A few days back, I was watching on YouTube a faith healing service by a well-known preacher. Many hundreds attend this service to seek a cure for their diverse illnesses. Persons with difficulty in walking, some suffering from years of pain, persons with problems in hearing and vision are instantly cured or much relieved of their ailments after being touched or blessed by the preacher. Is it a miracle, or are there more mundane explanations for this fascinating phenomenon?

The word ‘placebo’ from the Latin, meaning ‘I shall please’, derives from the Office of the Dead, the cycle of prayers recited for the repose of the souls of the dead in the Roman Catholic Church. The vespers service of this series of prayers is called Placebo from the phrase “placebo Domino in regione vivorum” – I shall please the Lord in the land of the living.

During the COVID epidemic, many concoctions were touted as being effective. Several people came forward urging health officials to recommend their preparations for mass production. Angry members of the public wrote letters to the media claiming that the Ministry of Health was not using these preparations because pharmaceutical companies influenced them. The people who used these preparations too wrote to saying how they were cured by these wonderful preparations. Most were not lying but firmly believed that they got better because of these potions. No doubt the feeling of wellbeing was mostly because of the placebo effect but had little effect on the epidemic which was controlled only after the effective vaccination programme.

In 1700s, physicians used placebos when writing a prescription of an inert substance to please a patient. Many patients actually benefited thanks to what later became known as the placebo effect. Until the 19th century, when effective medicines and procedures became available to doctors, the placebo effect was the most a physician could offer to patients. Though now we have scientifically validated medicines, the placebo effect is still a significant factor in patient healing.

Henry Beecher of the Harvard Medical School did pioneering work in the study of placebos after the Second World War, where he served as a frontline medical officer of the United States Army. During the conflict, he saw that with morphine in short supply, a nurse was injecting a soldier with saline prior to an operation. The soldier thought he was being given morphine and did not feel any pain. After the war, Beecher reviewed several studies which have used placebos as a control and observed that the treatment effect of placebos in patients was 35 percent. This had a major implication for the testing of new drugs. If a doctor wanted to know whether a new medicine worked for a particular condition, it was not sufficient to simply give it to patients suffering from that condition and see whether the drug worked. If Beecher was right, over one-third of patients would get better even if the drug had no direct effect on that disease process.

To gauge the drug’s effectiveness, the response of a group of patients taking the placebo has to be compared to another similar group of patients taking the drug, and the placebo effect subtracted from the overall response. For example, if the placebo patient group had a 30 percent response and the patients given the drug had a 60 percent response, the actual response to the drug would be 30 percent. This finding paved the way for a new and effective way to evaluate drugs: the double-blind placebo controlled clinical trial. Since 1962, The Food and Drug Administration of the USA has required drug companies to prove their drugs are effective with a double-blind placebo controlled clinical trial.

Though originally it was thought that the placebo response was around 35 percent, we now know that it can differ between disorders. Among psychiatric disorders, the placebo effect is high for depressive disorder but low for obsessive-compulsive disorder. The exact reason for this difference is yet uncertain.

What are the likely reasons for the placebo effect? Your mind is a powerful tool for healing in the right circumstances. But it is more than just positive thinking. A placebo probably won’t lower your blood sugar or shrink a cancer, though it may reduce the side effects of cancer treatment like nausea and tiredness. Placebos work best for pain reduction, and stress related conditions like sleep problems. For years, it was thought the placebo effect was proof that certain drugs did not work. But now researchers understand it is rather evidence that another non pharmacological mechanism is contributing to the adverse effects of the disease.

Do placebos work if the patients know they are been given a placebo? A study by Professor Ted Kaptchuk, a Harvard based researcher, has answered this question. He tested how people reacted to migraine pain medicines. One group took a drug for migraine, another group took a placebo labelled as “placebo”, and a third group took nothing. Still, the placebo was 50% as effective as the real drug in relieving the pain. The researchers speculated the patients associated the act of taking the pill as a positive healing effect, even if they knew they were not taking an active medicine. Other than taking an inert pill, there are other ways to get the placebo effect. According to Kaptchuk, other activities of healthy living, such as having the correct diet, exercising, meditating and quality social time, can produce the same beneficial effects as the placebo effect.

If you are a health care worker, note that warmth, empathy, good listening skills in a supportive environment can enhance the effect of whatever medicine or procedure you are using on the patient. You will then also fulfil the placebo prayer – “placebo Domino in regione vivorum” – I shall please the Lord in the land of the living.

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