The Placebo Effect

The placebo effect and some of it's related results are some of the most mysterious phenomena in medicine, biology and psychology.

The gist of it is quite simple. Make people think that they should feel something- and they do. The far too classic humans-behaving-as-cattle mentality.

You've probably heard the story in one form or the other- the one from my college goes- two guys walk into a room-party expecting to find drinks, the host hands them glasses of pepsi mixed with mountain-dew and tells them it contains alcohol just to shut them up.
Three glasses later they end up kissing themselves, claiming they were too drunk to know otherwise.

But of course, the drink contained no alcohol- so biologically- they couldn't have been drunk. It's easy to just call guys like this wannabe morons and continue on with life like nothing's happened- but you've just been witness to something poorly understood even today- even after vast amounts of research in many fields.

Imagine the same effect mentioned above, applied to the field of medicine.

For many years it's been responsible for the spread of crackpot science- Homeopathy, Ayurveda (though many parts of this have scientific support), 'Vitamins' as cures for infectious disease. They prescribed their remedies- sold them with confidence- and the patients reported results.

A clear cut case- the patients report improvements! All of these 'alternative' medicines must therefore be effective.

Not exactly. Let's take the case of Homeopathy.

Homeopathy's two fundamental laws are -

1) The more diluted a mix is- the more potent it is.

Yes. The more diluted a mix is, the more potent it is.

This is in contrast with 'allopathy'- modern medicine, which works on the general idea that higher concentrations of an ingredient are 'stronger'.

2) An ingredient that causes an ailment at higher concentrations- heals it in lower concentrations.

Surprisingly- this is at least partially true for some cases. Vaccines work on the principle of making anti-bodies develop immunity by exposing them to alien protein strains that must be devoured. Snake anti-venom is made using snake venom. However, these cases are true largely because you need the causative agent to know what to destroy. An ingredient that causes an ailment is needed to figure out how to cure it.

You can't, for example, cure illnesses born of poisoning this way. Exposing a guy to small doses of CO won't make him resistant to carbon monoxide poisoning. Cure arsenic poisoning by drinking water contaminated by arsenic.

And certainly- injecting 'small doses' of small pox without weakening them first is about the most evil thing you can do.

------------------------------------------

If you are horrified by what I've written by homeopathy and want to refute it... you're free to google it yourself. There are plenty of corroborative sources online, find them, find flaws in them and we'll have an argument. Be sure to provide raw stats- My recent probability and statistics course should help with the p-values.

If you're horrified by the two laws and wonder how come homeopathy hasn't killed off large swathes of the population already-

It's because the first law negates the harmful effects of the second.

You take 1 drop of an arsenic solution and drop it into 99 drops of water/alcohol. You now have a 1X or 1C solution. The (according to chemistry) strongest and (according to homeopathy) weakest solution.

Mix it up, take a drop from the above hundred and put it in 99 drops of water/alcohol. You now have a '2X' or '2C' solution of 0.01 percent concentration of the original.

Typical homeopathic solutions lie in the 20x to 30X zone. that is for a given sample- they contain ten to the power minus forty or ten to the power minus sixty times the number of molecules in the original drop.

This was all fine and dandy in the 1700s when atoms hadn't been discovered and the molar concept had not yet been established. Today we know that 16g of carbon contains approx 6.022 10^23 molecules of carbon. I'm not sure how much 1 drop weighs- but let us, for an approximation, assume that the drop manages to contain 1 mole of the active ingredient- 6 x 10^23 molecules- (this is a mass effectively greater than 1 gram, and practically greater than 20 grams at least considering that pure elements esp. gases, aren't used as 'active ingredients'.

This means that 6 x 10^23 molecules in that original drop are diluted to a level that is equivalent to them being divided into 10^40 equal vials of the final homeopathic solution. The probability of finding a SINGLE molecule of the original ingredient in a vial of 20x (moderate strength) solution is about 6 x 10^-17. (I.e. substantially less likely than you picking up a single random rock and it being made of pure gold.)

That's one atom. One atom can't do much, to be honest.
However it is in practice a few hundred times even less likely- because we originally took a very sweeping approximation- a drop of water solution does not weigh 20 grams.

So if you're taking homeopathic "meds", you're mostly ingesting sugar, water and alcohol- harmless. No need to worry about arsenic poisoning, you'll occasionally find a single molecule of arsenic floating around here or there- shouldn't do too much damage.
Just to be safe- remember to ask for the 'high power' (low concentration) tablets.

Now the question remains- if this quack medicine openly flouts some of the most basic rules of some of the most basic chemistry, how come people that take the sugar pills report an improvement in their condition?

--------------------------
When homeopathic medicine is tested against no treatment being provided- the homeopathic medicine shows better results.

When homeopathic medicine is tested against tablets made of random harmless-but-not-helpful ingredients. Both show equal results.

So random pills are equally effective as homeopathy. Nice.

The patient, upon receiving the medicine, has a certain 'expectancy', he expects to his situation to improve... and is more likely to believe that he feels better.

If he's given a painkiller placebo, he's more likely to believe that he is in less pain than a guy given no placebo.

It's simple up to right now- right? It's all in the mind- people are easily programmed, duped and coerced into believing things.

I'm sure the early researchers of the placebo effect would have come to the same conclusion.

I certainly wouldn't have thought it prudent to investigate further.

Luckily, there are people a little more insanely logical than even me.

So they actually decided to test to see how similar or different this 'imaginary' painkiller response was to the real deal.

Researchers discovered that Naloxone, a painkiller antagonist, actually stops the effects of a placebo.

Wait.

"WHAT THE FUCK ARE YOU TALKING ABOUT?"

Ah. Let me explain. Most painkillers belong to a certain class of drugs called opioids. Yes, because we live in a sad, sad, world, Opium the recreational drug belongs to this group and is the most popularly known member of it.

An opioid antagonist is a chemical that interferes with the working of the opioids- the painkillers. So this literally means that someone that ingests a placebo with Naloxone (without being told what naloxone does, of course. that wouldn't help with the placebo effect!) will not experience an alleviation of pain. But if it's all in the mind- it should make no difference. Naloxone itself does not 'cause' pain, it simply makes REAL, CHEMICAL painkillers less effective by a mechanism that is scientifically documented.

Why the hell is it working on imaginary painkillers?!

The Placebo effect is not just in the mind it seems.

Patients given placebos have shown tangible, observable differences in recovery! And largely to the positive!

Our brain is a powerful thing. We usually associate it only with control and co-ordination of motor functions- but it's in charge of hormonal release as well.

It's the brain that releases adrenaline when something scares the shit out of you, it's the brain that releases endorphins when you're happy, the brain that drives your body wild when you see the most attractive person you've seen for a while. Conversely, when the serotonin receptors on your nerve endings are overloaded, as any junkie will tell you, the it affects the brain as well.

The naloxone study lead scientists down a path to discover that the 'painkilling' due to a placebo was not in your head (not all of it, at least) but rather because of an opioid manufactured inside the body, by the brain, because of it's expectation parameters.

The brain wanted a painkiller. So the brain MADE a painkiller. Thus the brain got a painkiller.

The brain, overall, oversees the creation of a massive variety of chemicals in the body, some seemingly without conscious input (insulin, testosterone, HGH), while others that most certainly rely on conscious input (adrenaline, noradrenaline, sexual arousal, the entire sympathetic and parasympathetic nervous systems).

It's entirely plausible that there's a third class as well- a 'semi-conscious' brain that can't be tapped into directly like the parasympathetic/sympathetic systems, not simply by willing it, but by coaxing it in a way most people generally can't do.

'Believing', ridiculously enough, makes your brain produce the right chemicals it needs to sustain that belief... unless you've got naloxone to deactivate those chemicals as well.

I will not delve to the philosophical extrapolations of this... since it's fairly unscientific to do so. But certainly, some will look to this as being in support of the old adage 'believing you can do it' helping you actually 'do it'.

The effects of conditioning are startling and fascinating. From what we can tell, the brain can be trained to make the right chemicals needed for treatment- of pain and disease (for now), evoke the right responses, and with the correct conditioning- actually, substantially help with recovery.

Now researchers are arguing over the extent to which immunity and pain can be influenced from the top down- i.e. physiological changes from psychological changes, and doing experiments on rats.

There's a lot we do not know.

It's like having a latent superpower! And not the only one your body is hiding from you, I might add.

Maybe in the future we'll be able to make ourselves immune to pain at will, enhance our metabolisms into burning more fat simply by commanding it (imagine losing weight just by wanting to!), some might use the body's dopamine and serotinin as a substitute for well... er... dopamine and serotonin substitutes found in recreational drugs- though it seems unlikely that the body would willingly push dopamine levels so high that it could permanently damage receptors. Maybe we'd be able to fall asleep and wake up on command- there are even muscle delimitors that sometimes allow people access to incredible strength- atheletes might tap into those reserves by conditioning themselves.

Will all of it be legal? How much of it is really even possible? I have no idea.

Lots of people are trying to find out just what exactly this body of ours is capable of.

Till then, we will simply have to brainwash ourselves into making our superpowers work.

Please note- there's a Nocebo effect as well. Basically the same thing as the placebo effect but with a 'negative' expectation and a negative result. I suppose the case of the two guys getting drunk on pepsi and dew would be classified as a Nocebo. If people expect pain and suffering, their brains might just decide to oblige them by releasing pain receptor agonists.

So homeopathy helps because people believe it does. If my deconstruction of the two basic homeopathic laws has made you a disbeliever- the placebo effect will no longer help you, sadly.

I'm sorry, if that is the case.

I don't know if it's morally right or wrong to disable a believer's placebo effect simply because my ego pisses me off when homeopaths consider themselves to be equivalent to 'allopaths' despite doing no research, having no scientific models for how their medicines work, going against the basic concepts of chemistry, and yet claiming to be a 'science'.

Another interesting area, I guess, is to experiment on whether 'believing' in the placebo effect itself can actually activate a placebo response... who knows? it might actually be possible.

I'll end with a piece of advice that's pretty novel for this blog.

When in medical treatment... stay positive. It actually helps. We're pretty sure about that.
---------------------------------------------------------