Introduction
In the last post (44) I explored the possibility of my mind being powerful enough to restructure my reality: My mind had registered the act of drinking, the taste of alcohol and then "we" had filled in the blanks. Are "we" responsible for any other "misrepresentations"? I made that observation of "misrepresentations" in the context of my Parkinson's Disease (PD) against the backdrop of Somatic Symptom Disorder (SSD). As is the case in many of my posts, dear reader, this is food for thought.
Staying with this theme of restructuring my own reality, let's look at another powerful possibility known as the Placebo effect.
Mind matters: placebos in general
The Latin for placebo is "placere" that means "to please". The term placebo is often associated with clinical trials of drugs where non-drug substitutes - often referred to as "sham" or "inactive" medical treatment - called placebos, are administered to some trial participants in order to gauge, scientifically, the impact of the drug being tested. However, it has also been discovered over the years that some trial participants react to the placebo in a positive manner (leaving participants healthier), thereby negatively affecting the research outcome (leaving manufacturers poorer). Hmmm...
According to the Wiley Encyclopedia of Health Psychology (September, 2020), besides validating the impact of therapy, "placebos represent an excellent model to understand different brain functions and the way mental activity may affect several physiological functions...[and there is a increasing evidence to show that] social stimuli, such as words and therapeutic rituals, may change the patient's brain, and these effects are similar to those induced by drugs." So the brain may be more powerful than some of us have imagined.
According to a study in March 2021 led by Tor Wager at Dartmouth College, titled A detailed look at the neuroscience of placebo effects - and there are many other similar studies - "A large proportion of the benefit that a person gets from taking a real drug or receiving a treatment to alleviate pain is due to an individual's mindset, not to the drug itself...[and] placebo treatments to reduce pain, known as placebo analgesia, reduce pain-related activity in multiple areas of the brain." A placebo appears to provide more of a psychological benefit rather than a physiological effect! This becomes clearer below. A useful introduction to placebos would be to read Dr Joe Dispenza's book "You are the Placebo: making your mind matter" (available online) that describes how it is possible for people to cure themselves of ills and injuries by engaging in meditation, visualisation and positive thinking processes. The book contains meditation and visualisation procedures, anecdotes of his own and many cases involving the impact of placebos, including a story of a Dr Henry Beecher.
Apparently, during World War II, Beecher, an American surgeon, had run out of morphine when he was about to operate on a badly
wounded soldier. Without a painkiller, the soldier could have gone into shock and died. A nurse filled a syringe with a saline solution and injected the soldier with it, as if it was morphine, and the soldier survived the operation. After that, whenever the field hospital ran out of
morphine, Beecher injected soldiers with a saline substitute. In 1955, Beecher authored 15
studies published by the Journal of the American Medical Association. He called for a
new model of medical research that would include a placebo when conducting clinical trials.
By the way, another journalistic investigation titled
The Legend of the wartime Placebo, draws attention to the possibility of other overlapping factors omitted from the famous Beecher story. This second version is just to balance our thinking, dear reader, so do skim through the "Legend" (link above). Remember, it's food for thought...
So, if placebos appear to provide a psychological benefit rather than a physiological effect, then it would appear that the drug or placebo's packaging, appearance of medical personnel and physical delivery environment would be critical for successful impact. These factors relate to certain ingrained beliefs and expectations of the patient, as referred to by Benedetti and Amanzio (2011), who delved into the idea of how "words and rituals" could bamboozle a patient's brain. Their research concluded that "placebo-induced...changes in a patient's brain are very similar to those induced by drugs. This new way of thinking may have profound implications both for clinical trials and for medical practice."
Based on what I've presented above,
placebos can be powerful mental tools, when the "words and rituals" are appropriate.
Ashar, et al. (2017) also refer to the
"psychosocial context in which
the placebo treatment is delivered [including] the patient’s relationships with care providers...visiting a doctor’s office or taking a pill; these influence patients’
appraisals about how a treatment will affect them, including expectations for recovery." Who would have thought that "words and rituals" and a "psychosocial context" would be important elements required to convince one's brain of the success of a medical procedure.
But how does a placebo impact those of us with Parkinson's?
Mind matters: placebos and Parkinson's
"Long-lasting placebo effects have been reported in Parkinson’s disease. In some medication trials in Parkinson’s disease patients, improvement in motor scores of 20-30% in patients assigned to the placebo group has been observed for up to 6 months. Similarly, improvement and deterioration in Parkinson’s disease patients have been observed after the introduction and discontinuation, respectively, of placebo medication."
The Michigan Parkinson Foundation also released a paper titled "Placebo Effect and the treatment of Parkinson's Disease that comments on PD patients and images of improved communication between their nerve cells and dopamine leading to improved dopamine release: "There's experimental evidence that taking a placebo leads to changes in the brain, not unlike taking a dose of levodopa (the active ingredient of Sinemet). These investigations have used a research tool called positron emission tomography, which images the chemistry of the brain. Scientists at the University of British Columbia have shown that a placebo can enhance the signaling between nerve cells with dopamine, the brain chemical specifically deficient in PD." Research by Barbagello et al. (2018) titled "The placebo effect on resting tremor in Parkinson's Disease: an electrophysiological study" focuses on the effects of apomorphine and placebo on PD patients with resting tremors. "Our study demonstrates that placebo was very effective in reducing resting tremor in about half of patients...decrease in tremor amplitude in placebo responders was similar to that induced by apomorphine. The cerebral mechanisms underlying the placebo effect on resting tremor need further investigations."
Conclusion
It appears that the use of placebos and accompanying research into its various applications in surgery as well as a drug is well documented. In this post I have drawn attention to a few interesting studies on placebos and neuroscience that drew attention to the need for psychosocial factors and rituals for placebo success. There are also a few studies on placebos and PD. Here too, it appears that researchers have given placebos the green light regarding short-term use and positive impact both generally and with those who have been parkinsed. And I've tried to source readings that are not too difficult to read.
Well, dear reader, in this forty-fifth post I trust that you've learnt something about yourself and PD. Till next time...
