Modern medicine doesn’t have all the answers. There are treatments that don’t work at all, others that work for reasons that nobody understands, and all sorts of others again that are still to be discovered. When a person undergoes a fraud treatment for a sickness or injury – such as taking a sugar pill – but still experiences a measurable improvement in their condition, this is known as the placebo effect. “Placebo” comes from the Latin word, meaning “I shall please”.  The Placebo effect was first noted in the late 1700s, but not until the early 19th century did placebo acquire its modern medical meaning, according to the Shorter Oxford Dictionary the word placebo has been used since 1811 to mean a medicine given more to please than to benefit the patient.  These placebo effects are often considered “unworthy and illegitimate”. For centuries, placebos have been regarded as deceptive therapies (Papakostas & Daras, 2001), but western medicine itself has firmly established that the sugar pill can sometimes be a wonder drug. The amazing aspect of the placebo effect is it can cause actual physiological responses from the body – as if the patient had been taking a real drug all along. And some recent studies are revealing something extremely unexpected about the placebo effect: our response appears to be getting stronger!

placeboPlacebos are widely used in research trials as a way to control for the influence of the placebo effect. In the case of drug trials, one study group may be given an active drug while another group gets identical treatment with only the active ingredient missing. In theory this lets researchers study only the active ingredient while cancelling out the placebo effect. It has traditionally been assumed that deception is an indispensible component of successful placebo use. However, a proper understanding of the placebo effect shows that deception need play no role in obtaining this potent healing effect, because the administration of anything in the form of a treatment can do real good, and remarkably this applies even when people are aware that the “treatment” is nothing more than a placebo (Schafer et al., 2015). But yet the inconvenient evidence keeps trickling in that if placebos are lies, they can also be “lies that heal.” In an influential article first published in 1955,  the Harvard researcher Henry Beecher concluded that between 30 and 40 percent of any treated group would respond to a placebo (Beecher, 1955). But studies since have shown that placebos work for certain conditions – pain, depression, heart ailments, gastric ulcers and other stomach complaints – in up to 50 or 60 percent of people, sometimes more. Indeed, it’s not unheard of for placebo effects to exceed those attributed to the active treatment.

The world of running and sport is not nearly as profitable as the business of pharmaceuticals and medicine, so the benefits of the placebo effect on athletic performance has not been studied as thoroughly. But the placebo effect does work in running, as it does in all sports, and it works pretty well. Knee socks, nose strips, special necklaces or whatever the placebo of choice,  there is a definitive favourable outcome from the  belief that one has  benefitted from an advantage gained from its use (Clark et al., 2000). Imagine a placebo “steroid pill” that could make powerlifters believe they have greater strength. Competitive powerlifters took a sugar pill believing the pill was a steroid a few hours before lifting. These powerlifters lifted about 4% heavier weights(Maganaris et al., 2000). The even more interesting aspect of this research is that a second group was told they were receiving a placebo – a sugar pill. Even knowing the substance was a fake, they still lifted heavier weights than they did without taking it (Maganaris et al., 2000). The benefit of the placebo is not limited to strength athletes, runners were given a placebo injection of (“OxyRBX”) purporting to have effects similar to those of the infamous erythropoietin (EPO) on endurance running performance. The runners self-administered subcutaneous saline injections daily, believing it to be OxyRBX. The injected placebo improved 3-km race time by 1.2% (Ross et al., 2015).

So the evidence suggests that placebo effects do in fact have a beneficial influence on athletic performance in competition. It is claimed that the French cyclist Richard Virenque was tricked into believing that he had taken a stimulant before a time trial in the 1997 Tour de France, he rode the time trial of his life, finishing second on the stage to the German cyclist Ullrich. After the race Virenque claimed “I felt good! That stuff’s just amazing” but in fact rather than relying on any illegal stimulant”His result did have something to do with the magic capsule – but there is one thing he doesn’t know……. I had got rid of the fabulous potion and swapped it for one which contained a small amount of glucose. There is no substitute for self belief… ” (Vogt W. 1999 p. 104). Placebos are a reminder of how little is known and understood about the mind-body relationship. So, the placebo effect may not only be one of the most versatile and disregarded therapeutic interventions, but also one of the most underutilised athletic performance enhancers.  Maybe placebos are a dose of self belief and reassurance wrapped and packaged in palatable parcels.

 

References

Beecher HK. (1955). The powerful placebo. J Am Med Assoc 159, 1602-1606.

 

Clark VR, Hopkins WG, Hawley JA & Burke LM. (2000). Placebo effect of carbohydrate feedings during a 40-km cycling time trial. Med Sci Sports Exerc 32, 1642-1647.

 

Maganaris CN, Collins D & Sharp M. (2000). Expectancy Effects and Strength Training: Do Steroids Make a Difference? The Sport Psychologist 14, 272-278.

 

Papakostas YG & Daras MD. (2001). Placebos, placebo effect, and the response to the healing situation: the evolution of a concept. Epilepsia 42, 1614-1625.

 

Ross R, Gray CM & Gill JM. (2015). Effects of an Injected Placebo on Endurance Running Performance. Med Sci Sports Exerc 47, 1672-1681.

 

Schafer SM, Colloca L & Wager TD. (2015). Conditioned placebo analgesia persists when subjects know they are receiving a placebo. J Pain 16, 412-420.

 

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