Most of this activity has been proven to occur in the brain stem. The brainstem is responsible for regulating most of the body’s automatic functions such as breathing, blood pressure, heart rate, and sleep. 

Is it ethical to give a patient a placebo? Some would say no, especially if it denies that patient a known treatment that has been proven to work. But in the right circumstances, I think it’s useful. I’ve certainly done it. In fact, 50% of all doctors do this! In my opinion, it’s not really unethical if you do it with the right patient, and you don’t deny them treatment. A lot of clinical trials have been stopped because the drug works so well, and they don’t think it’s ethical to continue denying the drug to the people getting the placebo.  

Note: When I’ve written for a placebo, I write it out as OBECALP, which is placebo spelled backwards. Every pharmacist knows what it is. I’ve done this very few times in my practice, when (a) I knew it was going to help, (b) there was nothing pathologic there, and (c) no reason not to. 

I think it’s really interesting that this works. It can even get pretty specific. If people are given an energy pill and are told it will give them energy, their blood pressure and pulse rate increases. And, if the same people being given the same pill are told that the pill will help them relax and sleep, their blood pressure goes down, pulse rate goes down, and they relax. 

Note: The same thing can happen if a patient is told that a placebo could have harmful side effects. They often will feel bad afterwards. This is called the Nocebo Effect. That’s a real effect too! 


Why Am I talking About This? 


I think the way doctors approach their patients has a tremendous effect on patient outcomes. Personally, I like to be positive with patients and tell them the best things that could happen, not the worst. Sometimes you have to give patients bad news, but that shouldn’t be the default. A lot of doctors do it the opposite way. I’ve heard from so many patients that their doctor has told them they don’t have a chance, or that there’s nothing that can be done. You can’t practice medicine for as long as I have, and not realize that there’s a strong emotional aspect to a patient’s health. If you’re negative, it really hurts the patient. 

If there is one thing I strongly believe in, it’s HOPE. I think it plays as much of a role in healing as good medical science. There is always a fine line. That’s what makes medicine an ART, as well as a SCIENCE. The way you approach things (i.e., diagnosis, treatment) is so important. In my opinion, meditation, exercise and strong relationships play a vital role in achieving your optimal health. 

A few takeaways…

  1. Be intentional about your health: eat nutritionally, exercise, and get good sleep.
  2. Stay away from negative people. Negativity is terrible for you, whether it be for your health or just your state of mind. 
  3. Think positively and be around more positive people. You’ll be much healthier because of it.
  4. Realize that something can always be done to help you. 
  5. Never lose Hope. 
  6. Nurture your relationships and your emotions. Note: The U.S. Surgeon General stated in a recent article “Loneliness poses health risks as deadly as smoking.” HEALTH, May 2, 2023, Loneliness Poses Health Risks As Deadly As Smoking, pbs.org 

There’s a strong emotional and mental aspect to healthcare. I hope you realize this. As my very healthy 102 year old friend told me, “the reason I’m the way I am, is because of my faith and my positive attitude”. Think about that.  

Till next week.