Your Doctor’s Bedside Manner May Be What Is Really Curing You

The placebo effect is just getting more and more curious. It has been known for some time that it is getting stronger, so much so that it is causing problems for the pharmaceutical industry; they are unable to make their new drugs perform any better in the group that is really receiving them than in the control group that is only getting a placebo – an inert sugar pill.

New research conducted at Massachusetts General Hospital and Harvard Medical School indicates that placebos “work” whether or not we are consciously aware of having received them. The previous theory was that it was primarily the act of intervention – being given a pill to take, being given an injection, etc. – that triggered the placebo effect. In other words, the subject is consciously aware that something is being done to help their condition, and sure enough the condition improves, whether they are actually given any real medicine or treatment or not.

But in this latest study, the subjects were unaware that any stimulus or intervention had occurred, and the placebo effect was triggered anyway.

Subjects reacted subconsciously to something too short to perceive consciously

In the study, subjects were shown faces on a screen as varying degrees of heat were applied to them. High levels of pain or discomfort were thus associated over the length of the experiment with certain faces, such that when the faces were later shown to the same subjects, they reported feeling the same levels of pain or heat, even though none had been applied. So far, this all complies with the existing beliefs about the placebo effect; the subjects “felt” the heat or pain because they consciously saw a face they had been trained to associate with it.

But in the next phase of the experiment, the faces were flashed – interspersed with other images that held no association for the subjects – for only 12 milliseconds. That is far too short an interval for the brain to be able to consciously recognize the image. The subjects felt the heat or pain anyway. In other words, the placebo effect had been triggered by something completely unconscious or subconscious, without the subject being aware of the trigger at all. It had, in fact, been triggered by a part of the brain that is completely separate from our conscious awareness.

The researchers concluded that the mechanism that controls the placebo effect is more automatic than conscious, and occurs in a split second in parts of the brain that could not be affected by their conscious expectations.

The implications of this for health care are not understood

Doctors and researchers aware of the power of the placebo effect have long known that their “bedside manner” affects the prognosis of the treatments and drugs they give to patients. And everyone seems to respond to these conscious “cues” – the placebo response is triggered no matter how intelligent or skeptical the patient may be. A doctor telling you that a treatment will improve your condition improves the outcome of the treatment. The doctor just believing that the treatment will improve the condition improves the outcome of the treatment.

But these new findings suggest that the placebo effect can also be triggered by things that we are not consciously aware of. Is it thus possible that if a doctor tells us that our condition is going to improve as a result of a treatment or drug but doesn’t believe it, that the opposite of a placebo effect – a nocebo effect – will be triggered by his disbelief, which we are picking up subconsciously? No one knows the answer to these questions, only that they have been raised by this new information that the placebo effect can be triggered subconsciously.

Other fascinating facts about the placebo effect

Whether we pick up the “cues” we receive from our physicians consciously or unconsciously, they still seem to trigger the placebo effect, and thus can radically change how well a particular drug or therapy “works” for us. Although there is much we don’t know about the placebo effect, here is a list of curious things we do know about it:

• More is “better.” Being asked to take two or four placebo pills is more effective than being asked to take only one.

• Method of delivery is important. Injections or medications delivered via an IV are perceived as more effective than the same medication (or placebo) taken as a pill.

• The color of pills (placebo or real) changes their effectiveness. Yellow pills “work better” as antidepressants; green pills “work better” to reduce anxiety; white pills or tablets “work better” as antacids. In cognitive tests, pink pills improve concentration better than blue ones.

• The shape of the medication (again, placebo or real) also has a bearing on its effectiveness. Patients report that capsules “work better” than pills.

• Medications (or placebos) with a visible brand name stamped on them “work better” than plain pills.

• The more expensive the subject feels the drug is (real or placebo), the better it is perceived to “work.”

• Placebo operations (those in which the patient is sedated and told that surgery was performed when none was) for knee pain and for angina have been proven to in some cases be as effective as actual surgeries. In clinical trials, patients who had a pacemaker installed showed improved heart function, even when it was never turned on.

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Juliette Siegfried, MPH

Juliette Siegfried, MPH, has been involved in health communications since 1991. Shortly after obtaining her Master of Public Health degree, she began her career at the National Institutes of Health in Bethesda, Maryland. Juliette now lives in Europe, where she launched ServingMed(.)com, a small medical writing and editing business for health professionals all over the world.

Juliette's resume, facebook: juliette.siegfriedmph, linkedin: juliettes, (+31) 683 673 767

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