The Placebo Effect: Where Psychology Meets Medicine Analysis

Written by Emir Taha Macit

The placebo effect is a phenomenon that occurs as a result of a patient’s belief in the effectiveness of the treatment they undergo, causing the patient’s health to improve even if the treatment is generally ineffective. It is a fascinating effect that has led to various new treatment plans, but also caused disastrous misconceptions throughout history. The placebo effect is a useful tool for medicine when utilized correctly, serving as a positive aspect of building trust with patients.

Since most mind-body interactions have historically been difficult to understand, the mechanisms of the placebo effect are still debated. It stems from the anticipation of an effective treatment, and helps alleviate the perception of symptoms and sometimes even assists in the recovery process. Some of this alleviation comes from chemicals such as endorphins being released by the brain, but the full extent of this is not yet known. Because it helps with the perception of symptoms, it is more effective in cases like depression and anxiety, where symptoms lean more to the side of being psychological or perceptual. As symptoms are mostly subjective and vary, the placebo effect is more noticeable in such cases.

While positive expectations can cause improved outcomes, negative expectations can cause worse ones. The negative counterpart of the placebo effect is the nocebo effect. It may occur when patients expect to endure the potential side effects of a treatment, potentially causing them to experience the effects even if they would not have had the side effects if they had not been disclosed. However, the nocebo effect is not the only thing that may cause harm as a result of expectations; the placebo effect can also be harmful.

Although the placebo effect seems to be beneficial in every way at first, when we think about the implications of a dangerous treatment causing a placebo effect in patients, we start to see where it can go wrong. Old treatments such as bloodletting, the act of withdrawing blood from a patient as a means of treating symptoms as simple as fevers, led to a placebo-induced improvement in many patients, causing the now-obviously-unsafe treatments to continue for a lot longer than they would have otherwise. In times when the placebo effect was not understood, the unsound treatments caused the loss of many lives, including figures such as George Washington, who died after having bloodletting performed on him several times due to a throat infection. These situations display the potential harm of the placebo effect when not supported by enough scientific research, which is why it needs to be utilized correctly to become a useful tool.

The modern and proper testing of treatments is highly controlled. When testing new drugs, various methods are utilized along with the patients’ consent to control the possible placebo effect. One of the main methods is randomized controlled trials, or RCTs. RCTs minimize bias by assigning participants to two different groups and randomly giving the groups a real pill or an inactive one. Neither the patients nor the doctors know which group has the real pill. This way, the placebo effect is accounted for, allowing researchers to truly determine the effectiveness of the drug.

Regarding the modern use of placebos in medicine, it is often used indirectly by doctors, but may also be used actively and ethically. The indirect part involves building trust and a bond with patients, leading their expectations of treatment effectiveness to be higher, but it does not involve any special treatment or drug. The active method is an interesting one and has highly varying results. It functions by providing patients with inactive placebo pills and telling them that they have shown to improve perception of symptoms, and if the patient starts to anticipate these results, the pills may help their situation by causing a placebo effect.

In conclusion, the placebo effect is a complex occurrence that has its benefits and harms depending on how it is used. It is an effect that needs scientific backing and ethical use to achieve its purpose without causing harm. As we have seen from old, dangerous treatments, it can also cause a chain effect of keeping a method in use, resulting in a great risk for patients. With its different uses and methods, along with reliable information, it has the potential to help patients tremendously.

References:

1. Munnangi S, Sundjaja JH, Singh K, et al. Placebo Effect. [Updated 2023 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513296/

2. Colloca L, Miller FG. The nocebo effect and its relevance for clinical practice. Psychosom Med. 2011;73(7):598-603. doi:10.1097/PSY.0b013e3182294a50, 

3. Margo CE. The placebo effect. Surv Ophthalmol. 1999;44(1):31-44. doi:10.1016/S0039-6257(99)00060-0