One of the world’s leading researchers in the neurobiology of placebos, Fabrizio Benedetti , M.D. of the University of Turin Medical School, Italy, delivered the final lecture of a three day conference on placebo’s Friday night at the Italian Embassy in Washington, D.C. This conference was sponsored by the National Institute of Health and the Samueli Institute.
Although the first two days of the conference were invitation only, this final lecture was open to the public. In addition to Dr. Benedetti, Luana Collca, M.D. (educated in Italy but now working at the Complementary and Alternative Medicine at NIH). Also presenting was Franklin Miller, Ph.D. ( medical ethics ) from NIH.
I was in the audience of about eighty people in the beautiful new embassy building Friday night. Most of Dr. Benedetti’s research is in the area of pain management. As a neurobiologist he studies how the body responds physiologically to a placebo or nocebo.
Here are a few of the high points from Dr. Benedetti’s lecture
“Placebo Effect = Context Effect” I always thought about a sugar pill as a placebo, and that a patient’s faith in the pill (thinking that it has a beneficial drug) is what triggers the placebo effect.
Dr. Benedetti’s research indicates that is it the ritual surrounding receiving a pill that triggers a physiological response that lessons pain. This ritual includes the surroundings of the doctor’s office, the doctor, what the doctor says, etc.
Benedetti showed photos of a woman who had undergone surgery on her back that limited the range of motion of her left arm – how high she could lift it.
- With no drug about 90 degrees
- After receiving a placebo – she could raise her arm about 140 degrees (180 would be straight up)
- After receiving a nocebo (a sugar pill with guidance from the doctor that it would limit her motion) she only raised her arm about 45 degrees
He had numerous examples of similar results from other studies. How and when physicians should use a placebo in practice was covered in remarks by Frank Miller. I came away from the evening with sense that research is now documenting this phenomenon, but the medical community is still wrestling with how to incorporate it into practice.
To end his lecture Dr. Benedetti put up a slide with the following quote:
“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”