This is just a question that bothers me from time to time.

For those who might not know, a placebo is a "sugar pill", or in a larger sense, it is any treatment that is harmless but has no known medical value. The "placebo effect" has been known for centuries. If you give a patient a sugar pill and tell them it is powerful medicine that will cure them, the patient is more likely to be cured than if you told them there wasn't any effective treatment you can give them and they must simply heal on their own.

Every well-designed medical study goes to some lengths to eliminate the placebo effect from compromising its data, by creating a control group that receives nothing more than a placebo treatment. If the treatment gets better results than the placebo, then it has some medicinal value. Some medicines actually do worse than placebos in these studies.

So, if the placebo effect can promote healing, and is powerful enough that it must be eliminated from medical studies, why don't medical practitioners study the most effective ways to enhance the placebo effect, and use it more widely in their medical practise?

I mean, it's free. It cannot possibly do harm in those cases where no better treatment exists. It is proven effective. It used to be a common, even daily part of medical practise in all centuries before the middle of the 20th century.

What happened? Why aren't modern physicians learning the best way to use the placebo effect in med school? Why isn't this effect being leveraged to the max? It just bothers me.

-- Brian McLaughlin (brianm@ims.com), July 10, 2000

Answers

Actually, the placebo effect is being "leveraged" to the max, and always has been. Ask any doctor that you know well enough to get an honest answer from. Placebo effect is, and probably always has been, the most commonly prescribed remedy in this country.

And, it's causing problems -- a lot of antibiotics are prescribed for things like colds and the like. The doctor knows that the cause of the illness is most likely a virus (which will not be affected by antibiotics), but gives out an order of antibiotics because the patient wants them and the placebo effect is, indeed, of some significance.

As to whether doctors could (or should) hand out sugar pills and tell the patient they are medicine -- give me a break. In the US, at least, doctors can't do that -- you can't delude your patients intentionally to that extent, no matter how good you think it would be for them. You can "sugar coat" things (or hand out antibiotics that probably will do no good), but you can't lie.

We in the legal industry call that concept "informed consent."

And, would you really want to recieve medical care in a world where you had to worry that your doctor was lying to you, and not telling you what was wrong with you or what the chances of a cure were, in the hope that the placebo effect might help you?

-- E.H. Porter (Just Wondering@About.it), July 10, 2000.

What happened? Why aren't modern physicians learning the best way to use the placebo effect in med school? Why isn't this effect being leveraged to the max? It just bothers me.

I mean, it's free.

-- MadWhoMe (iknowiexistbut@msoasleepidontrealize.it), July 11, 2000.

Even in cases where there is no medicine specific to the germ, there are still things that could be prescribed for enhancing the immune system (with the placebo effect tagging along). But few physicians subscribe to that.

-- David L (bumpkin@dnet.net), July 11, 2000.

>> ... you can't delude your patients intentionally to that extent, no matter how good you think it would be for them. <<

Point taken.

But it needn't be that blatant. A doctor could easily approach it somewhat like this:

Untreated, your condition has prognosis X. The standard treatment is treatment Y. With this treatment, your prognosis is X++. We could go with that alone, if you like. It has these possible side effects and looks like this.

However, I'm thinking I'd like to combine treatment Y with another proven treatment, P. P is simple, you just have to [...] once a day. While I can't guarantee P will improve your prognosis beyong X++, P is guaranteed not to produce any side effects, and studies show it could increase the effectiveness of Y by as much as 10%.

It's your choice. Would you prefer to go with Y, or Y+P?

-- Brian McLaughlin (brianm@ims.com), July 11, 2000.

Strikes me that much of so-called alternative medicine is all placebo effect. Billions of non-reimbursed dollars are spent on trendy treatments ranging from reflexology to non-touch massage. Ironically, the more that the treatments cost, the greater the placebo effect. It pleases me to announce that I will soon be opening the Lars Placebo Playground staffed by my certified placebo healers; $200/hour.

-- Lars (lars@indy.net), July 11, 2000.

Brian -- the placebo effect may be a good thing. But, I don't want my doctors to lie to me -- ever -- even for a good reason (unless I tell them to). Trust is essential to the doctor/patient relationship. You can't trust people that lie to you.

Personally, the way I feel is this -- the placebo effect is the effect of belief and hope on the human body. For me, knowing that a competent physician is trying to assist me probably has a lot of placebo value. Having my physician lie to me would destroy that.

-- E.H. Porter (Just Wondering@About.it), July 11, 2000.

>> Having my physician lie to me would destroy that. <<

In what way would my suggested approach constitute a lie?

The physician would be giving you completely accurate information, and also giving you the choice of making use of it. The placebo itself does not need to be a sugar pill. It only needs to be an activity that does no harm in itself and gives the patient greater hope. If the placebo is proved to help in X% of cases, then telling you it may help is not a lie, in so far as I can see. It may. Often it will.

I really don't see the lie, if you only say it does what it is proved to do.

-- Brian McLaughlin (brianm@ims.com), July 11, 2000.

Sorry, Brian -- I just would not be helped by a physician who played games with my mind. Perhaps I'd never figure it out, and be comforted. But, I suspect I would figure it out and never trust that doctor again.

It may well be that your desires and needs are different. If so, I suspect that the best thing to do is express them clearly to every doctor that treats you.

At least to me -- in medicine, trust is the most important thing.

-- E.H. Porter (Just Wondering@About.it), July 11, 2000.

Brian wrote:

"The physician would be giving you completely accurate information, and also giving you the choice of making use of it. The placebo itself does not need to be a sugar pill. It only needs to be an activity that does no harm in itself and gives the patient greater hope. If the placebo is proved to help in X% of cases, then telling you it may help is not a lie, in so far as I can see. It may. Often it will. "

---------

I once had a doctor who was constantly saying, "I don't care if you shave your head and paint it blue-- if it works, it works." In fact, that's about the main medical advice he gave me.

I never did shave my head and paint it blue. Maybe I was supposed to? Maybe that would have fixed the ruptured discs compressing my spinal cord.

I think I aggree with the person earlier talking about more placebo effects out there in medicine. My primary experiences with doctors have involved their total _reliance_ on the placebo effect.

A side comment to Lars re: alternative treatments. Do you think animals are subject to the placebo effect? I was under the impression they are not. Yet there are growing numbers of effective alternate treatment modalities for them, as well. (That's not a blanket statement that all are effective, by the way.)

-- sign me -> (cynical@bout.drs), July 12, 2000.