Alexander Golbin, MD

“You take a sugar pill and your pain will be gone.”  “If you believe that your doctor gave you a magic pill, then that is a placebo,” answered one of my patients when I asked him about placebo. He also added that nobody believes doctors nowadays and the placebo is for dumb or naïve people. I agreed with his answer on some level and decided to tell you the fascinating discovery about how important the placebo effects are even for the smartest patients.

The Placebo Effect was known since the dawn of civilization, but only recently neuroscience discovered this phenomenon is the essence of the deepest secrets of mind-body “programming” for health, disorder and even death. In the May issue of Psychiatric Times, neurobiologist Dr. Medina summarized eloquently the neurobiology of Placebo Effect and how this phenomenon is related to illness. He described new and exciting findings that point to the brain mechanisms by which mind-based expectations influence body-based physiologies and pathologies.

Many researchers treated placebo as an annoying statistical nuisance or as an odd statistical quirk not worth paying attention to. But now placebo is being taken seriously. In a landmark study in 1979, one group performed a rigorous study of placebo analgesia (the ability of sugar pill to mimic the analgetic effect of pain relievers). What they found was that placebo phenomenon not only works, but also established a neuroscientific basis for it. This study was replicated many times since then. One of the most fascinating findings was that one could experimentally increase or decrease the analgetic effect of placebo at will. A strong correlation was found between what was expected from a pill (called treatment expectation) and reported descriptions of how great this particular pain medication was: the greater the expectations, the greater the observed placebo analgetic effect.

The Placebo Effect is based on the physiology of expectation, and we know that expectations have a very significant role in almost all emotional processes of the brain. The more emotionally important the stimulus, the more it triggers attention. This is directly related to survival, more exactly to a threat to survival. Those who do it quicker, live longer.

Many scientists believe that the primary job of emotional response is to serve as a kind of “reminder” about the dangerous stimulus, so we are continuously attending to it. Expectation of danger is a timing issue. It is the ability to react to an event that hasn’t even happened yet. This is a very useful evolutionary trait – nothing could be faster than the reaction to an event that has not yet occurred!  Many brain networks are devoted exclusively to the expectation responses.

Placebo Effect is a special case of functional anatomy and is related to the brain reward processing system. Specific areas of the brain (for doctors: the ventral tegmental area of the brain is a specific reward network that connects the amigdala, ventral striatum, orbitofrontal cortex, and rostral anterior cingulated cortex (rACC) via dopaminergic projections). The important conclusion is that dopamine made the EXPECTATION of trouble turn into changes in the body that are actually making REAL troubles.

To make it simple and clear – if you REALLY EXPECT the problems to happen – you might get it!

How does our brain decide what is dangerous? One system is related to processing of threatening visual stimuli. Such stimuli go to amigdala and extrastriate complex that have so-called top-down modulations through the limbic regions (this region decides how strong emotions are needed). Involvement of dopamine connections in Placebo Effect was also confirmed by investigators that did not study placebo but investigated addictive behaviors. One phase of the expectation cycle is called the anticipation phase. It was shown that this anticipation phase is related to dopamine activation of a network.

It was found later that placebo was seen not only with pain medications. Placebo Effect may apply to ANY emotional experience and belong to a strange land between mind and the body in norm and illnesses. In one careful study it was found that subjects had a pleasant experience even if they were given very unpleasant stimuli but told that it was important for their health. These subjects were simply expecting benefits and accepted “no pain–no gain” logic.

The new data about the neurobiology of placebo effect confirmed that we could program our health or make ourselves sick by the expectations in our mind (strong beliefs) to actual changes in body physiology – for good or bad.

When a patient anxiously reads possible side effects of medications and gets them all it is an example of the “reversed” placebo. Another example of bad expectations produces so-called “Anniversary Phenomenon”, when the  person expects to die at a certain time and/or day, like on his birthday as his father did; or spouses who die shortly after death of their loved one.

How to “re-program” yourself from being sick to being healthy is a complicated issue which we will discuss in the next issues.

Ref: John Medina, Placebos and Psychosomatic Illness

Psychiatric Times, May 2006:17 -20