Placebo And Nocebo Effects - The Conflict Between Positive And Negative Thoughts
Placebos are harmless inert substances that produce responses equivalent to active medicines
The word placebo literally means, "I shall please". It is an inert substance, which is given in the garb of a medicine. It has a psychological, rather than a pharmacological mode of action, and often produces responses equivalent to the active medicine. Placebos can release endorphins (natural chemical substances that reduce the intensity of pain) in the brain, and have effects similar to a pain reliever. Substances commonly used as placebos are lactose tablets or capsules and distilled water injections. They can supplement pharmacological effects of a medicine, and are a classic example of how expectations and beliefs can be powerful forces, that can induce sickness or promote good health.
Use of Placebo and Medical Ethics
Any relationship between a physician and a patient creates a situation in which the placebo response may occur. The degree of this response depends upon the personality and optimism of the physician, or the patient, the setting or nature of communication, fatigue and concentration. The entire process of healing the sick creates a psychological bond between the caregiver and the sufferer. Primitive modes of religious or magical therapy leaned heavily on positive beliefs creating a placebo situation.
Characteristics Of A Placebo
- Color and shape of the tablet: Variations in placebo response to tablets of different colors - green is the best for anxiety - have been demonstrated.Unusual size and shape of tablets also reinforce the beneficial effects.
- Nontoxic nature: Placebos must be harmless. Lactose tablets are commonly given, but even this substance is not totally harmless.Many common diseases such as alopecia areata and chronic urticaria have been cured with many different preparations that do not have any pharmacological effect in these conditions, but the sufferer has been sustained through the natural course by receiving a potion or a lotion that at least sustains the faith and the hope, and is free from potential toxicity
- Prescription: Carefully worded instructions may reinforce a placebo effect. No official placebo has been included in the British National Formulary. A placebo is believed to work better if both physician and the patient believe in it.
- Incurable disease: Administration of a placebo as a therapeutic measure is justifiable if no known effective treatment exists. It is less likely to cause harm than a poorly tested or a powerful new medicine of uncertain value.
Both placebo and nocebo effects have a psychological rather than a pharmacological basis
The Nocebo Effect
When expectations and beliefs are negative, and myths predominate over real facts, then placebo's dark twin - the nocebo effect comes into play. Negative expectations, fears and anxiety can actually make a person fall ill without any organic cause, or even worsen a pre-existing illness. Severe anxiety has psychological effects, such as tension, apprehension, fear, difficulty in concentration, and bodily effects, such as palpitations, difficulty in breathing, shakiness, and severe perspiration. Fatigue, sleep disturbances and digestive upsets also occur. Anxiety can become self-generating since the symptoms reinforce the reaction causing it to spiral. When people taking medicines or even dummy pills are warned about side effects, they are most likely to experience them. Even if they are not warned, some people will develop adverse effects from a dummy pill, simply because they think it is a real medicine, and follow the myth that all medicines cause side effects.