Can Evolution Explain the Placebo Effect?
By Colin Barras / Source: New Scientist
On the face of it, the placebo effect makes no sense. Someone suffering from a low-level infection will recover just as nicely whether they take an active drug or a simple sugar pill. This suggests people are able to heal themselves unaided - so why wait for a sugar pill to prompt recovery?
New evidence from a computer model offers a possible evolutionary explanation, and suggests that the immune system has an on-off switch controlled by the mind.
It all starts with the observation that something similar to the placebo effect occurs in many animals, says Peter Trimmer, a biologist at the University of Bristol, UK.
For instance, Siberian hamsters do little to fight an infection if the lights above their lab cage mimic the short days and long nights of winter. But changing the lighting pattern to give the impression of summer causes them to mount a full immune response.
Likewise, those people who think they are taking a drug but are really receiving a placebo can have a response which is twice that of those who receive no pills. In Siberian hamsters and people, intervention creates a mental cue that kick-starts the immune response.
There is a simple explanation, says Trimmer: the immune system is costly to run - so costly that a strong and sustained response could dangerously drain an animal's energy reserves. In other words, as long as the infection is not lethal, it pays to wait for a sign that fighting it will not endanger the animal in other ways.
Nicholas Humphrey, a retired psychologist formerly at the London School of Economics, first proposed this idea a decade ago, but only now has evidence to support it emerged from a computer model designed by Trimmer and his colleagues.
According to Humphrey's picture, the Siberian hamster subconsciously acts on a cue that it is summer because food supplies to sustain an immune response are plentiful at that time of year. We subconsciously respond to treatment - even a sham one - because it comes with assurances that it will weaken the infection, allowing our immune response to succeed rapidly without straining the body's resources.
Trimmer's simulation is built on this assumption - that animals need to spend vital resources on fighting low-level infections. The model revealed that, in challenging environments, animals lived longer and sired more offspring if they endured infections without mounting an immune response. In more favourable environments, it was best for animals to mount an immune response and return to health as quickly as possible. The results show a clear evolutionary benefit to switching the immune system on and off depending on environmental conditions.
"I'm pleased to see that my theory stands up to computational modelling," says Humphrey. If the idea is right, he adds, it means we have misunderstood the nature of placebos. Farming and other innovations in the past 10,000 years mean that many people have a stable food supply and can safely mount a full immune response at any time - but our subconscious switch has not yet adapted to this. A placebo tricks the mind into thinking it is an ideal time to switch on an immune response, says Humphrey.
Paul Enck at the University of Tübingen in Germany says it is an intriguing idea, but points out that there are many different placebo responses, depending on the disease. It is unlikely that a single mechanism explains them all, he says.
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