Episode Title: Is the Placebo Effect Real? The Science Explained by Dr. Burki

What is a placebo, and is the placebo effect real? 

In this episode of Gyno Info, I answer a listener’s question and explain what placebos actually are. The word “placebo” comes from Latin and means “I shall please.” Historically, it referred to a sugar pill or inactive treatment given when no real therapy was available. Today, giving a placebo without a patient’s knowledge is considered unethical because it involves deception — and trust is essential in medicine.

That said, the placebo effect itself is very real. When you believe a treatment will help, your brain can release endorphins, reduce stress, and even decrease pain processing on imaging studies. I discuss examples like fake aspirin relieving headaches and studies where patients couldn’t tell the difference between real numbing medication and salt water because they expected relief. 

The placebo effect can improve symptoms like pain, anxiety, depression, insomnia, nausea, and IBS — but it cannot treat serious conditions like cancer, infections, or medical emergencies. Belief is powerful, but it does not replace evidence‑based care.

I also explain the ethical uses of placebos today, including reminder pills in birth control packs and double‑blind, placebo‑controlled drug trials, which help us determine whether medications truly work. 

The takeaway is simple: belief and trust matter, but honesty and real medical treatment always come first.

You can write to us at Questions@GynoInfo.net

And follow us on Instagram @gynoinfo

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Burke, the podcast dedicated to teaching everyday women what they need to know about their body and how it works to successfully deal with the healthcare system and communicate with their doctors. Each week, I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. GynoInfo will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree, one episode at a time. So now let's begin. Hello. Welcome back to Gyno Info, the podcast about women's health in normal everyday language that normal, everyday people can understand. No special medical words and no doctors speak, just normal language. A special welcome to those of you who just discovered us and are listening for the first time. Please all take a moment now to subscribe to GynoInf. It makes it easier getting back to this episode in case you have to interrupt in the middle and would like to finish the podcast later on. The same episode might not show up in your feed anytime soon. Today I'm going to answer a question from one of our listeners. It will take me a whole podcast because it's such a fascinating topic. The person asks, What is a placebo? The word placebo comes from the Latin word placere, to please. The expression to placate someone has the same word root. And of course, the Spanish word placer. And that is exactly what a placebo was used for in the past. A dummy pill, a fake sugar pill that doctors prescribed to please or placate the patient without letting them know that they were not getting a real medication. Doctors used to do that when they thought that the patient was imagining their symptoms. Presumably much more often on women than on men. If we go by all the modern studies that show how women's symptoms are still not taken as seriously as when men complain about the same thing. This was an honest effort to make the patient feel better. Because when someone believes that they're getting a real treatment from a doctor, they will feel better, at least for a while. Even if the treatment given is just a placebo, a sugar pill. This is what we call the placebo effect. Giving placebos sugar pills without the knowledge of the patient is no longer considered ethical to do. Because it's really just lying to the patient. It is now illegal against the law in most countries, especially if a doctor or a pharmacist then also charges for it like it were a real medication. So doctors are no longer allowed to prescribe placebos, except in some special circumstances that I will go into later in this podcast. But the placebo effect is the main tool of most quacks and fake and faith healers. They'll sell products often for quite hefty price that have never been shown in any serious study to be effective. I will explain later in this podcast what I mean by serious study. The people prescribing these fake products, they even believe themselves that their potions work. And that is the very key ingredient for the placebo effect. Belief. Though I doubt that most of the internet influencers who push often ineffective and useless products on their innocent victims truly believe that what they are pushing is effective. All they really are interested in are clicks and money coming in. So they keep pretending. And they don't have a bad conscience, even, which is beyond me, but it is the case, I guess. But back to the placebo effect. It is a real and powerful effect, and something that has always fascinated me a lot ever since I was a medical student. If I, as a doctor, give you a pill that looks like an aspirin and tell you that I'm giving you this really effective new type of aspirin for your headache, it is very likely that your headache will really get better, even if it was just a fake aspirin. This placebo effect works in about half of people or more, and it works quite well, depending on the symptoms one is treating. And if a medical professional is giving out the medication, it will work for more people than if one just replaced the real aspirins in the medicine cabinet at home with fake aspirants. I always love this example of the placebo effect that I learned about when I was a medical student myself. A bunch of medical students got either real lidocaine, a local anesthetic injection in their mouth, or just salt water by their dentists before their teeth were being drilled. Most of the medical students did not notice the difference. The pain of the shot alone made the young doctors all believe they were getting the real thing. The fact that a doctor or a trusted person gives a treatment is really important, even if that trusted person is a quack. Or a mom saying to a young child that she will kiss the ooi better. The placebo effect is very real and powerful, and I'm still fascinated by it as another interesting way the human body and especially the human brain works. Not that I have been prescribing placebo and sugar pills to my patients myself. I would never do that, of course. It's also not legal. But even real medications work better if both the person being treated and also the doctor prescribing them believes that they will work. And just like I would never prescribe a placebo to a patient, I would also never prescribe something I do not believe in, and that I would not be willing to take myself if I had the same problem as my patient. I really believe in what I'm prescribing and do expect it to work, which is really important, as we just heard. The placebo effect works through the part of the brain that manages expectation. The brain expects that the treatment will work because of the trust in the doctor or because of prior experience, because aspirin or the shot at the dentist worked last time. This expectation makes the brain send out its own pain relievers, natural opium-like substances called endorphins. Believing that you're getting better will also change how the brain processes pain. Special brain imaging like functional MRIs or PET scans can show that the areas of the brain that handle pain signals are suppressed when the brain expects a treatment will work. Then the whole ritual of being taken care of, of being listened to and carefully examined also lowers the stress level. And with a lower stress level, less stress hormones like cortisol are being put out by the brain. And less stress also helps you relax, which also helps with pain. With this ritual of being taken care of, is where non-traditional healers and moms for that matter also do much better than overly busy doctors, because caring takes time. As I have already hinted at, not all symptoms and diseases respond to the placebo effect equally well. It works best for symptoms and conditions where the brain is a major player for pain, anxiety, depression, stress, sleeping problems, and chronic bowel diseases like irritable bowel syndrome, IBS, and feeling nauseous, those respond especially well to the added placebo effect promoted by caring medical providers. That makes the regular treatment even more effective. But the placebo effect will do nothing for you when you have a ruptured appendix or bleeding to death from an injury or have a major infection or in a diabetic coma because you have sugar diabetes and really need insulin. I knew one of my sons was growing up when he said, Mom, you can kiss it, but I do not think it will work. And he was right. He had a bad ear infection and needed antibiotics, needed much more than the placebo of mom's healing kiss. This misunderstanding of the power of belief, the power of faith, in other words, of the placebo effect, can lead to terrible tragedies in some religious communities who believe in the power of faith to heal everything. Praying can of course make the belief in a given treatment stronger and make that treatment all the more effective for that and lower stress levels and help relieve certain pains. But prayer will not save a child with a cancer or a twisted bowel or someone who needs a cesarean section or any other operation and who needs insulin or thyroid hormones or antibiotics. Keeping these necessary life-saving treatments from people who really need them in the name of faith leads to terrible disasters and unspeakable and avoidable suffering and tragedies. The thing that I find most upsetting about all this is when people who are undergoing all that terrible suffering are being told that their faith just isn't strong enough. This is not only physical, but it's also spiritual torture in the name of religion and is just plain wrong. That is terribly mean to do that to anybody. Placebos are still being used legally and responsibly in two other settings. The first is, of course, familiar to most women. The sugar pills and some of the birth control pill packages that are either four or sometimes seven fake pills used after the active real birth control pills as a reminder. So one does not fall out of the habit of taking a pill every day. They're usually clearly marked with a different color. And the second place where placebos are being used is in drug trials, when new medications are tested against the fake, against the placebo, to see if the new medication is better than not taking anything. If the same number of people get better, let's say lower their blood pressure or can move their joints better with a tested medication than with the placebo, then you know that the medication being tested didn't work at all. To be a real effect of the new medication, they would have to do significantly clearly better than with a fake pill, than with the placebo. Interestingly, the placebo effect also works for certain side effects, bad effects that are managed by the brain's expectation centers. Sometimes in drug trials, in medication effectiveness studies, more people taking the placebo will have headaches or nauseousness or stomach or bowel symptoms than those taking the real medication. Then you have clear proof that the tested medication certainly does not cause those symptoms. If, on the other hand, nobody gets a rash on the placebo, but a lot of people on the tested medication get a rash, then this is a real side effect of the tested Drux. The absolute gold standard nowadays, the kind of tests that have to be run, usually several of them with large numbers of people, before any new medication will be approved by the government agencies and can be used on people, is called a double-blind placebo-controlled study. A study where half the people receive the real drug and half of them are placebo. That is the placebo-controlled part. And then neither the doctor giving the medication nor the person taking the medication knows who is getting what. That's the double blind part. This is because doctors' brains also respond to expectation. If they know a person is taking the real medication, the doctor's brain will make their eyes see better joint movement, perceive better results than when they think the patient only got a sugar pill. Of course, people taking part in such a study have to be told that they might get the real thing or the placebo in advance and sign a contract saying that they understand this and what it needs. Now, this brings us to the end of this episode on the placebo effect. I hope you found it interesting to learn about how the brain works and how what we expect to happen will profoundly influence what will actually happen or what we see that is happening. I certainly find the working of the human brain a never-ending wonder. How all this ends up interacting with artificial intelligence, with AI, remains to be seen. And I also hope that you found the podcast thought-provoking, that it makes you think with your fascinating brain, and that you will share it with as many other women and men as you can. Men do have brains too, you know. They just work differently than those of women, which will have to be the topic of another podcast. And remember that if you have any further questions about this or any other topic having to do with women's health or health or the human body in general, please don't hesitate to send them to me at questions at gynoinfo.net. Again, that's questions at gynoinfo.net. And please also make sure that you click the subscribe button wherever you listen to or watch gyneoinfo. So you can get back to it easily, whenever and wherever you want. And because the more people subscribe, the easier it will be for others to find us. Thank you. Until next time. Until next time. Thank you for listening. And remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you, not to judge you. And also, regular well-woman visits are always a good idea that you should make time for. You deserve it and you owe it to yourself, and you owe it to your body and your health. This podcast is part of Pridehouse Media, hosted by me, Dr. Burke, produced and edited by Josh Rosenzweig. Original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at GyNoInfo and on LinkedIn at GynoInfoPodcast.