Writer: Jessica A. Dennehy
Editor: Isabella Io
During the mid-1800s in the American West, political turmoil, rapid advances in technology, and a frantic nationwide search for economic opportunities collided, compounding into a period marked by widespread craftiness, desperation, and a mass search for solutions to the nation’s many problems. Consequently, when Chinese laborers used traditional Chinese medicine to alleviate their various ailments, many Westerners took notice. One such traditional remedy was oil derived from the Chinese water snake, which, when rubbed onto the joints, could reduce inflammation, combat arthritis, and treat joint pain. Rich in omega-3 acids, genuine water snake oil had impressive benefits—benefits which soon caught the attention of the now-termed “snake oil salesmen,” who capitalized on its popularity and marketed it on a national scale. [1]
Due to a limited supply and high demand, these salesmen quickly switched from using oil derived from the Chinese water snake to using rattlesnake oil. They further claimed that their concoctions could not only treat joint pain but also alleviate chronic pain, headaches, "female complaints," and even kidney issues. One of the most notorious of these frauds was the brand Stanley's Snake Oil, which, despite its namesake, was later revealed to primarily contain mineral oil, fatty oils—most likely from beef fat—red pepper, and turpentine. [1]
Despite the lack of ingredients and evidence that would explain any genuine health benefits, many people swore by the health benefits and effectiveness of rattlesnake oil and the plethora of other unproven patent medicines available on the market at the time. This phenomenon brings us to the central topic of this paper: the placebo effect. How can these health gimmicks “treat” so many health complications with no science behind them, and do they really treat them?
What is the Placebo Effect?
A placebo is a "fake" treatment that resembles medicine. It can take various forms, including but not limited to a pill, injection, or even an aerosol. The defining characteristic of all placebos is that they lack any active substances that could affect one’s health. However, their users assume it is a real and valid medication. The placebo effect arises from the general population’s psychological response to these placebos, especially within the context of medicine.
Responses to the placebo effect can be both positive and negative; symptoms can improve, or side effects can occur—all from the psychological response to the placebo itself (which cannot produce its own side effects as it contains no active ingredients). Certain conditions are known to be affected by placebos, including:
Depression
Pain
Sleep disorders
Irritable bowel syndrome
Menopause
Reactions to chemotherapy
Research on the placebo effect has predominantly focused on the relationship between the mind and body, with the most common theory being that it arises from an individual's own expectations. If a person expects a placebo to have an effect, their body may “psych itself out” and create the same conditions they anticipate the placebo would have produced. [4]
The placebo effect and how placebos work are still not fully understood, as they involve complex neurobiological reactions. These reactions may increase the release of “feel-good” neurotransmitters. These can include endorphins, which act as the body’s natural pain relief and can create a sense of well-being while also decreasing stress, as well as dopamine, which can induce a sense of pleasure. [5][6] Other bodily responses can include increased activity in brain regions associated with mood, emotional responses, and self-awareness—all reactions aimed at providing a therapeutic effect to the body. [3]
How Are Placebos Used?
Understanding the power of placebos and the influence of the mind, researchers have developed methods to address and help combat the placebo effect. Preventing the placebo effect from skewing results is critical in clinical trials and other medical studies. Placebos are commonly used in studies to better understand the effects of certain drugs or treatments on specific conditions. For example, in a theoretical study of a new cholesterol-lowering drug, participants would be randomly divided into two groups: one receiving the actual medication and the other receiving a placebo. Neither group would be informed of what treatment they were assigned; all participants would believe they received the real treatment. Researchers can then later compare the outcomes of the two groups to determine whether the drug is effective, or if the concept of being treated influenced their responses and assumptions regarding their health. They can also assess any potential complications and side effects, whether from the true medication or the placebo, whose potential negative effects will be touched upon later. This ensures that observed effects are not attributable to the placebo effect and that data bias, or the inaccurate/ incomplete collection of data, is minimized. [4]
Researchers are also able to use placebos in determining whether observed effects or potential complications can be attributed to the actual drug or to the placebo, especially in modern drug development and clinical trials. If the two study groups experience similar effects and results, placebos can help reveal whether the drug is simply ineffective, necessitating further research and improvements, or if there are non-pharmacological factors influencing the outcomes of the trial. [3]
Regardless, experts have continually sought effective methods to counteract the placebo effect, as eliminating it from the equation would make drug testing more accurate and reduce costs. Moreover, there have been studies where the placebo effect is leveraged to treat diseases and alleviate unpleasant side effects of treatments. [4]
How is the Placebo Effect Accounted For in Medical Testing?
In a study on asthma and affiliated treatment development, a placebo inhaler had no effect on breathing test results compared to simply sitting still and doing nothing. However, when participants were asked about their perceived effectiveness, they reported that the placebo inhaler was just as effective as the actual medication in relieving their asthma symptoms. [4]
In another study, participants were divided into different groups and given the same pill—a placebo. One group was informed that the pill was a stimulant, while the other was told it was a depressant. After taking the pill, the group that believed their placebo was a stimulant experienced increased heart rate and blood pressure, along with improved reaction times to certain stimuli. Conversely, the group that believed their placebo was a depressant, intended to aid sleep, experienced the opposite effects, aligning with the marketed intentions of their placebo. [4]
A psychological factor in the complexity of the placebo effect is an individual's expectations about achieving a certain outcome. Experts suggest that there is a strong relationship between how intensely a person expects to see a result and the actual manifestation of that result. They have concluded that the stronger the expectation, the greater the chance the individual will experience the outcome, almost like it was willed to be. Moreover, this relationship with expectations is not limited to the person receiving the placebo; the expectations and biases of healthcare providers and caregivers can also influence patients’ manifestation of results, even if from a placebo. [4]
What is the Nocebo Effect?
As a reminder, the placebo effect occurs when an individual experiences a reaction or response to a placebo, a medicine lookalike that has no impact on heath. The effect can result in both positive and negative outcomes while ranging in severity. The nocebo effect is a subcategory of the placebo effect, referring to situations where a negative outcome arises due to the belief that a drug or procedure will cause harm. While the term "placebo" comes from Latin, meaning "I will please," "nocebo" comes from the Latin phrase "to harm." Thanks to the nocebo effect, patients are more likely to experience negative, adverse effects if they expect them. This is predominantly reflected in patients who experience a severe reaction from a placebo in a clinical trial. [2]
Some experts have even suggested that the nocebo effect may have a greater impact on clinical outcomes than the placebo effect, as negative perceptions and biases are often formed more quickly than positive ones. [2]
Conclusions and Takeaways
Placebos are not exclusively negative in medicine; they have been used to alleviate some of the grueling side effects associated with chemotherapy, menopause, and even depression. However, concerns related to drug development often involve data bias. If the placebo effect interferes with the results of the actual treatment, it is crucial to find ways to account for it. The power of the human mind is remarkable, working both to create and also combat the data biases and the mysterious effects that stem from the placebo effect.
Sources & Works Cited
[1] Gandhi, Lakshmi. “A History Of 'Snake Oil Salesmen' : Code Switch.” NPR, 26 August 2013, https://www.npr.org/sections/codeswitch/2013/08/26/215761377/a-history-of-snake-oil-salesmen. Accessed 31 July 2024.
[2] New Zealand Medicines and Medical Devices Safety Authority. “The nocebo effect.” Medsafe, 7 March 2019, https://medsafe.govt.nz/profs/PUArticles/March2019/The%20nocebo%20effect.htm. Accessed 31 July 2024.
[3] “The power of the placebo effect.” Harvard Health, 22 July 2024, https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect. Accessed 31 July 2024.
[4] Saling, Joseph. “The Placebo Effect: What Is It?” WebMD, 13 March 2024, https://www.webmd.com/pain-management/what-is-the-placebo-effect. Accessed 31 July 2024.
[5] Watson, Stephanie, and Howard E. LeWine. “Dopamine: The pathway to pleasure.” Harvard Health, 18 April 2024, https://www.health.harvard.edu/mind-and-mood/dopamine-the-pathway-to-pleasure. Accessed 31 July 2024.
[6] Watson, Stephanie, and Howard E. LeWine. “Endorphins: The brain's natural pain reliever.” Harvard Health, 18 April 2024, https://www.health.harvard.edu/mind-and-mood/endorphins-the-brains-natural-pain-reliever. Accessed 31 July 2024.
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