Placebo, Nocebo, and the Evolutionary Design of Healing

Majid Ali, M.D.

The words placebo from the Latin “I shall please” and nocebo from the Latin (I shall not please) once were of great significance in all healing traditions. Then something strange happened. Placebo became a curse word in one healing tradition and a darling for the other (who used it to taunt the other).

Many patients tell me that their blood pressures values, especially the higher systolic numbers, are usually higher when they see their other doctors and lower at our clinic. I am surprised at this. People expect more of natural remedies from holistic physicians and more drugs from their doctors who limit their work to prescription drugs.

Why Did Evolution Design Placebo Biochemistry?

To make hope an agent of healing, why else? It had to be this way. Thoughtful physcians throughout history recognized that. In the placebo-busting tradition, a notable entry is of the 1811 Hooper’s Quincy’s Lexicon-Medicum which defined placebo as any treatment that was adapted to please a patient than to benefit that individual.

What Do Brain Scans Say About Placebo?

My sense of evolutionary design is that it would have created paths that link anticipation of pain with pain-causing centers and relief expectation with the regions of brain which provide relief molecules. My “evolutionary sense” has not yet let me down. This is exactly what has been observed with functional MRI scans.

With functional brain MRI scans, one would expect to find that prefrontal cortex, an evolutionarily more advanced region of the frontal brain involved with caution and anticipating pain would communicate directly with the part of the brain evolved to respond to pain. That, indeed, is the case. The more an experimental subject prefrontal cortex is revved up with anticipation of pain, the greater the activity observed in the midbrain which releases opioids for pain control.

My sense of evolutionary design also tells me to expect pathways of cellular cross-talk between tissues that experience healing responses and the brain centers that respond to them. In the mid-1980s, I recognized such pathways as the scientific basis of auto-regulation (described at length in my book “The Cortical Monkey and Healing.”

Functional brain MRI scans have documented the existence of  such brain communication. Specifically, expectations of relief and healing with a placebo that generates hope of pain control (and healing).

The Core Issue

So, now we come to the real issue of whether a placebo is given with honesty and authenticity of natural remedies that prevent bio-energetic insults to cells and tissues or with the deception of sugar pills. Who does what in clinical medicine? I leave that question to readers’ imagination.

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