It’s All in Your Mind: The Placebo/Nocebo Effect

“The overall thesis was simple: We have barely scratched the surface of our mental and spiritual capabilities.”
— From The Lost Symbol, 55

Take a moment to answer this question: How much of the effect of a treatment or medicine is due to your belief that the treatment or drug will work?

The answer may surprise you: about one third of the time, the treatment or drug works only because you believe it does. It’s called the placebo effect. It’s so powerful an effect that all pharmaceutical and many other kinds of medical clinical trials have to account for it so that they can tell if it is really the drug or treatment working or only the role of expectation and belief that is at play.

The word ‘placebo’ is Latin for ‘to please,” and in medicine it refers to a patient’s expectations and beliefs that a treatment will work, even if that treatment is known to have no beneficial or curative effect. In clinical studies of pharmaceuticals, for example, there are usually two groups under study, one taking the medicine being tested and one getting an inert substance, such as a sugar pill, that should have no healing effect. Surprisingly, up to one third of the time the sugar pills alleviate the patient’s symptoms. Here’s an example from performance psychologist Christopher Walton’s book, Incredible You: Unleashing the Power of Beliefs and Intentions to Achieve an Extraordinary Life (forthcoming, 2010):

“Stewart Wolf, MD, did a double-blind study with pregnant women who were suffering from nausea and vomiting. He divided the group in two and gave one group an anti-sickness medicine and the other group a placebo, a substance that has no known therapeutic effect, in this case on nausea. The women in the anti-sickness group improved—their nausea was gone. However, many of the women in the placebo group also found relief, too. This is the placebo effect at work—in this case, women who believed the treatment would relieve their nausea were cured of their symptoms, even though, unbeknownst to them, the treatment they were taking was medically useless for nausea. . . .

“To explore the placebo effect even further, Dr Wolf gave the placebo group another medication, which he characterized as a ‘new, strong, very effective anti-sickness’ drug. This time not just some of the women, but all of them experienced relief from nausea and vomiting. What was this amazing new pharmaceutical? Ipecac. Don’t know what Ipecac is? It’s a very powerful drug used in hospital emergency rooms to induce vomiting! Just the strong belief that they were taking an amazing new anti-sickness drug was enough to totally reverse the chemical action of this drug on their bodies! Just think about this result for a moment. The women’s belief in the doctor and expectation in the effect of the drug not only totally eradicated their symptoms, but it completely reversed the chemical action of a purgative drug in their bodies! I don’t know about you, but for me this study is among the most convincing evidence yet that our minds are amazingly powerful, so powerful that we can ‘change’ nature (in this case chemistry and the chemical reactions that should be completely independent of any influence except for the laws of physics, which underlie chemistry).”

Your mind is a powerful agent for affecting the physical world, including your own body. However, your mind not only can make an inert substance activate your own self-healing capacities, it also can do the reverse as well. The “nocebo effect” is when your beliefs activate undesirable or even harmful reactions in your body. For instance, in the Institute of Noetic Sciences book The Heart of Healing, there is a reference to a report in the World Journal of Surgery, from 1983, in which the authors “reported a large study on the effectiveness of various chemotherapies for certain types of cancers. As in all studies of the kind, some patients received placebos. The study also reported on side effects, including hair loss, which is a common and expected result of chemotherapy. Buried in the data was the startling revelation that fully 30 percent of the patients given the placebo had lost their hair” (28). How can this result be explained? The nocebo effect. When people believe they will lose their hair from taking a medicine—even if in reality they are taking only a sugar pill—some of them will lose their hair. Their mind is telling their body what to expect, and the body is listening. Current biological scientists have no explanation for this effect, but noetic scientists do, with their theories of entanglement, nonlocality, mind-body interaction, and more. (See the Quantum Physics section for an explanation of entanglement and nonlocality, and the New Biology link in this section of the website for some of the theory behind self-healing capacities.)

One area of medicine that is supposed to be off-limits to the placebo and nocebo effects is surgery. After all, there is nothing your belief can do to affect how a surgeon cuts in to your body and repairs it. Or is there? One orthopedic surgeon decided to find out. Dr. Bruce Moseley, of the Baylor School of Medicine, wanted to know which of two routine arthroscopic knee surgeries that he did was the most effective. To find out, he had to control for placebo, so his study involved three groups of men who were experiencing severe physical limitations and pain because of knee problems and arthritis. One group would get a procedure in which he shaved damaged cartilage out of the knee cavity. A second group would undergo the other procedure, which involved flushing loose cartilage and debris from the knee cavity. A third would undergo what Moseley called a sham operation: they would think they were going through the knee operation, but actually would not. He would make an incision, but not actually do anything to their damaged knee. In every other way the operation would appear to be real, from the operating room team being in the room, to all tools and equipment being readied, and even to playing a video of the operation so the semi-conscious patient would hear and see (via a monitor) an actual operation. None of the men knew which operation they had received, one of the real procedures or the sham operation.

The result of this study—which has become famous and is the most often cited surgical placebo study—was that all three groups experienced relief, some of them to the point that they were not using wheelchairs or were able to play sports for the first time in years. The three groups were followed for six years after the operation, and all were still experiencing relief, even after those in the sham operation group found out that nothing had actually been done to their knees. Dr Moseley was forced to concluded, “My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was down to the placebo effect.”

Many medical professionals and a large proportion of the public write off the placebo effect as if it were just another anomaly in science. But it deserves our attention, for it shows that the human mind is the most powerful agent of healing known, so powerful it can change the effects of chemicals and heal us of diseases of all kinds. Spontaneous remissions from cancer, multiple sclerosis, and just about every other disease have been recorded in the medical literature. And so have nocebo cases where deaths occurred not because of a disease but because the patient thought he or she had an incurable and terminal disease. It turned out that later tests or autopsy showed there was no disease present. Belief and expectation are “drugs” in and of themselves, since what we think changes our brain and body chemistry. We don’t yet know why some people are able to “believe” themselves well, while others who sincerely want to get well don’t. The dynamics of the placebo and nocebo effects remain a mystery, but are well worth exploring. Perhaps some day soon they will be taken seriously enough to warrant massive funding and intense scientific scrutiny. Each of us, however, can start right now to use the placebo effect to our benefit. Attitude, belief, intention all matter, not only to the state of our bodies and health, but also to the very condition of our lives and of the state of the world.