What Else Can Improve Health?

The common sense view of placebos is that they are fake treatments that, somehow, are effective just because the patient believes in them.  Medical doctors often consider them unethical, a form of cheating.  But the reality is a bit more complex.

Since the mind is not a machine or a computer, the hopes and anxieties, the expectations and beliefs aroused in us by any treatment for an illness will inevitably result in physiological changes in the brain.  We don’t know exactly how this works, but clearly some of those changes can mimic and amplify the effects of “real” treatments.

Olivia Judson writing in The New York Times pointed out that the psychological benefit associated with a placebo can also enhance the impact of ‘real’ treatments.  In fact, it can be impossible to discriminate how much of the effect of the drug is due to the brain’s expectations and how much to the action of the drug itself.

The effects vary tremendously in different populations, and seem to be affected by the attitude of physicians administering the placebos as well as the impressiveness of the “rituals” involved in their use.  Surgery, for example, has usually more psychological impact than injections, which in turn have less impact than pills.

Judson writes: “So the key is to figure out how to maximize that enhancement without lying.  One idea would be to deliberately increase the element of formal ritual in medicine.”   (See, “Enhancing the Placebo.”)

Other psychological factors contribute to health, and there is evidence that people in relationships – even people who have pets – do better.  It is likely, then, that the mere existence of health insurance and access to care will make a difference.  If a sugar pill can help patients get better, it seems likely that just knowing you can get the help you need, without going into debt, will also have a physiological impact on the brain.

To be sure, insurance and access will encourage some to overuse available care.  But it would be good to know more about the placebo effect of healthcare insurance.  Having it might provide more than peace of mind.