Can your brain learn to respond to a placebo?

DNA with light shining behind itImagine how much money the NHS or medical insurance companies would save if we could swap some of our drugs for placebos after a few days of taking them?

As far as some exciting new research is concerned, it certainly seems to be a possibility.

A placebo is an empty pill; that much most people know. But just like someone can learn to play tennis or hit a golf ball and get better over time, a new study has found that the brain can learn to respond to a placebo and can get better at it over time too.

The research involved 42 patients with Parkinson’s disease, who had had the disease for between 11 and 24 years. It was led by Fabrizio Benedetti, professor of physiology and neuroscience at the University of Turin Medical School. It was published in the Journal of Neurophysiology.

Any improvements in the patients were assessed by a) measuring muscle rigidity at the wrist and b) measuring the activity of individual neurons in the thalamus of the brain.

The patients were initially given a placebo and the scientists measured their responses. After one placebo, there was no clinical improvement and no changes in individual neurons.

Next, a patient was given an injection of the anti-Parkinson’s drug, apomorphine. The following day they were due to receive their second injection of apomorphine but it was secretly swapped for a placebo injection. Even though they received a placebo, there was a measureable clinical improvement and an increase in activity of neurons on receiving the placebo.

That wasn’t the half of it though. If they received two doses of apomorphine before the placebo, the clinical improvement and neuronal activation was ever greater, and greater still after receiving three prior doses of apomorphine, and even greater yet if they received four doses before their placebo.

The rule they found was this: “The greater the number of previous apomorphine administrations, the larger the magnitude and the longer the duration of the clinical and neuronal placebo responses.”

Amazingly, in patients who received a placebo after four previous administrations of apomorphine, the placebo gave them the exact same physical improvement as the drug did.

In other words, once the person (and their brain) learns what to expect from a drug, the drug can be swapped for a placebo – at least in the case of apomorphine and Parkinson’s disease.

It’s important to point out here that this is not just ‘all in the mind’ or that only ‘weak minded, or gullible, people’ respond to placebos, which is a common sceptical response.

Let’s think about it for a second: The study showed actual physical changes in the brain when a person received a placebo. It is certainly not ‘all in the mind’. And I would argue, in fact, that it takes a strong mind to cause these physical and neurological changes!

It is these brain changes that lead to physical improvement. So rather than it being ‘all in the mind’, the mind, in fact, causes neurological changes in the brain.

Indeed, many previous studies have shown that expectation drives the placebo effect. Benedetti defines a placebo as: “The administration of an inert treatment along with a positive psychosocial context inducing positive expectations of clinical improvement.”

That is: a patient expects a result and this expectation alters their biochemistry to bring them the result that they are expecting.

Think of what this means. A placebo is an empty pill. Typically made of sugar or chalk, it has no pharmacologically active ingredients. But in the mind of the person receiving it, she or he imagines it to be a medicine that will bring them relief or improvement.

It is this imagined, expectation of improvement that activates the placebo response, altering activity in the brain and delivering the person the very result that they are expecting.

So, given that healthcare seems to be all about money these days – of course, it’s about health, really, but everything seems to have a price tag! – I wonder how much scope there is, given further research, to swap some drugs for placebos after a person’s brain has learned what the drug does.

Now we’re really entering the days of taking seriously that the mind impacts the body quite significantly.

Is expensive Nurofen better than cheap Ibuprofen?

happy peopleNow, not being a marketing person I’m really not in favour of creating different versions of the same thing and charging more for them. But given the recent news headlines, the question many people have is, ‘Is Nurofen better than Ibuprofen?’… even though they are the same thing.

I know people who swear that Ibuprofen simply isn’t strong enough for them and that they find that only Nurofen works for them. They use a similar argument for Panadol vs Paracetomol, preferring to pay several times more for the branded Paracetamol.

However, an interesting thing happens when you do pay more for the same thing. In the 1980s, a study was performed where over 800 women were given one of two versions of the same aspirin for headache pain.

One group of women received an expensive looking version in quality packaging labelled as ‘Aspirin’, and another group received a cheap looking version in plain packaging labelled as ‘Analgesic’. However they were both the exact same aspirin, merely in different packaging and with a different name.

The other two groups of women received placebos but one groups’ placebos were expensively packaged and labelled ‘Aspirin’ and the other groups’ were in plain aspirin packaging and labelled ‘Analgesic’.

Now, you’d expect both versions of aspirin to work the same, given that they are both aspirin, and both placebos to work the same, given that they are, well, sugar. But that’s not what the study found.

The expensively packaged aspirin worked better than the cheaper looking version, even though they were the exact same drug. And interestingly, the expensive looking placebo also worked better than the cheap looking placebo. And funnily enough, the expensive looking placebo was nearly as good as the cheap looking aspirin. So what’s going on?

Basically, we associate price with quality so when we pay more for something, we expect it to work better. And it turns out that what we expect or believe actually changes what happens in the brain.

It’s not psychosomatic! It’s not ‘all in the mind’! Research into the placebo effect shows us that belief changes brain chemistry. Believing that something is going to relieve pain actually causes your brain to make it’s own versions of morphine (known as endogenous opiates).

And our beliefs about how the medicine is administered matter too. In the US, an injection of a placebo for pain works about 50% better than a placebo tablet even though they are both placebos. In the UK, it’s reversed. A placebo tablet for pain works a little better (about 10%) than a placebo injection. Why the difference? Surely if they are all placebos they should work exactly the same. Again, the difference is down to what we believe.

In the US, people talk about ‘getting a shot’ and so people in the US generally believe that injections are better for pain than tablets are. On the other hand, people in the UK talk about ‘popping pills’ and so UK people tend to believe in tablets for pain. It comes down to cultural language and that language reflects what we believe.

The bottom line is that things are never ‘all in the mind’. Our beliefs change our brain chemistry (and also what’s going on all throughout the body) and that change can often produce healing effects.

Interesting though this is, and also an untapped resource in terms of our capacity to affect our own health if we learn some mental techniques, the issue that bothers people is that the relatively high pricing of branded medicine seems to be all about profit.

I can’t say for sure that pharmaceutical companies aren’t aware of how to boost the placebo effect and that they price things higher to tap into it. I left the industry in 1999 so I’m not on the ball with their knowledge base. I spent four years in drug development after my PhD in organic chemistry. Given the time since I left I really can’t comment on their motivations.

Certainly, my colleagues back then were definitely not knowledgeable about how the placebo effect works and the general opinion was that it was simply a nuisance that got in the way of achieving a true measure of how well a new drug was working in a clinical trial.

But in the words of Fabrizio Benedetti, professor of physiology and neuroscience at the University of Turin School of Medicine and world authority on the placebo effect, in a paper published in the journal Annual Review of Pharmacology and Toxicology, he wrote:

The placebo effect has evolved from being thought of as a nuisance in clinical pharmacological research to a biological phenomenon worthy of scientific investigation in its own right.”

I would say that there is definitely more to the mind than most people think. The human mind really is a relatively untapped resource in its ability to bring about changes in the brain and body. The challenge for us, really, is learning how to tap into this phenomenon and learning how to direct and control it.

That’s my motivation for studying and writing about the mind-body connection.

 

Further reading: For many studies on the mind-body connection and other mind-body phenomena, including meditation, neuroplasticity, and visualisation strategies for harnessing the mind-body connection, see my book: ‘How Your Mind Can Heal Your Body’.

Mind Over Matter

mirror neuronsI’ve written a lot over the years on the subject of the mind-body connection. The origin of my interest actually goes back to when I was 11 years old and I was in the school library. A book fell of the shelf beside me. It was ‘The Magic Power of Your Mind’ by Walter Germaine.

At the time my mum was suffering from depression, which had begun a few years earlier as post natal (post partum) depression. I had an instinct that the book would help my mum so I took it home.

It really helped her. It didn’t cure her in a day or anything like that, but it taught her insights and strategies and gave her hope that she could chart a course through some of the difficult times. As a teenager, I often heard my mum say things like, “I can do it,” while pumping her fist, “It’s all in the mind,” “It’s mind over matter,” and “It’s the Thought that Counts,” which incidentally became the title of my first book. These were examples of my mum’s positive self-talk that she’d learned. Today we think of these as affirmations.

Growing up, a fascination with the subject and possibilities of mind over matter gradually developed in me. Later, after I completed my PhD in organic chemistry, I took a job in the pharmaceutical industry. It was there that my interest and understanding of the mind-body connection went up a notch. My job exposed me to the whole area of drug development where I learned a bit about the placebo effect. I quickly became more interested in the placebo effect and the whole mind-body connection than in developing drugs and often spent hours of my spare time pondering and reading up on the subject.

I left the industry after 4 years to write and speak full-time. Now, 8 books later, my interest hasn’t dropped a bit but in fact has grown considerably.

When I left the pharmaceutical industry in 1999, mind-body science was in its infancy, really. Now, there is a wealth of research showing beyond all doubt that your thoughts, beliefs and emotions cause physiological, biological, and even genetic changes all throughout your body. And when I say genetic changes, I’m not meaning that we change our genes or anything like that, but that our thinking changes the pattern of ‘on’ and ‘off’ of our genes. A gene might get switched on or off, for instance, as a consequence of what you’re focusing on.

Thinking of someone or something that causes you stress, for example, switches on stress genes, the consequences of which can lead to constriction of the arteries. Thinking of someone you love, on the other hand, activates completely different genes, the consequences of which can actually dilate your arteries.

Believing a drug will help you can cause it to work better. Believing it won’t help you often negates some (or all) of its potential effect. Paying more for a simple painkiller makes it work better than a cheaper version because of your belief that more expensive equates to better.

Imagining eating can reduce appetite by signaling the brain that you’re full, imagining moving your muscles repetitively actually causes structural changes in the circuits of the brain, making those muscles stronger. Paying attention to your breathing also causes structural changes in the brain in such a way that makes it easier to find peace amid chaos.

Imagining happy things alters brain chemistry that can make you feel better. Imagining things you’re afraid of activates fear centers of the brain.

Imagining moving your arm convinces your brain that you’re actually moving it, an insight from neuroscience that has reaped benefits for thousands of stroke patients, and athletes.

A pilot can even fly a plane with his mind if the navigational controls are interfaced with a device that reads his brain activation.

There is no doubt whatsoever that your mind affects your body. The skill in making it work for you, really, is learning to control what you focus on.

And that really comes down to training, in much the same way that you learn any skill through training.

So I thought I’d give you a little insight into the mind-body connection today, enough perhaps to give you some faith in yourself, that you really do have the capacity to bring about positive changes in your health by adjusting your focus.

Drugs Work Better if You Know You’re Getting Them

whisperImagine the scenario: There’s 2 patients. One is connected to a morphine drip while he’s reading a book and the other is being given a morphine injection by the doctor. They’re both given morphine at the exact same time. One is aware of it but the other isn’t.

You’d think they’d both need the same amount of the drug, wouldn’t you? Well, it turns out that how much they actually need depends on whether they know about the morphine or not.

On average, people receiving morphine for pain need about 12mg to get the painkilling effect. But that’s only if they don’t know they’re getting it. If it’s administered in full view, they don’t need nearly so much to get the same effect.

The same kind of thing has been shown with diazepam. People sometimes get diazepam for anxiety after an operation. It turns out that the diazepam only works if the patients know they’re receiving it. If they don’t know they’re getting it then it doesn’t work. Weird isn’t it?

The reason is that it’s all in your mind!

Chemistry will play itself out in exactly the same way a hundred times out of a hundred in a test tube. But once you put human consciousness in the test tube, in other words the test tube is technically the human body, the chemistry is swayed left or right, so to speak, depending on what’s going on in your mind, depending on what you believe.

It’s true. What we believe shifts chemistry in our brains and bodies. If a person is given a placebo instead of morphine, but believes that it’s morphine and therefore believes in the pain killing effect, their brain produces a natural version of morphine to carry out the job of giving them what they are expecting to happen, i.e. a reduction in pain. The natural versions are known as endogenous opiates.

So when a person is receiving morphine from the doctor, who is administering it in plain sight, their belief in what morphine does produces endogenous opiates. So because the endogenous opiates are there to provide part of the pain killing effect, the patient doesn’t actually need as much morphine.

Imagine what it could mean for medicine if we could harness the placebo effect like this.

The Amazing Power of the Placebo

placebo pills(Repost)

Nearly everyone has experienced a placebo effect!

The fact that you take a medicine tells me that on some level you must believe in it or expect it to work, or you believe in the doctor who prescribed it, or even in the improvement you’ve heard about in other people.

This belief, or expectation, activates the placebo effect. Of course, the drug works too but your mind can enhance it….. or suppress it.

The same placebo can do opposite things, for instance, depending on what the person believes it is for. If patients are given a placebo and told it will relax their muscles then it will, but the same placebo can cause muscular tension if the person believes that’s what it does. Similarly, believing that it is a stimulant will increase heart rate and blood pressure, but thinking that it is a depressant gives it the opposite effect – reducing heart rate and blood pressure.

Some people who are given alcohol placebos, thinking they are drinking real alcoholic beverages, even get drunk.

And placebos can enhance athletic performance. In a 2007 study, non-professional athletes had been given morphine during a pre-competition training phase. On the day of a competition the morphine was secretly swapped for a placebo but the athletes still experienced an increase in pain endurance and physical performance that would be expected from taking morphine.

I wonder if they would have been banned from competition if they’d been caught taking performance enhancing placebos (PEP). As an ex-athletics coach myself, all athletes really need is a PEP talk! 🙂

In another study, 40 asthmatics were given an inhaler containing a placebo that was just water vapour, but they were told that it contained allergens that would restrict their airways. Nineteen of them went on to suffer considerable constriction of their airways. Twelve of them actually experienced a full-blown asthma attack. When they were given a different inhaler and told it would relieve their symptoms, it did, even though it was also a placebo. One person in the study developed symptoms of hay fever too after being told that the inhaler also contained pollen.

Colour can matter with placebos, because of what the colour represents to us. A University of Cincinnati study tested both blue and pink stimulants and sedatives on students, although unbeknownst to the students the stimulants and sedatives were placebos.

But the blue placebo sedatives were 66% effective, compared with 26% for the pink ones. Blue placebos were around 2.5 times more effective for relaxation that pink ones. This is because blue is generally considered to be a calming colour.

Where you live also affects the power of placebos. In a US study of migraine treatments, placebo injections were 1.5 times more powerful than placebo pills. But a European trial found that placebo pills were about 10% better than placebo injections. The reason for the difference? It’s in our cultural language. US patients tend to speak of ‘getting a shot’ so they believe in it more, but Europeans talk of ‘popping pills’, or at least they do in the UK.

On a kind of similar note, in trials of Tagamet, the anti-ulcer drug that was popular in the 80s, the placebo was 59% effective in France but the drug itself was 60% effective in Brazil – a difference of 1%. The placebo in one country was as good as the drug in another!

Studies like these strongly hint that we have far more ability to affect our health through our thinking than we might have believed in the past.

How a placebo is packaged and sold also makes a difference to its power. In a UK study, 835 women were given one of four different pills for headaches. One group received a well-known branded aspirin tablet. A second group received a simple tablet labelled ‘analgesic’, which was typical of a cheaper mass-market brand. A third group received a branded placebo, while the last group received a basic ‘mass-market’ placebo labelled ‘analgesic’.

It turned out that the branded aspirin worked better than the unbranded one, but amazingly the branded placebo worked better than the unbranded placebo – even though they were both made of sugar.

The placebo effect might even lift the power of Viagra beyond its basic pharmacological effect, at least according to psychiatrist Aaron K. Vallance, who suggested in a 2006 paper that the medicine might be enhanced because the name ‘Viagra’ is similar-sounding to the words, ‘vigour’ and ‘Niagara’. This might create a perception of vigorousness and power. I wonder if it would work so well if it was called ‘Flopsy’! 🙂

Of course, the drug works extremely well. Drugs are built to carry out biological functions in the body. I know this for a fact. My PhD was in building molecules, or organic chemistry as it’s officially known, and I spent 4 years in cardiovascular and cancer drug development in the pharmaceutical industry. But there is no question that the mind impacts the body. Imagining something, for instance, can even physically impact brain structure.

The challenge is in tapping into this latent power within us. Doctors can help or hinder, even when they don’t know they are doing it.

We know this because some of the variation in placebo effects simply comes down to the communication between medical staff and patient. For relatively common ailments at least, a doctor or physician who shows confidence or optimism about the patient’s recovery is much more likely to see the patient recovering than one who is unsure or pessimistic.

What is said and, importantly, how it is said can make a big bit of difference. But ultimately, it’s what then goes on in the patient’s mind that leads to the health-giving effects.

I personally believe that we have far more ability to affect our health and, dare I say, to heal ourselves, than we have ever thought possible. The question is how to tap into this ability.

I believe we can make a start by doing something active with our minds and believing in it. This is why I explain the science of how the mind impacts in the body in my talks and books – so that people can understand how their thinking affects their health. That way, when they apply visualization strategies, they tend to believe in themselves, and in so doing they are tapping into this ability.

Of course, this is not to be done instead of medical advice, but in addition to it. That is just being intelligent. We might as well get the best of everything.

And that includes the best use of the mind too!!

 

Further Reading

David R Hamilton PhD, How Your Mind Can Heal Your Body – For examples and explanation of the placebo effect, other mind-body phenomena, and various visualization strategies for different ailments. UK paperbackUS paperback,  UK Kindle,  US Kindle

Daniel Moerman, Meaning, Medicine, and the Placebo Effect – for heaps of research on the placebo effect. UK paperbackUS paperback

 

How Your Mind Can Heal Your Body – UK & Ireland Speaking Tour

In these workshops, I’ll share all the ways that the mind impacts the body, from the placebo effect, to how meditation impacts the brain, to how attitude affects the heart and ageing, even to how visualisation can physically impact brain structure. You’ll also learn how people around the world have used mind-body interventions (visualisation strategies) to help facilitate recovery from illness and disease, learn the principles involved, and learn and practice a few visualisation techniques.

Dates:

GLASGOW – 22nd March 2014

LONDON – 29th March

NORWICH – 5th April

KINROSS – 6th April

DUBLIN – 12th April

MANCHESTER – 26th April

NEWCASTLE – 3rd May

US dates to follow … will be announced on my newsletter

Did you know you’re a chemist?

serotonin
serotonin

Yes, you are a chemist! As you think, you shape the chemistry of your brain and blood, you shape the chemistry of your relationships, and you also shape the chemistry of your life.

I have a PhD in chemistry and was once a professional chemist. I trained in how to build molecules and found myself working as a scientist with one of the world’s largest pharmaceutical companies.

I loved ‘organic chemistry’, which is where we stick atoms together in various combinations to construct a particular shape of molecule. My specialist fields were cardiovascular disease and cancer.

But even though we think of chemists as people who work in labs, everyone is a chemist and the labs we work in are the laboratories of our bodies, our homes, and the laboratories of our own lives. Here’s the different ways you’re a chemist.

1) How you practice brain chemistry

As you think, you practice brain and blood chemistry. When you think about someone or something that stresses you, then you produce stress chemistry in your brain and blood stream.

You elevate levels of cortisol, adrenalin, norepinephrine, and histamine. Prolonged thinking like this often leads to a build up of free radicals and inflammatory cytokines in your bloodstream. These are chemicals that play a role in heart disease and ageing. And you’re doing this with your mind!

If you were to think of someone that you love instead, or think of a moment of affection, so you produce different chemistry. You elevate levels of dopamine, serotonin, growth hormone, and oxytocin.

If you consistently think in this way, so you increase oxytocin in your bloodstream, which helps sweep those damaging free radicals and cytokines out of your blood. It is a ‘cardioprotective’ hormone. And again, you’re doing this with your mind.

To take a scientific example, research shows that a hostile mindset is linked with cardiovascular disease. People who tend to be most hostile and aggressive have a much higher risk of heart disease than the general population. An attitude of love, compassion and kindness, on the other hand, is associated with better cardiovascular health.

2) How you practice relationship chemistry

A hostile or aggressive mindset also shatters relationship quality. It steers conversations towards complaints and criticism and guides us away from the things that really matter.

When we overly focus on what’s wrong with things or what’s wrong in the world, we get so caught up in the emotions of anger and frustration that we actually miss out on savouring special moments that happen around us. During these times, we move farther away, emotionally, from those who matter most to us.

When we point the mind towards the heart and focus on what’s good and the good qualities in people, on the other hand, we sow seeds of emotional closeness. People find us more approachable and more enjoyable to be around. We gradually move closer, emotionally, to those who matter most to us, as well as build a network of people who value us for who we are.

3) How you practice life chemistry

Our thinking also shapes the events and circumstances of our lives. We move towards, or attract, those things that we give most attention to.

The trouble most of us have is that while we might have a goal or aspiration, we only give it a fraction of our focus. Throughout the day, a whole manner of things occupy a greater portion of our minds: how crap our current state of affairs is, how such and such a person is causing us stress, how we have too much month left at the end of our money, as well as, of course, a lot of happy thoughts too. But most of us generally apportion a larger percentage of our thinking to where we are and the woes of the past than to imagining and visioning our future. We need to flip this around a bit and learn to direct a better portion of our attention to where we want to go.

Even if it’s not an event or ‘thing’ you want but a state, learn to direct more of your attention inwards, perhaps through meditation.

So everyone is a chemist. I like to reflect on the fact that I started out as a chemist, left that role to study and write about the power of the mind (initially based on the placebo effect. You may have read my bestseller, ‘How Your Mind Can Heal Your Body’), and only years later realised that I never stopped being a chemist at all. I’ve just learned to practice different kinds of chemistry, kinds of chemistry that we’re all practicing in every moment of our lives. We just don’t realise that we’re doing it.

Now if we do realise it, we can impact our health in a favourable way, we can nurture and build our relationships, and we can use our chemistry prowess to shape the landscape of our lives.

Most people grow up with the idea that the mind is impotent, that its only function is to interpret life, think and make decisions. But the mind can be thought of as a force, one that pushes chemistry in the brain and body, one that brings love into our lives, and one that pushes outwards to create our hopes and dreams.

You are much more than you think you are and far more capable than you think you are! Now believe in yourself!

So how DOES your mind affect your body?

DNA against lightMost people learn from an early age that the mind is just something that we use to think with and that it interprets life events. Any ideas that the mind could somehow affect the body have traditionally, in the West at least, been written off as fantasy or some mysterious and unexplained mind-over-matter effect.

Actually, it’s not mysterious at all and evidence shows that there is absolutely no doubt whatsoever that the mind impacts the body. Try to think of a sexual fantasy without having a physical impact or causing hormonal fluctuations in your body!

Your mind is affecting your body right now. It affects it 24 hours a day, 365 days a year. Most of the time we just don’t notice.

We’re all chemists, you see. I’m a trained chemist. I have a PhD in organic chemistry, which involves building up molecules by sticking atoms together. For this, I earned a place developing drugs for heart disease and cancer in a large pharmaceutical company.

To be honest, though, my interest was really on the people in medical trials who improved on placebos, and so accelerated my interest in the mind-body connection.

Yes, we’re all chemists. If you had to think of someone who causes you stress then you’d produce stress chemistry in your brain. You’d also elevate levels of cortisol and adrenalin in your bloodstream, and cause increased blood to flow to your major muscles. If you think in this way consistently, then there’s a fair chance that you could produce higher levels of free radicals and chemicals of inflammation in your bloodstream too.

Or you could think of someone you love or feel affection towards. This time, you’ll produce love chemistry in your brain, which will involve dopamine, serotonin, the brain’s natural versions of morphine and heroin, known as endogenous opioids, and the love hormone, oxytocin.

Oxytocin will also be produced around the body and will quickly dilate your arteries and lower your blood pressure. It’s called a ‘cardioprotective’ hormone – it protects the heart. It might even initiate labor if you’re heavily pregnant. With consistent thinking in this way, the elevated oxytocin levels will neutralise free radicals and inflammation in your blood vessels. Not bad at all, I think, for something you’re doing with your mind! Yes, we’re quite the chemists.

Again, bear in mind that this is stuff you’re doing with your mind!! Your mind is not some impotent instrument that just interprets the world, where your thoughts, intentions, hopes, and your dreams simply float off into the ether. You can think of your mind as a force, because it does actually bring about effects all throughout your body.

You could take your chemistry prowess a little farther and use your mind to change the physical structure of your brain. You could impress your friends at dinner by giving them a demonstration. It might be a little boring for them, though, as they’d have to watch you with your eyes closed, paying attention to your breathing for about an hour or two (it’s called meditation, to the uninitiated). But, hey, if you had a portable scanner with you then you could show them the scans by the time they finished their second course. They’d see changes in the bit above your eyes. And you could really impress them by specifically making changes to the left side of this bit. All you’d have done was to infuse your meditation with thoughts and feelings of love and compassion.

You could even do a little magic trick and ask them to choose any body part and you could then stimulate that part with your mind without even moving it.

Say they chose your big toe, for instance. All you’d do is focus your attention on your big toe and they could measure electrical and chemical changes there. If this sounds far-fetched, simply thinking about a body area and immediately stimulating the corresponding brain area governing it is actually central to new emerging prosthetics technologies. Thinking of moving a paralysed limb, for instance, stimulates the area of the brain connected to it, which is linked to a computer device that can then move a prosthetic device, or even a make a character take a step forward in a computer game.

Brain-computer interfaces (BCIs) are potentially the next big step in computer gaming, actually. It’s all made possible because the brain doesn’t really distinguish between whether you’re doing something or whether you’re just imagining it.

Yes, things have come quite far in the whole mind-body field in the past decade. It’s funny but had I suggested, a little over a decade ago, that any of the above could be possible, I’d probably have been laughed out of any lab. It’s funny how things change, isn’t it?

I was actually asked, a little over a year ago, to give a lecture on the mind-body connection to medical students, so it’s great to see that some areas of mind-body science are now beginning to be taken seriously. And may it just keep getting better and better! Ripples!!

 

If you’re interested, here’s a link to a download of a recent lecture I gave entitled, ‘How Your Mind Can Heal Your Body’.

References:

For mind-body explanations and references to scientific journal articles, see David R Hamilton PhD, ‘How Your Mind Can Heal Your Body’ (paperback) (UK paperback) (Kindle) (UK Kindle)

For information on the connection between love, kindness, compassion, and oxytocin and how this impacts the heart, see David R Hamilton PhD, ‘Why Kindness is Good for You’ (paperback) (UK paperback) (Kindle) (UK Kindle)

The Amazing Power of the Placebo

placebo pillsNearly everyone has experienced a placebo effect!

The fact that you take a medicine tells me that on some level you must believe in it or expect it to work, or you believe in the doctor who prescribed it, or even in the improvement you’ve heard about in other people.

This belief, or expectation, activates the placebo effect. Of course, the drug works too but your mind can enhance it….. or suppress it.

The same placebo can do opposite things, for instance, depending on what the person believes it is for. If patients are given a placebo and told it will relax their muscles then it will, but the same placebo can cause muscular tension if the person believes that’s what it does. Similarly, believing that it is a stimulant will increase heart rate and blood pressure, but thinking that it is a depressant gives it the opposite effect – reducing heart rate and blood pressure.

Some people who are given alcohol placebos, thinking they are drinking real alcoholic beverages, even get drunk.

And placebos can enhance athletic performance. In a 2007 study, non-professional athletes had been given morphine during a pre-competition training phase. On the day of a competition the morphine was secretly swapped for a placebo but the athletes still experienced an increase in pain endurance and physical performance that would be expected from taking morphine.

I wonder if they would have been banned from competition if they’d been caught taking performance enhancing placebos (PEP). As an ex-athletics coach myself, all athletes really need is a PEP talk! 🙂

In another study, 40 asthmatics were given an inhaler containing a placebo that was just water vapour, but they were told that it contained allergens that would restrict their airways. Nineteen of them went on to suffer considerable constriction of their airways. Twelve of them actually experienced a full-blown asthma attack. When they were given a different inhaler and told it would relieve their symptoms, it did, even though it was also a placebo. One person in the study developed symptoms of hay fever too after being told that the inhaler also contained pollen.

Colour can matter with placebos, because of what the colour represents to us. A University of Cincinnati study tested both blue and pink stimulants and sedatives on students, although unbeknownst to the students the stimulants and sedatives were placebos.

But the blue placebo sedatives were 66% effective, compared with 26% for the pink ones. Blue placebos were around 2.5 times more effective for relaxation that pink ones. This is because blue is generally considered to be a calming colour.

Where you live also affects the power of placebos. In a US study of migraine treatments, placebo injections were 1.5 times more powerful than placebo pills. But a European trial found that placebo pills were about 10% better than placebo injections. The reason for the difference? It’s in our cultural language. US patients tend to speak of ‘getting a shot’ so they believe in it more, but Europeans talk of ‘popping pills’, or at least they do in the UK.

On a kind of similar note, in trials of Tagamet, the anti-ulcer drug that was popular in the 80s, the placebo was 59% effective in France but the drug itself was 60% effective in Brazil – a difference of 1%. The placebo in one country was as good as the drug in another!

Studies like these strongly hint that we have far more ability to affect our health through our thinking than we might have believed in the past.

How a placebo is packaged and sold also makes a difference to its power. In a UK study, 835 women were given one of four different pills for headaches. One group received a well-known branded aspirin tablet. A second group received a simple tablet labelled ‘analgesic’, which was typical of a cheaper mass-market brand. A third group received a branded placebo, while the last group received a basic ‘mass-market’ placebo labelled ‘analgesic’.

It turned out that the branded aspirin worked better than the unbranded one, but amazingly the branded placebo worked better than the unbranded placebo – even though they were both made of sugar.

The placebo effect might even lift the power of Viagra beyond its basic pharmacological effect, at least according to psychiatrist Aaron K. Vallance, who suggested in a 2006 paper that the medicine might be enhanced because the name ‘Viagra’ is similar-sounding to the words, ‘vigour’ and ‘Niagara’. This might create a perception of vigorousness and power. I wonder if it would work so well if it was called ‘Flopsy’! 🙂

Of course, the drug works extremely well. Drugs are built to carry out biological functions in the body. I know this for a fact. My PhD was in building molecules, or organic chemistry as it’s officially known, and I spent 4 years in cardiovascular and cancer drug development in the pharmaceutical industry. But there is no question that the mind impacts the body. Imagining something, for instance, can even physically impact brain structure.

The challenge is in tapping into this latent power within us. Doctors can help or hinder, even when they don’t know they are doing it.

We know this because some of the variation in placebo effects simply comes down to the communication between medical staff and patient. For relatively common ailments at least, a doctor or physician who shows confidence or optimism about the patient’s recovery is much more likely to see the patient recovering than one who is unsure or pessimistic.

What is said and, importantly, how it is said can make a big bit of difference. But ultimately, it’s what then goes on in the patient’s mind that leads to the health-giving effects.

I personally believe that we have far more ability to affect our health and, dare I say, to heal ourselves, than we have ever thought possible. The question is how to tap into this ability.

I believe we can make a start by doing something active with our minds and believing in it. This is why I explain the science of how the mind impacts in the body in my talks and books – so that people can understand how their thinking affects their health. That way, when they apply visualization strategies, they tend to believe in themselves, and in so doing they are tapping into this ability.

Of course, this is not to be done instead of medical advice, but in addition to it. That is just being intelligent. We might as well get the best of everything.

And that includes the best use of the mind too!!

 

Further Reading

David R Hamilton PhD, How Your Mind Can Heal Your Body – For examples and explanation of the placebo effect, other mind-body phenomena, and various visualization strategies for different ailments. UK paperbackUS paperbackUK KindleUS Kindle

Daniel Moerman, Meaning, Medicine, and the Placebo Effect – for heaps of research on the placebo effect. UK paperback, US paperback

 

 

The Healing Power of Belief

I recently read about an amazing story of the power of the placebo effect. It was recorded in 1957 and demonstrates just how powerful the human mind can be.

A patient had advanced cancer of the lymph nodes (lymphoma) and was told that he had no more than a few weeks to live. He couldn’t get radiotherapy or chemotherapy because he was anaemic but he had heard of a new experimental anti-cancer drug called Krebiozen and begged his doctor to give him some. So the doctor gave him an injection of it.

Within a few days of the injection he was out of bed and walking about the ward at the hospital. Very quickly the tumours, which had been the size of oranges, had shrunk and were now golf ball sized. His rapid improvement continued and he was soon released from the hospital totally free of cancer.

But about 2 months later there was a story in the papers saying that Krebiozen was no good. The man read it, believed it, even though Krebiozen was working for him, and within days his cancer had returned and he was back in hospital.

His doctor, realising there were few options, then told him a lie because he believed that the patient’s recovery might have had a lot to do with his belief in Krebiozen. So he told him that the papers had got it wrong and that the drug really was a great drug. The doctor told him that the cancer probably came back because the batch of drug he got had gone off a wee bit while it was sitting in the hospital pharmacy. He told him that a new batch of double strength Krebiozen was due at the hospital soon and he could get an injection of it.

Of course, there was no double strength stuff. The doctor made it up. A couple of days later, pretending that the double strength batch had just been delivered, the doctor gave the patient the injection. But it was an injection of pure water – a placebo. You know what? The cancer rapidly disappeared. The man was healthy and free of cancer once again.

But, once again, about 2 months later the papers ran another story, this time giving Krebiozen a death sentence. Apparently the trials had shown it to be useless. This proved to be the last straw for the patient because his tumours quickly reappeared, he was taken back into hospital, and he died 2 days later.

So if ever someone tells you that something can’t be done, or that you can’t be healed, maybe there’s a little voice inside that says you can. I believe that faith can move mountains.

The Placebo Effect is Getting Stronger

From 2002 to 2006, the number of drugs that were axed after Phase-II clinical trials (volunteer trials) increased by 20% because the drugs couldn’t beat the placebos they were compared against. More recently, in 2008, a new gene therapy for Parkinson’s disease failed against the placebo. Similarly, in March 2009, Eli Lilly withdrew a new drug for schizophrenia because the placebo effect was double that expected. Also in March 2009, Osiris Therapeutics’ new drug for Crohn’s disease was also withdrawn due to a high placebo effect.

What is going on?

There are a few forces that have generated the increase. The first is powerful advertising. Advertising plays on the mind; the very vehicle of the placebo effect. The Pharmaceutical Industry have hugely increased their advertising expenditure in the past 20 years. Many years ago, drug advertising was little more than a few posters on the walls of surgery waiting rooms. Now, big pharma have created powerful ads that are so effective that patients taking drugs in the west really expect something to happen when they take them.

Now the act of taking any drug in the west brings with it powerful memories as well as even more powerful unconscious associations generated by the advertising that ensure that taking a drug has an effect. But the downside, not for the patients but for the industry, is that the same applies when they take a placebo. Expectancy is a key element of the placebo effect. The same memories and associations are activated that ensure that taking a placebo heals too. Ironically for the drugs industry, as advertising gets better so too does the placebo effect.

The second reason is that there is a growing flux of drug testing now taking place in developing nations. In these trials, poor people who are often deprived of medical care are suddenly able to get the drugs they need. Many are desperate, and have extremely high hopes for the ‘fancy western drugs’ they receive as well as high-level belief in them. Their perception of rich nations is people enjoying state of the art drugs and healthcare into their very old ages.

But hope and belief are also key elements of the placebo effect. Thus, placebos in poor countries often do better than they would do in other countries. And since the global placebo statistics are made up from trials everywhere in the world, the statistics from the poorer nations lift the overall placebo rate up a few points. Thus, as more and more trials are carried out in poor countries, the higher the placebo effect will get. You could say, with the fancy advertising and trials in developing countries, that the pharmaceutical industry has, ironically, been responsible for elevating the placebo effect and making its own drugs harder to get on the market.
With similar irony, it was my own interest in the placebo effect as a scientist in the pharmaceutical industry that propelled me into studying the power of the mind over the body.

Another reason for the increase is due to an increase in the use of drugs to treat ‘psychological disorders’. In the past 20 years, there has been an increase in the number of conditions being diagnosed as ‘psychological disorders’. Pharmaceutical companies have ploughed increasing millions of dollars into their research and development.

But many of these psychological disorders involve areas of the brain that are also involved with our beliefs, expectations, hopes, thoughts of rewards, and how we understand and relate to each other. And these are the same areas that are active during a placebo response. Thus the placebo effect is unexpectedly high for conditions like depression.

For example, a 2008 study of Prozac (fluoxetine), Effexor (venlafaxine), Serzone (nefazodone), and Seroxat (paroxetine) covering 35 clinical trials that involved 5,133 patients found that the placebo effect accounted for 81% of the effect of these drugs. Thus, as more people are diagnosed with psychological disorders and the number of drugs used to treat them increase, the ratio of drugs for psychological disorders compared with all other drugs increases. And since they have a high placebo effect, the overall placebo effect also increases.

It’s a similar story with cardiovascular diseases. As cardiovascular disease is the leading cause of death in the west, in large part due to western dietary and lifestyle habits, drugs to treat it dominate the drug market. But drugs for cardiovascular diseases can also have a high placebo effect, which many believe is due to the strong brain-heart link. So as our diets and lifestyles worsen and our hearts pay the price, the drugs used to treat us ensure that the placebo effect is kept high.

Doctors/physicians have a hand in the increase too. Many are now much more aware that the placebo effect is not just a nuisance, or all in the mind, as was once thought, but that it is a real pharmacological phenomenon that produces physiological change in the brain and body. Thus, many doctors treat patients with more empathy and assurance than before in the hope that that will aid their recovery. Empathy and assurance also activate the placebo effect. As doctors show more care and confidence, patients get better faster, even when they are taking inert medication.

Consider, for instance, the results of a British Medical Journal paper that reported on 200 patients who had either been given a positive or a negative consultation by their doctor. For approximately the same medical conditions, the doctors told the patients what was wrong with them and that they would get better in a few days. Accordingly, 64% of them did get better over the next 2 weeks. But for the other half, the doctors told the patients that they weren’t sure what was wrong with them but to come back if they haven’t got better. Only 39% of this group got better…..64% versus 39% and the only difference was in how the doctor acted. For the first group, there was presumably more empathy and confidence.

There is a last unexpected factor that also increases the placebo effect. It’s difficult to quantify the degree of influence it has, but it’s sure to be exerting an increasing force. It’s us! Or at least, it’s our increasing knowledge of the placebo effect and our growing faith in our own capacity to affect our bodies.

In the past few years, research into the placebo effect has delivered a powerful new message. It is that our thoughts, beliefs, our hopes and our expectations impact our brains and our bodies. MRI studies now show beyond doubt that this is true. Recent brain research shows release of dopamine in the brain when Parkinson’s patients are given placebos, for instance. Other studies show release of the brain’s own version of morphine when people are given placebos instead of painkillers. And MRI scans of patients given placebos instead of Prozac show activation in the same areas of the brain.

One of the leaders in the field of placebo research, Fabrizio Benedetti, a neuroscience professor at the University of Turin School of Medicine and member of the Placebo Study Group centered at Harvard, recently wrote:

“The placebo effect has evolved from being thought of as a nuisance in clinical pharmacological research to a biological phenomenon worthy of scientific investigation in its own right.”

This kind of research is filtering into the public domain through the mainstream press, which raises everyone’s belief in the power of the mind. Popular general-public-focused books that discuss the mind-body connection, like ‘How Your Mind Can Heal Your Body’, ‘It’s the Thought that Counts’, ‘The Biology of Belief’, and ‘Molecules of Emotion’, also add to this. So as our collective awareness that the mind affects the body increases, it’s sure to elevate the placebo effect even more. The good news in all this is that we are beginning to recognize that we are not exactly powerless. Our own attitudes and beliefs, our hopes and our expectations, all play a part in our own healing.

A general, healthy way of being, then, is to cultivate a more positive attitude towards all that life throws our way. It might just help us live longer, healthier lives, and when we do get sick it might just help us recover faster.