A dose of belief

Medical science finds the placebo hard to swallow. But researchers have plenty of evidence for the mind's beneficial effect on real physical symptoms.

Patients given fake medicines or sham surgery often get better because they expect to - it's the placebo effect. Big capsules filled with inactive ingredients work better than small tablets, and two tablets work better than one. White tablets kill pain more effectively than yellow ones. It is an astonishing phenomenon.

You might think that people in pain simply imagine their improvement. Yet swellings can shrink, heart performance improve and constricted airways dilate - all thanks to the placebo response alone. What is going on here? And why is this remarkable happening steadfastly ignored by Western medicine? A recent groundbreaking conference on the "placebo response" - organised by the University of Westminster in London - has at last brought this biological mystery the attention it deserves.

The trouble is, the placebo effect is more than just an embarrassment to modern scientific medicine. It's a bombshell for our conventional notions of illness and disease. It reveals our capacity to modulate body symptoms and suffering in ways that can't be dismissed as "all in the mind".

The idea that mere "belief" can provoke observable physiological change "provokes a shudder of discomfort like a cold hand in the dark," remarks pain researcher Patrick Wall of St Thomas's Hospital, London. And no wonder: the demonstration that hope has the power to heal hardly fits the mechanistic models favoured by the medical establishment. It blurs that most well- defended of Western constructions: the boundary between mind and body, "psychological" and "physical".

The placebo response, once acknowledged, forces a merger between the "hard" world of objective scientific results with those messy realms of culture, social life and the individual psyche. It results from any action intended to heal - from any contact between doctor and patient or any procedure, such as admission to hospital, says Peter Fenwick, a neurophysiologist at the Institute of Psychiatry in London and the Radcliffe Infirmary in Oxford. "It flows from the interactions of patients with the circumstances they are in," he says. "It has already started, at the first contact with the doctor or healer."

Just the presence of culturally accepted "totems" or symbols of healing - diplomas on the wall, white coats, a clinic filled with impressive-looking equipment - can promote healing, says medical anthropologist Cecil Helman of Brunel University.

"The placebo response seems to depend in part on the creation of a particular ambience by the healer, whether it's a Harley Street specialist or a shaman in Latin America," he says.

Doctors' attitudes to their patients matter, too. To maximise the placebo effect, doctors need to "utilise a patient's belief system as an ally rather than an enemy," says Helman. In a nutshell, "don't treat them as meat, treat them as people," says David Reilly of the Glasgow Homeopathic Hospital. It's official: doctors can make us feel better just by being kind, sympathetic and hopeful. And the reverse is true, too. "Nocebos" are the opposite of placebos - the negative effects of belief on physical, mental and social health. People who experience insensitive or inappropriate treatment at the hands of medical practitioners can come away feeling worse.

Perhaps such negative experiences account, at least in part, for the growing popularity of alternative therapies - everything from reflexology and aromatherapy to homeopathy and crystal healing. The practitioners of these alternative therapies may often be better at exploiting the placebo response. Holistic healers typically take note of their clients' accounts and actively encourage them to believe that they can participate in their own healing, as Ursula Sharma, reader in social anthropology at the University of Keele, has documented.

But even within the mainstream, the placebo response is slowly becoming respectable, Fenwick claims, not least because it makes economic sense. "If we encouraged everything in the healing situation that can foster the response," he says, "the result would be shorter stays in hospital, less need for drugs and fewer complications."

Researchers are still struggling, however, to come to grips with how it works. Evidence is growing of the complex interconnections between our subjective experiences and the functioning of our immune and nervous systems. Already it is clear that stress and mood, for instance, can have profound effects on brain biochemistry; the mind can produce chemical changes in our bodies, says Fenwick.

Even relaxation can generate dramatic changes in bodily physiology, claims Herbert Benson of Harvard Medical School. He finds that the repetition of a prayer or some other meaningful form of words for half an hour or less can produce a "relaxation response" that may in itself have healing powers. Benson suspects this phenomenon may help to account for the miraculous cures reported in centres of spiritual pilgrimage such as Lourdes. Spontaneous remissions are part of the inherent capacity of individuals to heal themselves through biochemical pathways yet unknown. Fenwick agrees: such miracle cures really do happen, especially in cancers, he says.

Ranging from hard science to New Age mysticism, the London conference on the placebo response charted a concept in transition. In fact, some experts suspect we might be better off without it - so sullied is the term with overtones of quackery and imagined complaints. Even the Oxford English Dictionary gets it wrong, labelling the placebo as "a pill, medicine, procedure etc prescribed more for the psychological benefit to the patient of being given a prescription than for any physiological effect". Our premier wordsmiths find it difficult to shake off the deep-seated, but ultimately unhelpful distinction between mind and body.

"Placebo needs to lose its derogatory, negative connotations," Fenwick stresses. Some doctors still do not realise that it is a "gross error" to use a placebo to assess whether a patient's pain or disease is "real', and to dismiss the complaint on the basis of a placebo response. In reality, he points out, body and mind are inextricably intertwined, with the placebo response participating in every act of healing.

This realisation "adds to the most wonderful understanding of the nature of man," says Fenwick, as we begin to understand the importance of expectation and belief in the healing process. "Just think," Fenwick chuckles, "if we could identify this phenomenon and make it work we could do away with the medical profession"n

Start your day with The Independent, sign up for daily news emails
Life and Style
Steve Shaw shows Kate how to get wet behind the ears and how to align her neck
healthSteven Shaw - the 'Buddha of Breaststroke' - applies Alexander Technique to the watery sport
Arts and Entertainment
The sight of a bucking bronco in the shape of a pink penis was too much for Hollywood actor and gay rights supporter Martin Sheen, prompting him to boycott a scene in the TV series Grace and Frankie
tv
Sport
footballShirt then goes on sale on Gumtree
Voices
Terry Sue-Patt as Benny in the BBC children’s soap ‘Grange Hill’
voicesGrace Dent on Grange Hill and Terry Sue-Patt
Have you tried new the Independent Digital Edition apps?
News
ebookA unique anthology of reporting and analysis of a crucial period of history
Arts and Entertainment
Performers drink tea at the Glastonbury festival in 2010
music
Arts and Entertainment
Twin Peaks stars Joan Chen, Michael Ontkean, Kyle Maclachlan and Piper Laurie
tvName confirmed for third series
Sport
Cameron Jerome
footballCanaries beat Boro to gain promotion to the Premier League
Arts and Entertainment
art
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs Education

Guru Careers: Software Developer

£35 - 40k + Benefits: Guru Careers: We are seeking a Software Developer (JavaS...

Reach Volunteering: Would you like to volunteer your expertise as Chair of Governors for Livability?

Voluntary and unpaid, reasonable expenses are reimbursable: Reach Volunteering...

Ashdown Group: Payroll Administrator - Buckinghamshire - £25,000

£20000 - £25000 per annum + substantial benefits: Ashdown Group: Finance Admin...

Ashdown Group: Linux Systems Administrator - Windows, Linux - Central London

£40000 - £50000 per annum + Benefits: Ashdown Group: Linux Systems Administrat...

Day In a Page

Abuse - and the hell that came afterwards

Abuse - and the hell that follows

James Rhodes on the extraordinary legal battle to publish his memoir
Why we need a 'tranquility map' of England, according to campaigners

It's oh so quiet!

The case for a 'tranquility map' of England
'Timeless fashion': It may be a paradox, but the industry loves it

'Timeless fashion'

It may be a paradox, but the industry loves it
If the West needs a bridge to the 'moderates' inside Isis, maybe we could have done with Osama bin Laden staying alive after all

Could have done with Osama bin Laden staying alive?

Robert Fisk on the Fountainheads of World Evil in 2011 - and 2015
New exhibition celebrates the evolution of swimwear

Evolution of swimwear

From bathing dresses in the twenties to modern bikinis
Sun, sex and an anthropological study: One British academic's summer of hell in Magaluf

Sun, sex and an anthropological study

One academic’s summer of hell in Magaluf
From Shakespeare to Rising Damp... to Vicious

Frances de la Tour's 50-year triumph

'Rising Damp' brought De la Tour such recognition that she could be forgiven if she'd never been able to move on. But at 70, she continues to flourish - and to beguile
'That Whitsun, I was late getting away...'

Ian McMillan on the Whitsun Weddings

This weekend is Whitsun, and while the festival may no longer resonate, Larkin's best-loved poem, lives on - along with the train journey at the heart of it
Kathryn Williams explores the works and influences of Sylvia Plath in a new light

Songs from the bell jar

Kathryn Williams explores the works and influences of Sylvia Plath
How one man's day in high heels showed him that Cannes must change its 'no flats' policy

One man's day in high heels

...showed him that Cannes must change its 'flats' policy
Is a quiet crusade to reform executive pay bearing fruit?

Is a quiet crusade to reform executive pay bearing fruit?

Dominic Rossi of Fidelity says his pressure on business to control rewards is working. But why aren’t other fund managers helping?
The King David Hotel gives precious work to Palestinians - unless peace talks are on

King David Hotel: Palestinians not included

The King David is special to Jerusalem. Nick Kochan checked in and discovered it has some special arrangements, too
More people moving from Australia to New Zealand than in the other direction for first time in 24 years

End of the Aussie brain drain

More people moving from Australia to New Zealand than in the other direction for first time in 24 years
Meditation is touted as a cure for mental instability but can it actually be bad for you?

Can meditation be bad for you?

Researching a mass murder, Dr Miguel Farias discovered that, far from bringing inner peace, meditation can leave devotees in pieces
Eurovision 2015: Australians will be cheering on their first-ever entrant this Saturday

Australia's first-ever Eurovision entrant

Australia, a nation of kitsch-worshippers, has always loved the Eurovision Song Contest. Maggie Alderson says it'll fit in fine