The Placebo Effect
And, do our pets feel pain?
“I shall please”
– placebo in Latin
What is the first thing that comes to mind when you hear the word placebo?
Do you think of sugar pills? Perhaps you think of deception or maybe a fake drug that works for some people, some of the time? What about a sham drug that can work even when it is known to be a placebo? Or maybe you think that it is all just a bunch of nonsense?
All of those notions accurately describe placebo, except one. The placebo effect is most certainly not a bunch of nonsense.
Those who are fans of the hit TV series MASH may remember an episode where a wounded private was brought to the 4077 to be patched up. In post-op, the patient complained of severe pain, but the unit had run out of morphine.
Dr. Hawkeye Pierce comes to the rescue by administering a saline solution to the young man who thought he was getting morphine. Soon the private was laughing and flirting with the nurses – the placebo had worked.
Placebos were regularly used by doctors as far back as the 1700s, where they were given to hypochondriacs as a way of appeasing them.
Every doctor has their share of patients who believe they have every new disease that comes on the scene.
(What did the hypochondriac have engraved on his gravestone? “See, I told you I was sick.”)
However, it was Dr. Henry Beecher who first undertook the use of placebos as a stand-in for morphine during World War II. In doing so, he is credited with recognizing the placebo effect. And that discovery is still a valuable source of utility and astonishment in the world of medicine.
As we all know, before drugs and other medical therapies are approved by the U.S. Food and Drug Administration, they must be rigorously tested. This is achieved through standardized blinded studies, an area where placebos play a significant role.
Simply put, a blinded study consists of a group in which half get the real medication or procedure, and the other half, the control, is given a placebo. This is called a blind study because participants do not know whether they are receiving real or fake medicine.
Many tests use a third control group that receives no treatment whatsoever. The comparison between this group and the placebo group allows the scientists to measure the placebo effect. The effectiveness of the active ingredient in the actual drug can be measured by comparison with the placebo group.
So, placebos play an essential role in drug development.
As it turns out, placebos can also have dramatic results with specific maladies such as pain and sleep disorders. However, there is no evidence to date that they can cure such conditions as cancer or Black Lung Disease.
How does a placebo work?
Much like the link between chronic pain and our brain, the placebo effect is another instance of our brain’s fascinating ability to heal. The brain, with proper stimulation, including expectation, can release natural painkillers such as endorphins.
Among the many amazing facts learned from studies using placebos, the shape, color, and quality of the drug can affect its efficacy. Capsules are more effective than pills, and injections are better than capsules. Placebo meds in brand-name bottles perform better than those in generic bottles, and two pills are more effective than one.
One study demonstrated that the color of the pill can influence the outcome – blue pills worked better for sleep disorders, while red pills were better pain-relievers than white pills.
Feeling depressed? What you want is a yellow sugar pill. In studies, it works better for depression than any other color.
There are even “nocebos” out there, and they work, too, just in the opposite direction – you feel worse!
In one study, a patient’s pain was mitigated by a morphine drip. When the patient was informed that the drip had been turned off, the patient resumed experiencing pain even though the drip was still running.
Bottom line on placebos – our own expectations create the results.
It should be clear by now that the whole notion of the placebo effect is purely one of creating expectations. We take a drug, we expect results, even when it is a bogus drug.
To take it a step further, studies show that even when told we are taking a placebo, we still get positive results at the same rate as when we are in the dark (blind study).
Think about that for just a moment: as the doctor hands you a bottle of pills for sleep problems, he says, “Take two of these placebo pills at bedtime, and you should sleep like a baby tonight.” You read the bottle labeled Placebo Medication, and it says in bold type “No Active Ingredients.” None. Nada.
Yet, despite having full knowledge that you have swallowed tablets made solely of sugar and cornstarch, you get the best night’s sleep in a month. Possible? Yes, it has proven to be so in test after test.
The human brain is the most complex bio-machine in the world. Yet, we are only beginning to understand the breadth and depth of its complexities.
Our conscious mind is a mere sliver of the full functionality and potentiality of the brain. Human consciousness is considered the “hard problem” * of science today. Likewise, we know very few of the vast capabilities and functions of the unconscious brain.
And humans, you and I, are using an organ to understand the selfsame organ – our brain. Now, that in itself is amazing.
Switching gears – do our pets feel pain?
Anyone who has ever cut into the quick when trimming your dog’s nails knows for sure that they feel pain. Like us, when they feel pain, they withdraw the injured body part immediately. This is called nociception, and all invertebrates have it.
Additionally, there is the conscious recognition of pain, and our pets respond accordingly. They may hide when they see you getting the nail trimmers out the next time. Animals learn quickly to avoid pain.
They react to pain much as we humans do, and the only thing we do not know for sure is how they experience the pain. Even with humans, an assessment of our own pain is subjective.
Another indicator that animals suffer from pain is that they respond positively to painkillers when injured.
Dogs and cats are sentient beings; they feel pain, they experience hunger and thirst. They feel heat and cold, and they can succumb to prolonged exposure to extremes of temperature, just as we do.
Therefore, we should never expose them to unnecessary pain. In most progressive countries, there are laws that prohibit such behavior. But this protective attitude toward domestic animals hasn’t always been the case.
We were well past the Age of Enlightenment and a long stride into the 20th Century before scientists acknowledged that animals feel pain. Shockingly, most veterinarians were advised in training to ignore pain in their animal patients. Thankfully, we are well past that kind of thinking.
Rene Descartes, the 17th century French philosopher (“I think; therefore, I am”), mathematician and scientist, was said to have nailed a live dog to his classroom wall, preliminary to his vivisection demonstration. He regarded all mammals, save humans, as nothing more than automatons.
This was Descartes’s way, albeit grossly inhumane, of impressing upon his students the uneducated notion that dogs were nothing more than “meat machines.” He contended that the dog’s wails and whimpers were just examples of the machine malfunctioning.
Personally, I believe that Rene should have been nailed to the wall to see if arrogant and heartless philosophers feel pain.
This ends our exploration of pain. Thank you for your patience in allowing this unavoidable subject of interest to persist for three weeks in a row. I hope that it was not painful reading.
* Hard Problem of Science – the difficulty of explaining how and why awareness arises out of something in a purely physical state, the brain.
Until next week,