By Hymie Anisman, Department of Neuroscience, 杏吧原创 University

Placebo responses, as most people are aware, refer to responses elicited by a treatment that can鈥檛 actually have direct organic effects on neurobiological processes. The effects of placebos are often considered in the context of pain relief or in some psychological conditions, such as depressive symptoms. However, placebo effects have also been reported in response to purported administration of muscle relaxants or drugs that affect cardiac functioning (e.g., blood pressure), and in programs to quit smoking.

The value of the placebo
The placebo response can be exceptionally powerful, and it鈥檚 thought that the efficacy of many drug treatments, in part, includes a placebo component. In fact, in response to mild or moderate pain, placebos can be as powerful as a low dose of morphine. Thus, it鈥檚 unfortunate that not everybody is a 鈥榩lacebo responder鈥�, and only 25-50% of individuals exhibit analgesic responses. Many variables contribute to these individual differences, including personality factors, such as optimism and altruism (Morton et al., 2014), as well as the presence of particular genes (Hall et al., 2015).

The development of a placebo response is particularly tied to the expectancy of positive effects being obtained, and various environmental stimuli that are linked to feeling better (e.g., hospitals themselves have distinct aromas that may act in this capacity) may contribute to the occurrence of the placebo-related perceptual, behavioral and clinical changes (Vase et al., 2015). In fact, environmental triggers that instigate placebo-like responses can be subtle to the extent that individuals might not even be aware that they were being affected. For instance, seeing another patient receiving effective pain medication primed individuals so that they expressed pain relief after being given the same treatment. Conversely, if patients expected that a genuine drug would not have positive effects it was less likely to be beneficial (referred to as a nocebo response).

Placebo effects are most often considered in the context of inert medications, but they听also appear in other forms, including mechanical or electrical devices to reduce pain or muscle aches, acupuncture needles inserted into inappropriate locations, and faith healing can arguably be considered a placebo. Likewise, physicians themselves might be a component of a broad placebo treatment that encourages well-being and our expectancies and trust related to the physician (provided that there is trust) may have considerable bearing on whether prescribed treatments will be followed and positive outcomes obtained (Stewart-Williams & Podd, 2004).

Not surprisingly, the emergence of placebo responses is also likely dependent on previous learning about the treatment, which encourages the belief or expectancy that the treatment will have positive effects (Kong et al., 2013). Importantly, social comparisons and social learning also affect the manifestation of placebo effects, and like a social contagion, if my friends (or members of my 鈥榠ngroup鈥�) find relief using a particular treatment, then I鈥檒l respond in the same way (Benedetti, 2014).

This, finally, brings us to the point of this blog. On occasion you might have heard a comment such as 鈥淥h, it鈥檚 just a placebo response鈥� in reference to some other person feeling better after being given a听treatment. What鈥檚 this 鈥淥h, it鈥檚 just鈥︹�� all about? If the person is feeling better then that鈥檚 great, and if it鈥檚 due to expectancies causing particular brain neurochemical changes that were responsible for reduced pain, that鈥檚 perfectly fine (BTW, placebos actually do cause several types of neuronal changes that likely contribute to sensory and mood alterations). The person with a migraine doesn鈥檛 care how the meds they took got rid of the headache, so long as it did the job (to quote Deng Xiaoping 鈥淚t doesn’t matter whether a cat is white or black, as long as it catches mice鈥�).

Then there’s the phoney treatments
There鈥檚 no question that in many ways, inert agents (that could in a sense be considered as 鈥減honey” treatments) have positive effects. But, what if a person tries a particular treatment, possibly following the lead of others, but this agent has absolutely no positive effects on the progression of a disease (other than to produce a placebo effect, and perhaps to transiently set their mind at rest), but some other treatment had been available that could cure the illness or, perhaps, stop its progression. There are many cases in which exactly such things have happened, even to people who are very smart. They choose some sort of wacko treatment (shark cartilage, certain nuts, particular herbal teas, and a great number of other 鈥榥atural products鈥�) instead of those that have a known track record.

In this regard, one of the greatest and most successful scams in the alternative health domain is that of homeopathy. This remarkably dopey treatment has been around for over 200 years, and seems to be still going strong in some groups (especially in communities near universities, and in upscale neighborhoods where people wear those odd shoes, Birkensomethings, and favour听 shopping at the fruit and nuts groceries that are referred to as health food stores, although they seem to sell the same foods that can be obtained just about anywhere, but being ‘organic’ the price is jacked up). The popularity of homeopathy might have developed because its been been considered an听 鈥榓lternative medicine鈥� rather than an 鈥榓lternative scam鈥�.

The scam of homeopathy

Samuel Hahnemann

Homeopathy was introduced by Samuel Hahnemann in 1796, based on his view that a substance that causes illness symptoms can also be used to cure people who are sick (a doctrine that argues that 鈥榣ike cures like鈥�). In an odd sort of way, this does make sense. We do, after all, we do actually use dead or inactivated viruses as vaccines to prevent illness stemming from later exposure to the same live virus. In the case of vaccines there鈥檚 a perfectly reasonable explanation as to why they’re听are effective, and there are good explanations (usually) when they fail to work as they should.

In the case of homeopathic medicines, it seems that a bait and switch is being pulled. You don鈥檛 actually get the relief that鈥檚 advertised beyond that of placebo response, which might be okay, except that homeopathic providers get people to use homeopathy as an alternative to treatments that are effective. Don鈥檛 believe me? Check out this . The chutzpah in this is boggling.

So, what is homeopathy and why does it have the word 鈥榤edicine鈥� attached? Moreover, what does it take to become a听flim-flam man (or woman), regularly milking ‘marks’ for whatever they’re worth. Based on the symptoms expressed, an individual鈥檚 personality characteristic, and some psychological condition displayed, the homeopath, based on years of specialized pseudo-science training, selects a particular substance to be used in treatment. This agent will then be diluted, and this solution diluted again, and again and again, so many times that the final product will have none or hardly any of the original molecules present. But, magically,听the molecules that are present, having once been exposed to the solution, will have a 鈥榤emory鈥� of that original solution! Expecting to be cured, and having paid a considerable sum for a cure, cognitive dissonance may enhance the placebo effect that would otherwise occur (Ernst, 2002).

Viruses and cancerous cells aren鈥檛 frightened by homeopathic treatments, and continue apace in creating illness or death. Likewise, reliable scientific reports have documented the failure of homeopathy to produce positive effects in illnesses ranging from, asthma, arthritis, chronic fatigue syndrome, eczema, cholera, malaria, and heroin addiction. In fact, these treatments aren鈥檛 effective for anything! Nonetheless, there are line-ups of wanna-be doctors wanting 鈥榓ccreditation鈥� to offer homeopathic treatments, and once they graduate they seem to be doing a brisk business capitalizing on the malaise and fears of others. Stunningly, in some countries homeopathic treatments are (or until recently were) covered by universal health care.

Why people might turn to homeopathy
There are several reasons that homeopathy might be popular in some sets. They might not trust the 鈥榤edical establishment鈥� and like the sound of 鈥榓lternative medicine鈥�. Or, they might not trust standard vaccines or the compounds in which the vaccine is carried (thimerosal) and so somehow think that homeopathy will be okay (actually, it鈥檚 a guarantee that it won鈥檛 cause autism as it鈥檚 only water). Besides, they might like that 鈥榬ebel鈥� flavor that comes with boycotting the 鈥榤edical establishment鈥�. It鈥檚 also possible that a lack of knowledge brought them to the point of using this form of treatment.

Alternatively, perhaps they were convinced by Prince Charles (the British Dude who seems not to have a real job, but lots of opinions), who has been a strong advocate of homeopathy. Incidentally, his grandfather George VI and his great grandfather George V were both advocates of homeopathy (the organic apple doesn鈥檛 fall far from the natural tree). In Britain there are currently about 6,000,000 people who see homeopathic practitioners, and homeopathic remedies have increased by almost 25% this past year, despite the British Medical Association comparing it to Witchcraft. Think it鈥檚 less popular in Canada? If you visit a large health food store, such as Whole Foods, which has substantial book sections, you might have noticed a number of books dealing with the benefits of homeopathy. Some of these stores even have 鈥榗onsultants鈥� who are there to offer advice on health, including homeopathic remedies. I think it would be about as odd to ask the grocery kid about health advice, as asking my doctor for advice on food recipes.

Hymie Anisman has recently authored two book听providing an evidence-based approach to understanding the role of stress on human health, and identifying听characteristics and听behaviours that render people more vulnerable or resilient. Both are available at Amazon.ca

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Pills image courtesy of Michelle Meiklejohn at听