THE POWER OF SUGGESTION

THE PLACEBO RESPONSE

A placebo is an intervention designed to simulate medical therapy, but not believed by the clinician to be a specific therapy for the target condition. It could also be a treatment now believed to be inefficacious, though believed to be efficacious at the time of use. A placebo effect is a change in a patient’s illness attributable to the symbolic import of a treatment rather than a specific pharmacological or physiological property.

Who is susceptible to the Placebo Response?

It has been said that about one third of patients will have a placebo response in any clinical trial These numbers were based on a review of 15 studies of patients suffering a variety of conditions and represents an average. The response rate actually varied from 15% to 58%. In some documented clinical trials 100% of the subjects reported a placebo response. I believe that the problem with the large fluctuation in responses is due to the fact that clinicians do not understand the mechanism of response to a placebo. Because many of the influences to the placebo response are extremely subtle we may never be able to completely control the result.

WHY IS IT EFFECTIVE?

The placebo response is analogous to a procedure called "hypnotic induction." It involves the establishment of rapport between the clinician and patient. The degree of success in establishing rapport has a direct effect on patient outcome and depends on a number of factors including, but not limited to:

• Trust in the clinician, his staff and their abilities.
• The clinician’s belief in the effectiveness of the treatment.
• The clinician’s ability to communicate his belief to the patient.
• The patient’s attitudes about his treatment and his rapport with the clinician.
• The physical setting, such as the ambiance of the office.
• Understanding and use of the placebo effect will significantly increase the effectiveness of most interventions.

WHEN IS THE PLACEBO RESPONSE USED?

The placebo response is used unintentionally hundreds of times a day. It is also called "bedside manner," "charisma," "professionalism," "salesmanship," etc. In this context it is easy to see how we can give and receive hundreds of suggestions every day. The problem is that these are, for the most part, unintentional and so we cannot identify just what it was that influenced a situation to our benefit. The trick is to understand and recognize the specific transactional motivators so that we can have some control of what we react to, and what others react to through our influence.

The hypnotic trance state has many levels and it is likely that we are all subjected to lighter levels of hypnosis daily. Have you ever bought something at a store and later wondered why you would buy such a thing? Have you ever agreed with someone and later wondered why you did not disagree with them instead? How many times have you arrived home from work only to realize that you don’t remember most of the drive? You have probably just experienced the state of hypnosis.

Do you have a phobia passed down from a parent or someone else that you knew as a child? Many people find themselves suffering from the same fears their parents had. This is often the result of conditioning from childhood. It is also a post–hypnotic suggestion.

The placebo response varies widely but has been documented in some significant studies. In a study done in 1960 it was found that, for angina patients who had a skin incision only, 100% of patients reported over 50% improvement in their angina after the first year. In many clinical trials the placebo effect has been found to be about the same as the percentage of positive outcomes for several now abandoned surgical techniques.

A placebo effect may be induced even as a result of what is believed to be a traditional course of therapy. In Spangfort’s review of long term outcomes of 2504 disketomies complete relief of sciatica was achieved in 37% of cases. Complete relief of back pain was achieved in 43% of patients. This in spite of the fact that none of these patients had disk herniation. Since there is no known therapeutic effect of surgical exploration the changes may be attributable to the placebo effect, or to natural history.

This is an area that includes patients who are classified as in "spontaneous remission." The medical annals are full of cases where a patient scheduled for surgery no longer has the condition for which the surgery was scheduled.

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