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The Placebo Effect - does it have a place in modern medicine?

By Andy Wilson

What is a placebo effect?

A placebo is a stimulated or otherwise ineffectual treatment for a medical condition intended to deceive the recipient. Sometimes these patients will perceive an actual improvement in their condition, which is the placebo effect. 

The effect is about the power of the mind to influence the body. It can occur when a person uses any kind of conventional or alternative healthcare and can affect any person whether they know about a placebo or not. 

Doctors have known for hundreds of years that when a patient expects their condition to improve, it often does. So, when a patient receives an empty tablet and is advised that this pill will reduce their experience of headaches, in 30% of clinical trials, it does. Time and time again, these clinical trials have shown that the placebo effect is real.

One particular example in the documentary showed how a spinal surgeon stumbled across the placebo effect when he realised he had treated the wrong vertebra with an injection of cement (vertebroplasty).  His patient, who had experienced significant pain symptoms before the surgery, nevertheless claimed to be pain free. This led the surgeon to obtain approval for a formal placebo trial.  The effect was confirmed by the trial when a retired lady claimed to be pain free and recommenced playing golf one week after surgery.   A great outcome.  The only issue was that this lady was under the impression she underwent surgery when in reality, she had only received a local anaesthetic.

So how does the placebo effect work?

There are several theories which attempt to explain the placebo effect. The most widely cited relates to “subject expectancy” – where the patient expects the treatment to improve their symptoms.   In the same way that Pavlov’s dogs salivated when the bell rang, the stimulus is the “medicine” and the response is “relief”.    Research has proven that, through thinking of the desired response, the brain produces endorphins, its own natural pain relievers.

Ethics of using a placebo

There are several ethical considerations when administering a placebo as a form of medication or in a clinical trial. The conclusions of a recent research paper,  “The Ethics of the placebo in clinical practice”, (published in the British Medical Journal, Volume 30, Issue 6), was that a placebo can be of service to physicians and therefore has its place in medical treatment.   Those that try to deny the use of placebos run the risk of using a narrow biomedical model to treat a person without taking into account holistic factors.    The BMJ paper sets out a series of ethical recommendations that should be considered when using placebos in order to ensure that their use has a legitimate place in modern medicine.

Summary

It is clear that experiencing the placebo effect is not the same as being tricked or being fooled. The effect is real and can happen to anyone. It is an example of how our expectations and beliefs can cause real change in our physical bodies. While it is a phenomenon that we don’t completely understand, we can see it working in all kinds of ways and all kinds of circumstances. Who knows how far it could lead in the treatment of conditions such as long term pain disorders or mild mental health disorders such as depression.