How would you feel if you visited your GP with severe pain caused by a bad back or irritable bowel syndrome (IBS) and you were told you had just the thing – a placebo; a pill that contains nothing but rice flour or sugar.
That possibility is closer thanks to a new study showing that giving people an “honest” placebo who they know they are going to be given a dummy pill can be extremely effective in providing pain relief.
And with a recent report from the Office of National Statistics showing that deaths from high-strength pain relievers like tramadol and codeine have doubled over the past decade, there is clearly a need for safe and effective alternatives.
I’ve been involved in studies of the placebo effect, including studies where we recruited more than 100 patients with chronic back pain and told them they were getting either a strong new pain reliever or a placebo. In fact, they were all given a placebo
But if the placebo effect is so effective, why aren’t doctors using it anymore?
I’m a big fan of the placebo effect. I find it remarkable that you can give someone a multicolored pill that does not contain any active ingredient and this will relieve their pain.
But it is also misunderstood. The assumption is that people who answer either weren’t sick at all or are gullible. Both are not true.
I’ve been involved in studies of the placebo effect, including studies where we recruited more than 100 patients with chronic back pain and told them they were getting either a strong new pain reliever or a placebo. In fact, they were all given a placebo.
In this study, published last July in the European Journal for Person Centered Healthcare, nearly half of the patients reported significant pain relief from swallowing dummy pills.
Like me Dr. Jeremy Howick, an Oxford University expert who designed our study, said people who respond best to a placebo are not gullible. They’re just more open-minded, especially when it comes to new experiences.
How does it work? Well, a couple of years ago I looked at a fascinating experiment that was being carried out by the Human Pain Research Group at the University of Manchester. They started by attaching electrodes to a volunteer, Jack, so they could measure his brainwave activity. Then he was given two creams that looked the same and said one was a regular moisturizer and the other might or might not contain an anesthetic.
In reality, they were both just moisturizers. He was asked to rub cream from one tub into his left arm and the other into his right.
Next, they heated Jack’s arms with a laser that he had to rate on a scale of one to ten for pain. What they didn’t tell him was that while his left arm got a full blast, his right arm had a weaker zap. They did this several times until Jack was convinced that the cream he had rubbed on his right arm contained an anesthetic.
Eventually they gave his right arm a full blast with the laser. Amazingly, part of Jack’s brain, the frontal cortex, began producing large amounts of brain waves called alpha waves, and this instantly attenuated the pain signals reaching the brain.
This and other research suggests that the placebo effect persuades your brain to express more alpha waves, which reduces pain, although no one knows why the waves work this way.
But if the placebo effect is so effective, why aren’t doctors using it anymore?
My sister Susie Stead has just published a book, Stephen From The Inside Out, about a friend who was classified as “schizophrenic” at a young age and who has been in psychiatric wards for more than 25 years. Stephen wasn’t diagnosed with autism until his late 40s
Well, there is a belief among doctors that placebo treatment only works if patients believe they are getting a “real” pill. And that would mean lying to patients, which is unethical. However, a new study involving people with IBS suggests that the placebo effect can work even if you know you are taking a placebo. IBS affects around 20 percent of adults in the UK and can cause debilitating stomach cramps, as well as gas, diarrhea and constipation.
There is no known cure, although lifestyle changes can help.
To find out if giving patients an “honest” placebo can help, researchers at Beth Israel Deaconess Medical Center in the United States recruited 262 people with IBS.
The patients were randomly divided into three different groups. One group was told they would be given no-active placebo pills, although patients were also told that taking the pills might improve their symptoms. The second group was told they would be given either a placebo or a pill with peppermint oil (which can help with IBS), but they didn’t know which one.
A third group acted as controls and received nothing.
Those who were given a pill were asked to take it three times a day, 30 minutes before meals, for six weeks. At the end of the study, patients in both pill groups reported much greater improvement in their symptoms than in the control group.
Seventy percent of these swallow pills said their symptom score improved by at least 50 points, while 30 percent said their score increased by at least 150 points, which was considered a “very strong” response.
I wasn’t surprised. In our back pain study, most of the patients who got relief from taking our placebo pills said they wanted to continue taking them even though they knew they were only swallowing ground rice.
It seems you don’t have to fool people to harness the power of the placebo, at least under certain conditions. If you trust the prescribing doctor, just taking pills that you’ve been told will do you good can really help.
There is a strong connection between the microbes that live in your gut called the microbiome and your brain. Not only does your microbiome affect your mood, but there is also evidence that changing their gut bacteria can help children with severe autism. More on that in a moment.
The popular image of autism is either a child rocking back and forth, barely able to speak, or someone brilliant at science but bad at human relationships. The truth is more complicated. Autistic spectrum disorder (ASD) can range from the severely affected to those who simply find it difficult to communicate and interact with other people.
A recent study by the University of Cambridge suggests that around 1.76 percent of children in England live on the autism spectrum, a higher number than previously thought.
What is tragic is that so many people with ASD have been misunderstood or misdiagnosed. My sister Susie Stead has just published a book, Stephen From The Inside Out, about a friend who was classified as “schizophrenic” at a young age and who has been in psychiatric wards for more than 25 years. Stephen was not diagnosed with autism until his late 40s, and none of his talents, including his exceptional memory and poetry, were celebrated during his lifetime.
While autism cannot be “cured”, speech and social therapy can help. There is also research suggesting that altering the gut microbiome from a fecal transplant (using a treated sample from a donor) may improve some of the symptoms and behavioral problems associated with severe autism.
The evidence for this comes from a small study by researchers at Arizona State University in the United States. At the start of the study, 83 percent of the children were classified as “severe” autistic, but two years after the transplant only 17 percent were classified as “severe”. The parents also reported significant improvements in their language, interactions, and behavior.
The researchers are now conducting a larger, placebo-controlled study in adults.
To sleep well? This is not a rhetorical question that I really want to know. So much so that, with the help of researchers from Oxford University, I recently started what will hopefully be the UK’s largest sleep study.
If you fill out our questionnaire – you can find it by Googling ‘BBC2 Horizon Sleep Census’ – you will get your personal sleep score and be able to determine where you are in the owl lark spectrum, i.e. to what extent you are more suitable for later nights or nights early in the morning. We will use the anonymous data to create a detailed picture of what we all do to sleep well, as well as the effects sleep has on how we think and feel.
I will report on our results later in the year.