During World War II, Henry Beecher, an American anaesthetist, made an extraordinary discovery.
Many of the soldiers he treated had suffered horrific injuries. He knew these injuries would be agonising, and quickly arranged for the soldiers to be triaged on the severity of their wounds so that those with the worst injuries could be given analgesia first.
But he began to notice something very strange. Over half the soldiers reported little or no pain, despite severe wounds, and didn’t request any pain relief. Pain management simply wasn’t the priority, and Beecher couldn’t understand why it wasn’t.
The men were not in shock and were still able to feel pain. In fact, Beecher noted that they complained about the intravenous lines in their arms just as much as other patients.
The placebo is a well-known psychological phenomenon whereby a person improves after taking a treatment simply because they have the expectation that it will actually make them better
What puzzled Beecher was that in peacetime, almost all his patients requested painkillers for injuries of similar severity. In fact, most would have wanted analgesia for far less severe injuries — and would complain bitterly if they hadn’t received it.
This puzzled Beecher: surely the same injury would cause the same amount of pain? It was then that he realised he hadn’t accounted for one thing: the power of the mind.
He saw that for the soldiers, a severe injury was actually a good thing, as it meant they would be discharged from the army and could return home. For civilians, however, it was a bad thing: a disruption to their life and routine, and it could mean financial hardship, too.
He understood that it’s not necessarily the magnitude of the injury that’s important for how a person experiences pain, but the circumstance in which it occurs. He wrote up his findings in a research paper, just a few pages long, and published it in a journal shortly after he returned home.
It caused quite a stir, and led other medics to come forward with similar stories. This all helped spark entire theories about how the mind could control symptoms such as pain.
The only reason I know this story is because a wily anaesthetist told me it at medical school, as he was lamenting how, because of advances in pharmaceuticals, this aspect of pain management had been largely forgotten.
It’s precisely this power of the mind that’s harnessed in the placebo response — a well-known psychological phenomenon whereby a person improves after taking a treatment simply because they have the expectation that it will actually make them better.
This week, a fascinating study revealed that even if someone knows they’re receiving a placebo, it still reduces their pain.
This can be explained by several factors.
First, it’s an example of the suspension of disbelief, similar to when we watch a scary film. We know it’s not real, we know they are only actors, but our mind allows us temporarily to suspend this and experience the fear.
It’s the same with a placebo. Despite our mind knowing it’s not an active drug, we can ignore this fact and our symptoms improve.
The placebo effect is also down to another trick of the mind: while people know that a placebo doesn’t have any pharmacological effect, they also now know that placebos work — and so it becomes a self-fulfilling prophecy.
There is another, incredibly important element to placebo power. Sadly, it’s far easier to prescribe painkillers than to explore what might be happening in a patient’s life socially and emotionally that will be impacting on their experience of pain.
I often think this is why alternative medicine such as homeopathy is so popular with patients who have chronic pain or other complex medical problems, especially when conventional medicine doesn’t help their symptoms. It’s not just the fact that people believe homeopathy is going to work and therefore it does, but that the practitioner will talk to the patient for a considerable time. It’s this interaction that helps as much as anything else.
So while I know there’s absolutely no scientific basis for homeopathy, I support its use and think it should be available on the NHS.
Scientists often dismiss the placebo effect, but I’m in awe of it and use it a lot in clinical practice. For example, when I prescribe a drug that’s expensive, I will tell the patient how much it costs because studies show we assume more expensive drugs are more effective.
The fact that we can get better simply because we believe we will is, to me, testament to the incredible power of the mind.
While those who use homeopathy might believe it’s working in a different way, does that really matter? It seems a shame to discount the benefit they get from this unscientific ‘treatment’ when the fact is there is genuine science in its placebo effect.