Panacea or Poison: Placebos and Nocebos in Modern Medicine

Placebos “work” for quite a few medical problems. But how? And what is the work they do?

What one thinks a medicine is capable of, one’s idea of that medicine, may affect us in the way “proper” medicines do. This implies that, in observing the work of a placebo we are watching an idea affect biology, the mind moving the body.

Despite the dualist notions this description elicits, where mind and body are held as separate entities, most neuroscientists, generally of a monistic bent, welcome the challenge of the placebo effect. Most insist that placebos precisely demonstrate that the mind is one with the body. Yet, fabulous stories of placebo cures, both astounding and well-confirmed, produce the evidence but not yet a complete account linking belief to cure. By what mechanisms do our thoughts affect our health? Are placebos a special case of how ideas impact our physical selves; or rather, does this open a window into how all thinking works?

The inverse of the placebo, the nocebo effect, produces rather than mitigates symptoms. Here an inert substance believed to be a “poison” can essentially poison us. More commonly, physicians worry about “suggestibility,” when, for example, a patient insists “if anyone will get that side-effect, it’ll be me.” At the same time, many patients refuse to consider that their “psychology” has anything to do with the symptoms they experience. But if we wish to move away from the notion that the nocebo effect is “all in one’s head,” what then is suggestibility? What accounts for the range of responses in the population to the placebo and nocebo effects?
History chronicles the universal desire to stave off illness, to lesser or greater degrees a concern of all cultures. What we now refer to as the placebo effect evolved out of the mythical and magical practices of the shaman. But, with a modern belief system less conducive to shamanism, the “inert” placebo is often viewed as deceptive. Might we yet arrive at an ethical reliance on placebo treatment, both to determine and then harness their evident value in promoting emotional and physical health?