The Placebo Effect And Factors Of Its Effectiveness
What is the placebo effect?
Simply, a placebo can be described as an inert substance which has no medically proven healing ability or positive physiological effect yet can improve the receivers symptoms of a condition. However, the definition of a placebo has become murky in recent times as we are becoming more aware of other aspects of healthcare which seem to contribute to the overall placebo effect.
We now have wider understanding into healthcare psychology and the study/use of the placebo effect has become far more advanced to that of Henry Beechers. Studies today look past the deceptive power of the placebo but and more so towards how patient practitioner engagement, healthcare set ups, past experiences, culture, expectation, desire, optimism, trust, treatment delivery and communication can all improve symptom relief in patients.
Some individuals may just simply feel better from visiting a practitioner or doing something they believe will help, such as living a healthier lifestyle. However, this type of placebo effect seems most related to the degree of confidence and faith the patient has in the practitioner/treatment.
How is the placebo effect measured?
The most common way to test the effectiveness of a placebo is using a double-blind controlled study, where both parties are unaware who is receiving which treatment. This helps avoid biases in result interpretations that can be caused by the researcher or patients knowledge. This is not as big a problem in studies of cancer treatment, where results are qualitative. Bias is more likely in studies with patient reporting for symptoms like pain or depression.
Placebos can have strong effects and individuals may think that the placebo produced a cure. However, we know that placebos do not cure. In studies looking at whether a tumor shrinks, placebos have very little effect on reducing tumor growth. Still, physical placebos can clearly help reduce certain symptoms such as pain, anxiety, and trouble sleeping. There is a theory that a placebo may help the brain remember a time before the symptoms and bring about certain chemical changes - A theory named remembered wellness.
What patient aspects impact placebo effectiveness?
Culture
It is imperative to consider the importance that the cultural differences in the bi-cultural patient practitioner relationship may have in a clinical setting. Radiation therapists should consider how these differences in beliefs, traditions, and general way of life could impact of treatment plans and be capable of changing protocols/ advice to suit the patient. In doing so, radiation therapists can ensure that all patients are being given both equal and optimal treatment.
Belief
Patients who already have some faith in a particular treatment are more likely to sign up for a study. For example, individuals who have faith in their doctors methods are more likely to sign up for a medical study. Similarly, Individuals who believe that radiation therapy works are likely to seek radiation therapy treatment. Those who don’t believe in a certain procedure probably won’t sign up to it. This means that individuals who sign up already have some expectation effect before the study or treatment starts. Many who take part will likely report at least small improvements in symptoms because they expect to be helped by the treatment. One particular study found that reward expectation accounted for 28% of the variance in the formation of placebo analgesia.
Expectation
Many people feel better after they get medical treatments that they expect to work. The opposite can also happen, and this seems to support the idea of the expectation effect even more. In one study, people with Alzheimer disease got less relief from pain medicines. These patients required higher doses – possibly because they had forgotten they were being administered the drugs, or they forgot that the pain medicines had worked for them before. This suggests that past experiences also play into the placebo effect and support the theory of remembered wellness mentioned earlier.
Mindset
There has been numerous studies showing string correlation between an individuals belief and physiological change. According to one study of 84 hotel maids, those who were told that they met sufficient exercise levels solely through their work showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. Perhaps if cancer patients focus more on the positive aspects and habits of their lifestyle which are conducive to improved health, they could experience better and faster recoveries.
What aspects of the practitioners role can increase the placebo effect?
Belief in treatment
In one study looking at individuals experiencing frequent migraines using the drug maxalt, different labelling of placebos and the actual drug found that by simply labelling the true drug container with “maxalt” symptoms significantly decreased as compared to a true drug container labelled “placebo”. If one word can impact on patient belief in a drug and increase the positive physiological effects, the effectiveness of a treatment plan could be massively increased by the way a radiation therapist communicates with a patient. If they personally believe in a treatment and communicate that the treatment will likely work - patients will be more likely to see an improvement.
Creating a positive patient-practitioner relationship
This can help decrease the both the amount of medication used and experienced side effects. A recent review found that there is substantial evidence that positive relationships between patients and practitioners are correlated with improvements in quality of life, anxiety and depression levels, as well as patient satisfaction and treatment adherence. Interactions that hold a business-like character and that create doubt and uncertainty around the practitioner’s skills and competencies could lead to nocebo effects or to a reduction of placebo effects.
Delivery of information and communication
Identifying patient mindsets may serve as an efficient way for evaluating a patient’s opinion on different aspects of the treatment process, including previous experiences and expectations regarding treatment plans or outcomes. In addition to the practitioner role in treatment delivery, other actions could be taken to enhance the placebo and prevent the nocebo effect. For example, a radiation therapist could avoid over emphasising negative information regarding a treatment by balancing it with information about the positive effects in a truthful and ethical manner. Patients should be presented with the realm of the nocebo phenomenon and offered the option to agree not to receive information about certain types of side effects. This preserves patient autonomy. A radiation therapist should always have a positive and optimistic outlook when delivering information but should not deceive a patient. Information regarding treatments, success rates and possible issues should be presented in a truthful way but remain focussed on the positives. Discussing negative aspects first and last should be avoided.
Creating an optimal healthcare environment
Preventing interactions that are insensitive and uncaring which come across as careless and show lack of warmth, while also creating a safe and welcoming environment for patients to reside during treatment, can prevent harmful nocebo effects while promoting positive placebo effects.
Uses of placebo effect for radiation therapists
Perhaps the largest benefit of the placebo effect for radiation therapy patients lies in the reduction of health risk factors which can reduce treatment effectiveness. There are many less obvious “health risks” which could reduce treatment efficacy besides obesity, high blood sugar, alcohol consumption, smoking, CHD, stress, or poor diet. For example, in June of this year late night shift work was listed as a possible carcinogen. Perhaps a simple suggestion to change shift work may help with treatment. Other studies have shown how losing just one hour of sleep through daylight savings time can increase our risk of heart attack by 24%, revealing the importance of sleep for our health and reducing illness. By using existing knowledge on the importance of diet, sleep, exercise, stress management etc radiation therapists could greatly increase patients overall health and their ability to fight against cancer.
Conclusion
The placebo effect is more than just the effect that the administration of an inert substance, or “sugar pills” deceptively to a patient. It is a way we can quantify and measure everything that surrounds pills and procedures when patients visit a healthcare practitioner.
In radiation therapy, the placebo effect is more about how we can create a healthcare environment that can help alleviate patient symptoms, stress, and anxiety without the use of pharmaceuticals/treatments. By creating a favourable environment, these placebo effects can be increased and used to reduce health risk behaviours associated with negative impacts on treatment outcomes.
The studies discussed above show how both the patient and practitioner can largely determine health improvement. Furthermore, the placebo effect shows us that sometimes the best way to fix what’s wrong with our health is by focusing on what’s right with our health. I believe it is ultimately the individuals choice to adhere to and believe in their treatment.
