‘As most of us would guess, the placebo perceived by patients to be more expensive worked better than its seemingly lower-cost equivalent … Perceptions of cost are capable of altering the placebo response,.
Quite a buzz lately about the placebo effect and back pain, extending from a randomized control trial in Portugal.
“Our findings demonstrate the placebo effect can be elicited without deception. Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered.” – Lead author Claudia Carvalho, Ph.D., ISPA
“It’s the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system,” (says placebo researcher Ted Kaptchuk, Professor of Medicine at Harvard Medical School). “The body responds to that.”
While this study focused on chronic pain, Kaptchuk says it is possible that patients with other conditions that involve self-observation – such as fatigue, depression, or digestive problems – may benefit from open-label placebo treatment.
“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” notes Kaptchuk. “It’s not a cure-all, but it makes people feel better, for sure. Our lab is saying you can’t throw the placebo into the trash can. It has clinical meaning, it’s statically significant, and it relieves patients. It’s essential to what medicine means.”
It seems that the placebo ‘hierarchy’ still plays out – a pill is trumped by a saline injection, which is trumped by ‘surgery’. Studies suggest that patients in the USA are opting for ineffective knee surgery in the belief this will relieve pain, even though it is likely that such an effect is … well, a placebo effect
“I personally think the operation should not be mentioned.” … But if a doctor says anything, Dr. Guyatt suggests saying this: “We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”
In Why Placebos Really Work: The Latest Science the Wall Street Journal points to the increasing frequency of ‘serious’ science envisioning health interventions that consciously include placebos and invoke the placebo effect. It seems the mind-body divide is something of an illusion!
Nevertheless, even though at least 50% of doctors actively prescribe placebos – often active drugs in such low doses that there is no apparent therapeutic benefit, or vitamins, antibiotics or over-the-counter analgesics like aspirin – they are still disinclined to prescribe a sugar pill. I guess they feel like it’s cheating, somehow.
… and have helped people with migraines, IBS and Parkinson’s.
Placebos have been shown to work for migraines, toothache and IBS
Parkinson’s patients continued to get relief after switching to placebos
After drugs, body becomes pre-conditioned to expect treatment and reacts
50% of American doctors found to prescribe placebos instead of drugs
New studies in the Boston suggest that placebos may causes changes in the body as well as the mind. Even with patients knowing they are being given a non-medicinal drug substitute they have still reported reduced pain and other symptoms in everyday, debilitating conditions such as irritable bowel syndrome or migraines.
As practitioners become a little more ‘open’ about their use of placebos, it’s time now to discuss the ethics of such use. From Glackin’s abstract:
It is widely supposed that the prescription of placebo treatments to patients for therapeutic purposes is ethically problematic on the grounds that the patient cannot give informed consent to the treatment, and is therefore deceived by the physician. This claim, I argue, rests on two confusions: one concerning the meaning of ‘informed consent’ and its relation to the information available to the patient, and another concerning the relation of body and mind. Taken together, these errors lead naturally to the conclusion that the prescription of placebos to unwitting patients is unethical. Once they are dispelled, I argue, we can see that providing ‘full’ information against a background of metaphysical confusion may make a patient less informed and that the ‘therapeutic’ goal of relieving the patient of such confusions is properly the duty of the philosopher rather than the physician. Therapeutic placebos therefore do not violate the patient’s informed consent or the ethical duties of the doctor.
The whole paper can be found here. It seems the article has stirred up something of a hornet’s nest among ‘psychopharmacologists’ – see the recommendations listed at the foot of the website.
An international expert on the “placebo effect” says with addiction and abuse of opioid prescription drugs on the rise, it may be time for doctors treating patients with chronic conditions or addictions to consider intermittently substituting substances like morphine with dummy pills.
With or without telling patients.
“Placebos are being used in routine medical practice now by many doctors in many circumstances, but the main goal is to reduce intake of drugs. If we are talking about narcotics and other drugs of abuse, the approach is, for example, give morphine on six consecutive days and then a placebo on the seventh day. There are three or four studies with good scientific approaches to this and in those three countries I mentioned, placebo prescribing is more common.”
Asked about the ethics of substituting pills, he said:
“If you want to reduce intake of certain drugs, why not? I think that’s perfectly ethical, but if you want to prescribe placebos so you aren’t bothered by hospital patients in the middle of the night, that’s a different situation.”
Benedetti told delegates that researchers now understand more about the psychosocial context for real drug or placebo treatment effects. Certain words spoken by the health professional (“This pill is really going to help you”), the rituals associated with treatment (such as needle injections) and other sensory experiences all influence whether patients have positive expectations of health improvement. Personality traits can be important factors in who responds to placebos; optimists are more susceptible to having a placebo response while skeptics may have a nil effect.
A leading surgeon reveals how doctors perform UNNECESSARY surgery to stop patients complaining.
A surgeon has admitted to performing a number of operations that don’t yield results due to a widespread acceptance of the procedure and to avoid patient complaints.
Ian Harris, a Sydney Orthopaedic surgeon, who works at a number of hospitals including the University of NSW, said he has performed surgeries on patients that don’t work, reported theSydney Morning Herald.
In a new book, ‘Surgery, The Ultimate Placebo’, Professor Harris has noted that the only benefits some surgeries provide is the ‘placebo effect’.