Placebo or nocebo – you choose

I think that the majority of you reading this will have heard of the placebo effect. It’s one of the most amazing demonstrations of how the mind body connection works.

When we talk about placebo most of us think of taking a sugar pill instead of a real tablet, say a painkiller, yet the pain disappears with only the sugar pill. But research into the placebo effect has demonstrated much more powerful results. A number of studies have now been conducted in many countries including Finland, USA and Canada comparing the results of real knee surgery and placebo surgery (where the person believed they were having the operation). The studies demonstrate the long term results are identical whether you have the surgery or the pretend surgery. Before I go any further I want to make it clear that I am not suggesting you should avoid surgery if your doctor recommends it. That said the implications of those studies are huge. The surgery in question is the most common orthopaedic procedure in the USA.

But it gets even better.

Recent research is showing that even when you tell someone a treatment is placebo, it still works! In one study a group of patients with irritable bowel syndrome were told they were receiving placebo pills. The label on the bottle even said placebo. After three weeks more than twice as many placebo patients reported relief from symptoms compared to a group who received no treatment.

No one is quite sure yet what the underlying mechanism is thats causes the placebo response. But the latest research is showing that the when placebo response activates it effects the supply of neurotransmitters in the brain.

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OK, so most of that probably isn’t news. But have you heard of nocebo? This is a less well-reported flip side of the same process. When a doctor tells someone about the side effects of a medication they are more than twice as likely to experience those side effects than someone who hasn’t been told about them. Now this poses a huge dilemma for doctors – should they tell their patients about the potential side effects and increase the likelihood that they will experience them? Even the words your doctor uses can effect the outcome. In one study they measured the difference in peoples’ responses to a particular injection depending on how the doctor described the experience beforehand. The more the doctor used the words pain, sting, burn etc the more the patients actually felt that pain, sting, burn etc.

There are even anecdotal stories of people dying when they believed they had a terminal illness but didn’t. These reports are not well researched and need to be treated with caution. But the nocebo effect is just as real as the placebo effect.

Again the latest studies are helping us understand this response a little but we have a long way to go to fully explain what is happening. At this point in time its looking like the area of the brain known as the hippocampus is the major player with nocebo.

However this is not only limited to the impact that doctors can have. Since the 1990s there have been a number of studies looking at what happens when you expose people to negative words related to their age. When older people are subtly exposed to stereotypically negative comments about people of their age, they begin to live this out. So if we say older people are slower and struggle, that’s what happens. On the other hand if you again subtly expose older people to positive terms associated with ageing such as gaining wisdom they have measurably better results in a range of tests. Some more recent studies are even showing that having a more hopeful view of the ageing process can increase your life expectancy by over seven years.

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Personally I find all of this fascinating, and that’s all well and good, but what does it mean in a practical sense? Well, we can all use this information on a day to day basis. Think, each time you interact with each other, about how you may be unconsciously using either placebo or nocebo. Are the comments you are making likely to increase the person’s feeling of wellbeing or the reverse? Think how much better our collective experience could be if we all chose to use placebo orientated language.

As you go about your life today I challenge you to tell three people how well they look. Watch them smile and start to live it out.

Finally research from the field of positive psychology tells us that doing things for others increases your personal sense of wellbeing too. So it’s a win win!


Have you ever taken a placebo or seen the effects mentioned in this article? Tell us about it below.