Feature of the month: The Placebo Effect - a whole new dimension

The New Scientist contains a great range of articles relevant for students applying to medical school. It pitches ideas and features at exactly the right level for everyone to understand and the pieces are written in a way that is easy to digest. It is worth picking up a copy of it from your local newsagent about once month or even better speak to your school careers teacher and see if there is any chance that the school could get a subscription. 

This feature will be based on one of the featured articles in the 12th March edition of the New Scientist - "The Power of Mind". Shannon Fischer reviewed the latest discoveries relevant to 'The Placebo Effect' - a topic that is excellent to read up on to use in an interview discussion.

So what is the placebo effect?

According to science daily, "the placebo effect is the phenomenon that a patient's symptoms can be alleviated by an otherwise ineffective treatment, since the individual expects or believes that it will work." Pretty cool, eh?

The New Scientist article talked about a patient, Linda Buonanno, who had been sick with irritable bowel syndrome for 15 years when she watched a TV advert recruiting participants for a new study. She was so desperate to get involved even though she was fully aware that the treatment she would be offered would either be nothing or pills filled with nothing. In other words, this trial was testing the placebo effect against nothing. She had what she described as "fantastic" results: "I felt almost like I was before I ever had IBS. It was the best three weeks of my life". Since the trial has ended, she has been trying to get hold of the pills (which she knows are filled with nothing!).

This adds a new dimension to the placebo effect. The term 'placebo' refers to the use of a substance that has no therapeutic effect as a control when testing new drugs in drug trials. It is meant to be the thing that has no effect in order to measure the benefit of the new drug. However, instead of obeying the rules and feeling no different, many patients report beneficial effects. 

The New Scientist article discusses how perhaps the placebo effect needs to be given more weight. The vision of the future would be to exploit this ability of the mind to heal itself and body without the use of drugs which often result in side effects that can nearly be as much of a problem as that trying to be solved in the first place. 

A researcher at a Boston Medical Centre described to the New Scientist the latest research that suggests that when a person is given a pill that they believe is real medication, their body creates a real physiological effect. In fact, in pain studies, placebos have been shown to dampen activity in the brain's pain-processing ares and increase the production of the body's own analgesic chemicals. 

The counter-argument that may be brought up in an interview if you discuss this is that pain has a psychological element. However, a follow up point that you could make in response, is that the placebo effect has been shown to work on conditions that would not be considered to have a psychological component. For example, people being treated for Parkinson's disease with apomorphine, were only told that they might receive a dose of the drug. Amazingly, they showed more dopamine activity in parts of their brain normally affected by the real drug! 

Remember, a key thing to remember, is that if you bring up a disease at interview, be prepared for them to question you about it. For example if you mention the study above make sure you know that Parkinson's disease is the degeneration of the basal ganglia (part of the brain) and deficiency of the neurotransmitter dopamine. 

So pain can be improved, Parkinson's disease can be improved and an even more recent experiment showed that the immune system can also be affected by the placebo effect! In this study, healthy participants spent 3 days taking pills containing the immunosuppressant cyclosporin A alongside a fruit flavoured drink. (FYI cyclosporin A is a drug used to help stop the body rejecting an organ transplant.) 5 days later, the participants took the same drink but with fake (placebo) drugs instead of the actual ones. And guess what? Blood tests showed that immune compounds suppressed by the actual drugs remained dropped with the placebo drug. 

In other words, the placebo effect works when the patient expects the improvement that can be seen. Similar experiments have shown the same result when the reverse is carried out. For example, people are told their pills are placebo pills and their pain relief is dulled even though they are still taking the active medication. It seems a no-brainer that we use this effect to our advantage - huge amounts of money could be saved, patients could be spared nasty side effects of drugs and still have relief from some disease symptoms that are extremely difficult to manage.

However, there is one large problem that stands in the way. Using placebo requires deceit and this goes against some of the major pillars of medical ethics such as patient autonomy and informed consent. This is what has led to the development of the study that we opened with about Linda Buonanno. Here, she was fully aware that she was taking a placebo medication and yet, she had "fantastic effects". So how do we explain this?

Well, in the previous studies, patients believed in the medication they were taking. In this case, so did Lisa Buonanno. She believed in "everything that surrounded the drug". This has led to much excitement. Simply believing in the placebo effect itself (!!) is enough to mean patients still believe in the medication they are taking. They know it is a placebo but they know that the placebo effect can occur and therefore believe in that! Moreover, certain conditioning methods such as taking the medicine at exactly the same time every day and making the pills brightly coloured seemed to exert real effects on the patient's body.

So now, the honest placebo could even work! Verbal suggestion, classical condition can also be combined with a lifetime's associations learned about the medical ritual. Can you think of what these might be? Here are some ideas - any or all of which could cue the body's self-healing powers!

  1. Popping the pill packet
  2. Swallowing it with a glass of water
  3. Believing in the drug's ability to have an effect
  4. Believing and trusting in the doctor that has suggested the treatment

As wannabe medical students, one of the most intriguing aspects of the list that could be causing the effect is the trust and belief in the doctor. Lina Buonanno described her doctor as "such a good doctor". Some studies are now implicating personality traits such as optimism as factors that determine the benefit of the placebo effect in different people. However, a very interesting study is one by a neuroscientist at Massachusetts General Hospital. She looks to analyse the doctor-patient consultation using fMRI studies to visualise which parts of the doctor's brain could be responsible for whether the placebo effect works on the patient. In other words, good people skills, empathy and communication skills could be what determines whether the placebo effect is successful for a person.... now your minds are definitely blown!!

Keep updated on the blog about ways to prepare for your medical application and to book your place on one of the Applican courses this summer go to www.applicancourses.com/book.