We really need a robust research agenda for the science of the placebo effect. Instead, we have science that uses the placebo effect to identify drugs and procedures and other medical interventions that supposedly cause healing and protection—but with the added feature of what’s called off-target effects, also know as side effects.
From an economic standpoint, as opposed to a financial one, this makes no sense. Why spend money on developing expensive medical products when simple actions that could serve the same purpose?
A short article in the forthcoming issue of Science reports that activity in a specific place in the spinal cord shows altered activity when a placebo is used for pain relief. The authors note that subjects were “primed” for the pain relieving effect of the placebo by being told that the cream applied to their arm contained lidocaine. The researchers monitored spinal cord activity using functional MRI and identified the specific site of opioid activity—that is, they watched the experimental subject’s bodies create their own pain killers as a consequence of applying a cream that the subject was told contained lidocaine but in fact did not.
This is quite astounding. Talk about solving the mind-body problem. But instead of marveling at this outcome, the researchers seemed to be more interested in what the experiment told them about how pain is generated and suppressed and how better “interventions” could be designed as a result.
In my opinion, researchers should be asking question like the following instead.
What characteristics of a person create a sensitivity to the placebo effect? It’s clear from this experiment as well as how the placebo effect is used in research generally that each person responds uniquely to a placebo. The placebo effect is described as a psychological effect on medical conditions, so it would make sense to ask what kind of person might benefit most from a placebo. It would also be worthwhile to ask how different forms of placebo work on people of differing temperaments, including, of course, different cultural forms.
What characteristics of a person’s body create a sensitivity to the placebo effect? Much of what seems to happen with a placebo is not conscious. Instead, it is the body responding directly to information about care that it receives. So it would make sense to ask what characteristics of a person’s nervous system, endocrine system, immune system, and other systems would help them benefit from a placebo. Again, we should expect that different forms of placebo will differ in their effect on different types of biologies, including age.
What environments best support an effective placebo? The environment is not independent of the person responding to it. The same environment could elicit quite different placebo effects depending on the person. For example, a person in a white coat with a cool, calm manner who administers a placebo in an impersonal, clinical setting might promote the placebo effect in one person and suppress it in another. So it would make sense to ask what environments promote the placebo effect and how those differ across personalities and unique biologies.
For the most part, researchers seek to eliminate the placebo effect so that the effect of a pharmaceutical or medical procedure can be objectively evaluated. I’m arguing for exactly the opposite because the placebo effect supports the capacity of the body to take care of itself. The conventional approach is to do something to the body to make it stop doing something that is unwanted. Very different.
You will no doubt recognize the approach I advocate in many alternative healing arts. When conventional researchers and practitioners label the efficacy of homeopathy or aromatherapy or flower essence therapy or traditional healers as the result of a placebo effect, they do not mean it as a compliment. It forces me to ask: is the point of research to determine the effectiveness of a drug or procedure? Or is it to find those methods that maintain and restore our health according to each person’s needs, culture, and biology?
“The Placebo Effect,” “Healing,” and other essays in our book Too Much Medicine, Not Enough Health discuss this perspective further.
