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Placebo responses are automatic and unconscious and cannot be predicted based on conscious volition. Instead, they reflect complex interactions between the innate reward system of the nervous system and encoded procedural memories and imaginal fantasies. The placebo response contributes inextricably to virtually all therapeutic effects, varies in potency, and likely exhibits its own pathologies. The Placebo Response further considers that the critical elements required to provoke placebo responses overlap substantially with what most current psychotherapies consider to be therapeutic, i.e. an interpersonal dynamic rooted in concern, trust and empathy. The potential importance of training caregivers in how to optimize placebo responses is considered a crucial feature of both the art and science of care-giving.
Richard Kradin, MD, is an active medical internist, psychoanalyst, immunologist, pathologist and medical researcher at the Massachusetts General Hospital in Boston, as well as associate professor at Harvard Medical School. In "The Placebo Response", he surveys the scientific literature on placebo effects and makes a number of interesting points, including these four:1. The placebo response includes measurable, physical effects. Decreases in wound pain, sea sickness, headache, cough, arthritis, ulcers, hypertension, warts and cancer have all been documented. In a study on depression, changes in prefrontal lobe activity were observed [p. 24].2. Both long-lived and extraordinary placebo effects have been reported. In two separate studies of a surgical procedure to alleviate coronary artery blockage, sham surgery proved just as effective as the real thing in reducing the frequency and severity of chest pain [p. 72]. Sham surgery was just as good as arthroscopic surgery for osteoarthritis of the knee [p. 3].3. "Evidence based" medicine relies in large part on placebo response. Drugs are often prescribed at a dosage that is ineffective or for a purpose for which their efficacy is unproven. The FDA approves a new drug when there are two studies showing that it's effective, although there may be many more that have failed. Most surgical procedures have never been evaluated in a placebo controlled trial. As Kradin puts it, "Medical practice swims in a sea of placebos and is none the wiser for it" [p. 65, 72].4. Communication can promote or inhibit placebo response. A physician's eye contact with the patient, body language, tone of voice, and choice of language have a great influence on therapeutic response. Much of this communication happens unconsciously [p.214].Though physicians may bristle at the idea that their armamentarium works in large part by placebo effect, their homeopathic colleagues are no less vehement in defending the efficacy of their medicaments. Yet frankly the results of homeopathic treatment are indistinguishable from placebo response. What can be said in favor of homeopathy is that the treatment is noninvasive and may increase the chances of placebo response. A meta-analysis published in the Lancet of 186 randomized controlled studies of homeopathic treatment showed that the treatment group was 2.45 times more likely to experience a positive therapeutic effect than the placebo group [Linde & Clausis, 1997]."The Placebo Response" is a revolutionary book, truly ground breaking. It opens the door to a radically new understanding of how medicine works and in which direction it should move.
