Citizen Science No. 5 by Jamie Zvirzdin

The Power of the Placebo Effect,
Part I: Magic Feathers and Medical Transparency

Dumbo! C’mon, fly! Open them ears! The magic feather was just a gag! You can fly! Honest, you can!”

I can recite many Disney movies almost word for word, but I also recall that the 1941 version of “Dumbo” made me acutely sad and anxious. And no wonder: a poor baby elephant with big ears is mocked by others at the circus, torn away from his mother, given hallucinogenic alcohol by his best friend and a magic feather by horribly stereotyped crows. The magic feather itself is a trick of the mind, a symbol of the powerful psychological phenomenon known as the placebo effect. Knowing more about this phenomenon can help us make more informed medical decisions and improve our mind-body connection and overall health, so grab your popcorn or peanuts and get ready to enjoy—and wince at—the circus of the human mind.

Placebo, a Latin term, literally translates to “I shall be pleasing.” Healers of all stripes have long administered placebo pills or healing treatments that pleased and comforted the patient but had no intrinsic therapeutic value. These wispy, non-medical interventions, like Dumbo’s magic feather or cotton candy at a circus, are all fluff, yet they still harness the power of belief and expectation—for some people—to activate the body’s natural healing mechanisms—sometimes. Even if they’re therapeutically null and void, placebos can still draw out real effects in us, influencing our health outcomes.

Those real effects can linger, too. Dr. Kathryn T. Hall, in her book “Placebos” (MIT Press, 2022), says, “Even though the placebo interventions themselves have no biological qualities that would induce a physiological change, placebo effects can be long-lasting.” Moreover, she adds, those effects compete with clinical benefits of active treatments. That competition has become so fierce, in fact, that pharmaceutical companies struggle to develop treatments that perform better than the placebo effect. It’s far easier and cheaper to market fast-acting, triple-strength, long-lasting miracle cures. Homeopathic Cold Remedies! Advanced Certified Blends! Immune Support! Himalayan Salt Crystals! Healing Crystals! Essential Oils! It is a little wild to walk down the aisle at my local drugstore and see all these products and their claims.

The history of how we discovered the placebo effect is as sad as giving hallucinogenic alcohol to a baby elephant. Around the time “Dumbo” came out, during World War II, an anesthesiologist named Henry K. Beecher ran out of morphine to treat soldiers in pain. He decided to inject a harmless saline solution into his patients, telling them it was a powerful painkiller, and he found that 40 percent of the soldiers reported pain relief. This “pure placebo” did no harm but at least gave relief to 40 percent of soldiers instead of zero percent. The other 60 percent? Out of luck, man.

Intrigued by this phenomenon, however, Beecher continued his research into the placebo effect when he returned home from the war. Despite controversy over Beecher’s methods and findings, his work helped to establish the placebo effect as a legitimate subject of scientific inquiry. Beecher’s work also influenced the design of clinical trials, and now researchers use placebo-controlled trials as a way to test the efficacy of new treatments.

Since then, medical researchers—and enterprising marketers—have learned that the placebo effect can be influenced by a wide variety of factors, from the color and size of a pill to the way a healthcare provider talks to their patients. There are “pure placebos,” like sugar pills or the saline injections Beecher used, and there are “impure placebos,” like low doses of an active treatment (homeopathy), vitamins, or supplements. Worst of all are poisons peddled as miracle cures—including “Morphina-Cura” (1906), a mixture of morphine and heroin to help people overcome their addictions to morphine, and a deadly dose of antifreeze relabeled “Elixir Sulfanilamide” that killed 71 adults and 34 kids in 1937, which led to the creation of the Federal Food, Drug, and Cosmetic Act in 1938.

So what happens in our brains when we partake of a placebo? Here’s what we know so far: When we believe a remedy will work, our brains release the “feel-good” neurotransmitters like endorphins and dopamine. Endorphins are natural painkillers and reduce discomfort, while dopamine is associated with reward and pleasure. In effect, our brains reward our positive expectations with feelings of pain relief and happiness. Our brains release their own painkillers, called endogenous opioids. These natural painkillers change how pain is processed in the lower parts of the brain and spine. Activating this part of the brain is like turning down the volume on a painfully loud TV.

Simultaneously, the placebo effect can increase activity in certain areas of the brain closely linked with mood, emotional reactions and self-awareness. These include regions like the prefrontal cortex, which is linked to decision-making and social behavior, and the anterior cingulate cortex, which is involved in mood and emotional regulation. When these areas show greater activity, it may lead to an enhanced sense of well-being and a more positive mood, further reinforcing the placebo effect.

Sadly, not all diseases can be improved with a placebo—especially those that aren’t controlled by the thinking parts of our brains. When we choose a placebo treatment instead of seeking better treatments with more robust studies backing them, we’re gambling with our own health. Caretakers who promote placebo treatments for a quick potential fix or to make a quick buck can end up harming their patients.

So I’m against quacks or overly optimistic caretakers who prey on the faith of those who trust easily—especially if patients pay for expensive placebo pills or treatments instead of seeking better and more effective care. That said, I’m all for positive and honest life hacks, MacGyver style. If the placebo effect is a type of health hack that can reduce pain for some people, let’s better understand it and use it—wisely—to our advantage. In fact, recent studies show that even if a caregiver actively identifies a treatment as a placebo, some patients can still experience that reduction of pain. These non-deceptive treatments are called open-label placebos.

In fact, Dr. Kathryn Hall—whose dog, her constant companion, is named Placebo—writes that patients who were given OLPs reported significant benefits in dealing with chronic low back pain, cancer-related fatigue, Irritable Bowel Syndrome (IBS) and allergic rhinitis. We’re still figuring out what works and what doesn’t, but it seems honesty is still the best policy when it comes to administering placebos ethically. If Dumbo could soar to the heavens after realizing his magic feather was as magical as a rubber chicken, perhaps there’s hope for us yet. In the meantime, we’ll keep our ears open and see you next month when we dive into the fascinating world of the nocebo effect—the evil twin of the placebo. Until then, enjoy the circus of the human psyche and stay away from questionable beverages.

Jamie Zvirzdin researches cosmic rays with the Telescope Array Project, teaches science writing at Johns Hopkins University and is the author of “Subatomic Writing.”