How the science of placebos and nocebos can revolutionise healthcare

In his latest book, the University of Leicester’s Professor Jeremy Howick brings together more than twenty years of research to explain how placebo science is now ready to transform healthcare and improve lives.

Just two decades ago, the idea that your brain can convince your body that a fake treatment is the real thing was confined to the realms of alternative medicine. 

Since then, clinical trials continue to demonstrate that placebos reduce pain and the symptoms of some diseases, like Parkinson’s, while also helping to reduce doctor burnout. Research now shows how they work – by inducing the body’s own powerful internal pharmacy to produce endorphins, dopamine, serotonin and endogenous cannabinoids. 

Placebos are more than just positive thinking.

Meanwhile, the nocebo effect is even more powerful, where negative expectations about treatment can lead to a nasty range of side effects. Working in the opposite direction to a placebo, the nocebo effect can increase pain, nausea and anxiety. In some cases it can lead to Voodoo death.

In The Power of Placebos, Professor Jeremy Howick tackles the crucial issue of using placebos and nocebos in healthcare. Based on rigorous analysis of new research evidence, presented with clear and accessible arguments, the book calls for a step-change in how healthcare systems and researchers use placebos and nocebos. 

The book also outlines how to overcome the barriers to adopting the science of placebos into conventional clinical practice.

“The time has come for the science of placebos and nocebos to be set free from within the walls of academia, so patients can benefit from their effects and avoid being harmed by poor communication,” explains Professor Jeremy Howick. 

“In clinical trials, it is just the opposite: placebo-controlled trials should be banned if we have an established treatment. Healthcare systems that leverage knowledge of placebos and nocebos are starting to emerge, and we need to encourage the movement.”

An essential read for doctors, healthcare policymakers, researchers and patients interested in how decisions about their healthcare are made, The Power of Placebos makes four central arguments: 

• It is an ethical requirement for doctors to induce placebo effects in their patients: 

The Hippocratic Oath requires that doctors help the sick, this now should include inducing placebo effects. Failure to do so foregoes an opportunity to benefit patients, which could be unethical.

• It is an ethical requirement for doctors to avoid nocebo effects: 

Informing patients about all the possible negative side effects of their treatment is necessary. However, focusing exclusively on side effects without communicating the potential benefits of a treatment can induce the nocebo effect and put patients off from treatments that might help them. Especially in clinical trials, patients are often provided with information about negative side effects and not told about the benefits their treatment might bring. This unbalanced communication can harm patients and needs to change.

• Placebo-controlled trials are not ethical: 

Whereas doctors must focus on placebo effects, in clinical trials it is just the opposite. Opposing recent guidance from the World Medical Association, the book argues that placebo-controlled trials are harmful (sometimes maybe fatal) if there is an established treatment that could be used instead.

• Creating healthcare systems that promote placebo effects (“Helping Dad”): Inducing placebo effects requires empathic, positive communication, the right atmosphere and environment, as well as the right incentives. The book provides a blueprint for a healthcare system that adopts the science of placebos.

Professor Jeremy Howick is Inaugural Director of the University of Leicester’s Stoneygate Centre for Empathic Healthcare, and the Founding Director of the University of Oxford’s Oxford Empathy Programme.

The Power of Placebos is published by John Hopkins University Press on 14 November, and is available to pre-order.