“The placebo effect is simply too good to be left to the realms of alternative medicine” – Shapiro
We are committed to raising awareness about the placebo effect and how it can be used to improve global health outcomes. As part of this we have to do three things:
- Tell people what the placebo effect is
- Tell people what the placebo effect is not
- Tell people about the potential of the placebo effect – now and in the future.
We have found that almost everyone thinks that they know what the placebo effect is, but there’s actually a lot of misconceptions. Part of our mission is to fight these misconceptions and to give people the truth, based on research. Research on the placebo effect is valuable because:
- The placebo effect can be a strong measurable effect
- The placebo effect involves much more than saline injections and sugar pills
- The placebo effect does not have to involve a patient being deceived
But we can’t stop there. We also want to encourage people to consider the potential of the placebo effect. How can it be put to use now and in the future?
At the moment, there’s still not quite enough research for placebos to make it into clinical practice, but research groups around the world are looking to change this. However, at Yekize, we take a holistic approach to the placebo effect, believing that it encompasses more than just placebos themselves, but “the whole ritual of the therapeutic act” i.e. the doctor-patient relationship, marketing/branding and hospital design. We’re not saying that any of these aspects alone can cure, but that they can make improvements to patient outcomes. For example, did you know that patients heal faster and require less pain medication if they have a natural view from their hospital bed, or that the colour of a pill can increase its effect? – This is all based in scientific research, but unfortunately, a lot of people have never heard of these findings. We want to change that.
All this is great, but how much will this really change things? At the moment, research into the placebo effect is incredibly limited, but there are some big questions that still need answering:
- Some people do respond to the placebo effect, much more strongly than others. How can we encourage everyone to respond to the placebo effect as much as possible, so they can maximise the effects of their treatment?
- How can open-label placebos be put to use ethically in healthcare?
- Can the conditioned placebo effect* be used cyclically and for a wide range of different drugs?
- Is the conditioned placebo effect effective if used open-label**?
*The conditioned placebo effect is a concept whereby a drug is given repeatedly, then replaced with a placebo. The patients continue to respond to the placebo as if it were the active drug for a limited time period. This has been shown to work in both humans and animals.
** Open-label placebos are placebos without deceit. The patients know that they are taking a placebo. This is usually combined with some educational materials about how and why the placebos might work for them.
“Health with Heart”
One rainy November afternoon, the idea that would later become Yekize, was born. Our founder, Tamsin Nicholson, recounts her experience:
I was reading a paper on the conditioned placebo effect and suddenly everything clicked into place. The paper, by renowned neuroscientist, Fabrizio Benedetti, described how people with Parkinson’s Disease had been given an active treatment (apomorphine) for 4 days, then this was surreptitiously replaced by a placebo for the next two days. During these two days, the patients continued to respond to the treatment as if it was the active drug. This is in itself a remarkable finding, but I came to understand that Benedetti had shown that in his test period, you could reduce the amount of active medication by one third to have equal effects. With an interest in global medicine, this clicked into place and I realised that there was huge potential to help people who lacked access to essential medications. If this worked for other drugs and diseases and if this system could be repeated, this had potential to help millions of people all over the world. Not only would it make medicines 1/3 cheaper, it could also mean that 1/3 more people could be treated with the same existing supply. This idea was great, but I had nothing to do with it at that moment, so I wrote it down in a little black notebook and forgot about it.
A few months later, I spotted an advert for an essay competition run by the St Gallen Symposium. The theme was ‘The Dilemma of Disruption’ and they were asking for innovative ideas that would challenge the status quo and create real change. I picked up my notebook and looked through and found my note and therefore the topic of my essay: Incorporating conditioned placebo response into treatment plans to improve access to medicine in least developed countries.
A few months later, I learned that my essay was in the top 20 and semi-finals. I’d have the opportunity to present my idea and I’d be given two teams of people to develop that idea with me. This was an amazing experience. It was the first time, I’d ever got the chance to share this idea with anybody and I got the perspective from people all over the world, from a wide range of different backgrounds. We decided that the best place to start was a pilot study into the conditioned placebo effect in the Bihar region of India. Admittedly, this idea was flawed from the outset – anaemia was not a good illness to pick, but we didn’t have the resources to check when we selected the target disease. Nevertheless, this concept got me voted into the final where I got to present and defend my idea in St Gallen City Hall. Having been surrounded by so many amazing and talented people at the symposium, I felt inspired to take my idea further. I felt that when you have opportunity, you have a duty to try and make the most of it. So, upon my return, I started working on Yekize.
After a few false starts, Yekize exists in its current form today: an organisation committed to raising awareness of the placebo effect, and its potential to improve global health outcomes.
Currently, we’re still getting set-up and we have a lot of work to do. But, we hope that soon, we’ll have others on board and we can start to really make a difference.