Why Placebos Work: Scientists Are on the Brink of Discovering How This Works

Earlier this year, a group called the Society for Interdisciplinary Placebo Studies held its annual meeting in the Netherlands. I am not making this up. There was a report about the meeting in The New York Times.

We all know what a placebo is. It is something prescribed by a respected caregiver knowing full well it contains no known medicine—often it’s a sugar pill—and yet it can work to make you better. Nobody has been able to find the scientific reason for this, which is why the Society for Interdisciplinary Placebo Studies holds its meetings. They are looking for answers.

In fact, they are looking for something that could refute a long-ago study that showed up placebos as quack medicine. This study was done in France in the 18th century. At the time, the Times writes, the healing powers of a man named Dr. Mesmer was all the rage in Paris. He claimed to be personally in touch with a force that no one else could perceive that gave him extraordinary powers. As a result, the sick and infirm would form lines to be personally seen by him. He would mumble something, play a glass harmonium and wave his hands and, presto, you were cured. It could be anything from a migraine headache to a gimpy leg to cancer. All you had to do was see him.

Modern medicine was in its infancy at the time—doctors often prescribed bloodletting and poison as cures for the common cold, for example. But scientists were sure that Mesmer was a fraud. As a result, the King of France, Louis XVI ordered a scientific test done to see if Mesmer had these extraordinary powers. The King created a committee that included a chemist, an astronomer and a physician, and he asked Benjamin Franklin, the Ambassador from the United States, to be the chair of it.

Someone sick was brought in. He was blindfolded. And then Dr. Mesmer was told to get in touch with his higher power and cure a particular part of the sick person’s body. Mesmer did his hocus pocus, and the subject, still blindfolded, declared a spot on his body they thought Mesmer had healed. But the doctor was working on another spot.

Thus Mesmer was exposed as a fraud. And that was that. Although later, the King lost his head, as did Marie Antoinette, but that’s another story.

In any case, supposedly fraudulent healing powers continue to exist, even in the face of the results given by Franklin’s report—and still nobody knows why. Paradoxically, when pharmaceutical companies go to test a new medicine with the FDA, their results must compare favorably with a placebo administered to others not taking the medicine. This is will o’ the wisp stuff.

Two people at this year’s meeting put forward new information that they believe pointed to a scientific basis for the placebo effect.

One of them was Ted Kaptchuk, who is a Harvard professor with expertise in Chinese medicine. (He gave the keynote address at the meeting.) The other was a molecular biologist named Kathryn Hall, who worked for a pharmaceutical company. They are now working together to find what they believe to be a particular chemical reaction in the brain that would explain how this works. And they think they have isolated its whereabouts.

When a placebo is working, a chemical in the brain called COMT is produced in greater or lesser amounts depending on a person’s genetic makeup. Using magnetic resonance and examining an rs4680 snippet from the COMPT, it was shown that when people are happy and think something they are given will make them well, the amount of COMT declines. They think what is causing this is the answer. But they haven’t quite grasped onto it yet. What they do know is that a placebo can be a trigger, especially when it is administered by someone the patient trusts. And they are looking at how COMT works.

I am writing about this because I think I am one of those who reacts to placebos. A classic example of this happened to me 20 years ago. It was springtime and it was the first year I was suffering with the effects of Rose Fever, which is similar to Hay Fever. Bring me near some roses in the springtime and my eyes itch and water and I begin sneezing. It has always been thus.

One day, however, I was at a wedding reception and there was no escaping the fact that the centerpiece on our dinner table was roses. My reaction was immediate and overwhelming. I had to leave the table and put drops into my eyes, and after that, avoid sitting there.

These roses were silk.

I had other sudden reactions. If I sat next to someone who had a cold, soon thereafter I would have similar symptoms. Sometimes they would go away when the encounter ended, sometimes not. Nobody could explain this phenomenon.

I considered myself, and still consider myself, sensitive in this regard. In college, I was diagnosed with Crohn’s Disease. This is a chronic condition that consists of your white cells, perceiving some kind of attack in your digestive tract, going on the attack and while trying to subdue whatever it is that might not even be there, causes inflammation of the intestines. If this happens often, scarring in the intestines can occur. There is no cure for this. I’ve been very fortunate to have a mild case of this over the years. An attack might come once a year. But three years ago, I had three attacks within three months, and my physician prescribed a new drug called Humira, which moderates the reaction of my white cells to perceived attacks. The Crohn’s has been completely quiet since. But my physician warned me to cease taking it temporarily if an attack elsewhere in my body fails to get a proper response.

According to the Times, Kathryn Hall and Ted Kaptchuk have studied various tests with people with I.B.S. (irritable bowel syndrome, which includes Crohn’s) and have documented the trend that a placebo that a patient trusts seems more effective in people and more likely to produce less COMT during the test.

Kathryn Hall in particular has had a remarkable journey herself with this. Working for a pharmaceutical firm, her job was to study new drugs being developed to determine their effectiveness. During her work, she developed painful Carpal Tunnel Syndrome. She was given codeine for her pain and told to wear wrist braces, the Times reports. But nothing helped. Finally, someone suggested she see an acupuncturist. She scoffed at the idea, but now facing surgery, decided to give it a try. In her very first session, a needle stuck in her forearm caused a sharp temporary pain in her arm. But it made the carpal tunnel pain go away.

“I couldn’t believe it,” she told the Times. “Two years of gross drugs, and then just one treatment…What was that? Rub the spot and the pain just goes away?”

It was, indeed, the end of her Carpal Tunnel. She soon left the pharmaceutical company and is now following her quest to understand more about that genome marker, and other biochemical influencers, in the brain.

Interestingly, as time goes by, especially in recent years, more and more medicines that go successfully through early tests in development come up short when paired with a placebo. The fail rate, according to the Times article, is now more than 90%.

This could mean that new medicines are not quite as advanced as earlier new medicines. Or it could mean that COMT is at fault. If that turns out to be true, then the trials might be changed to exclude those volunteers whose COMT is low.