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#020: Fabrizio Benedetti and the Placebo Effect

September 22, 2013
MP3

After a (far too long) sabbatical from the show, Smart Drug Smarts is back with a vengeance. This episode features Italian physician and researcher Fabrizio Benedetti. For almost two decades, Dr. Benedetti has been devoting the majority of his studies to the famous “Placebo Effect.” On Episode 20, he discusses both the causes and the effects of placebo on nootropics users, professional athletes, and the average person.

Three Mechanisms Of The Placebo Effect

Where most people are asking “What is the neural mechanism of the Placebo Effect?” Dr. Benedetti suggests that the better question is “What are the primary mechanisms of the Placebo Effect?”  There’s a lot going on here…

  1. The first primary mechanism is: When a patient is given a drug (or, in this case, a placebo), and they expect a positive outcome, their anxiety also decreases.   Anxiety-reduction itself has cascading, real effects throughout the body.
  2. Secondly, the body has natural reward systems (many based around that ever-popular neurotransmitter dopamine), and positive associations that invoke the placebo response — a professional hospital environment, positive contact with a trusted doctor, or the anticipation of reduced pain, etc. can trigger the body’s “reward” system even in the absence of any outside physiologically active compounds.
  3. Finally, remember Pavlov’s dog and the power of conditioning?  Associations like this can make us “feel better,” based on remembered (even unconsciously-remembered) past experience. As an example, consider aspirin. Aspirin is a round, white pill whose active ingredient assists with pain.  For many people, this association is so strong that a round white pill can trigger the experience of pain relief, even with wholly inert ingredients.

Where Placebo “Works” and Where It Doesn’t

The Placebo Effect rears it’s head in various frequencies and at widely-varying strengths depending on the context in which it is applied.  In general the rule could be summarized like this: The more a medical effect is something a subject can be consciously aware of, the more susceptible it is to placebo.

As an example, there have been high numbers of positive results using a placebo for anxiety and depression.  Both these are states that are very front-and-center in the consciousness of the person experiencing them.  On the other hand, there are almost zero placebo-derived results for oncological (cancer-related) drugs.  In other words, placebo effects, won’t kill cancer cells, or keep them from spreading.  But the patient might feel reduced pain after taking such a placebo.  The discomfort is placebo-susceptible; the underlying physiological problem isn’t.

The Placebo Effect For Smart Drugs

As the Placebo Effect relates to nootropics, it’s important to recognize that the brain learns the resulting “feel” of nootropics, just like any other drug.  And with that learning comes conditioned responses, (presumably positive) anticipation, and all the rest.  In other words — you are almost certainly experiencing placebo effects bolstering even your most effective nootropics.

And if you’re unfortunate enough to have any “snake oil” drugs or supplements in your brain stack or medicine cabinet, then —  unbeknownst to you — 100% of the “effects” you’re feeling from them may be courtesy of the Placebo Effect.

This Week In Neuroscience: The Mental Cost Of Cognitive Enhancement

The Journal Of Neuroscience presented a study suggesting that Transcranial Electrical Stimulation (TES) could be used to enhance cognitive performance.  This involves running small currents to certain parts of the patient’s brain.

The study involved around 20 people between the ages of 20-30. These participants were given various tests as TES was applied to different areas of their brain — along with (you guessed it, one group getting a placebo) — to compare and contrast their learning speed with the automaticity of the learned knowledge.

The interesting results were that improvement of different individual aspects of learning was a distinct success.  However, improving one facet with TES hindered the other.   (This held true in both directions.)  Kind of makes one wonder if the brain’s default settings is already the optimal balance between these two maybe-conflicting aspects of learning?

Either way, the success of TES in non-invasively improving brain function, even in isolated behaviors, and with trade-offs, means it will definitely be something we revisit on Smart Drug Smarts.

Read the original article here.

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6 comments

  1. Danny says:

    Welcome back to your podcast!

    1. Jesse Lawler says:

      Thanks, excellent to be back! Was getting tired of the “are you alive?” emails. 🙂

  2. Danny says:

    Welcome back to your podcast!

    1. Jesse Lawler says:

      Thanks, excellent to be back! Was getting tired of the “are you alive?” emails. 🙂

  3. Derek says:

    I think the Placebo Effect is a great teacher about who we are and how belief and expectation shape our lives and outcomes. 🙂

  4. Derek says:

    I think the Placebo Effect is a great teacher about who we are and how belief and expectation shape our lives and outcomes. 🙂

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