Tag Archives: Research

The ethics of placebo use in medicine

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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.

Placebo’s dark side: the ‘Nocebo’

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A detailed and comprehensive meta-analysis of the literature on the ‘nocebo effect’. We note that they report on studies using ‘placebo controlled trials’. Is it just us, or does this read a bit circular? You be the judge!

“Our intention here is to portray the neurobiological mechanisms of nocebo phenomena. Furthermore, in order to sensitize clinicians to the nocebo phenomena in their daily work we present studies on nocebo phenomena in randomized placebo-controlled trials and in clinical practice (medicinal treatment and surgery).”

Download the full article here.

STUDY OUTLINES WHY ANTIDEPRESSANT DRUGS COULD BE COMPLETELY USELESS & HARMFUL

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“Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.”

More on the continuing critique of widespread prescription of antidepressants here.

Taking dummy pills might reduce dependence on addictive drugs

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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.

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“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.

Full article here.

The Nocebo Effect: the Placebo Effect Flipped!

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A nocebo is the opposite of placebo …

“The nocebo effect is the placebo effect’s less attractive younger sibling. While the placebo effect has the ability to help people feel better in the absence of any active ingredients, the nocebo effect has the ability to make a person feel poorly in the absence of any active stimuli …  a very real medical phenomenon.”

Further nocebo thoughts, related to people’s perception of harm from WiFi radiation, here.

So You Think You Know ‘Placebo’?

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It’s rare (but becoming more common) to find the placebo effect studied as a phenomenon in its own right. This carefully considered and researched article points to several perspectives …

1. There are two processes going on, the placebo and the placebo effect.
2. Placebo effects are not caused by the object (e.g. the pill) or the procedure (e.g. an injection)
3. Much of what is considered to be placebo improvement may actually be patient report of improvement, without any actual physical improvement.
4. The patient’s inaccurate perception of a successful treatment in the therapeutic environment is also influenced by:

The natural course of the disease
Concomitant treatments
The Hawthorne effect
Regression to the mean

5. The placebo effect is not “the power of positive thinking” or belief, hope, mind over matter or the mind healing the body

Does branding have a placebo effect?

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 Image: James Merry

It seems that using an esteemed name-brand piece of sporting equipment actually generates stronger results.

“Our results indicate that strong performance brands can cause an effect that is akin to a placebo effect,” researcher Frank Germann of the Department of Marketing at the University of Notre Dame said in a press release. “Our results also suggest that the use of a strong performance brand causes participants to feel better about themselves when undertaking a task—that is, to have greater task-specific self-esteem. This higher self-esteem lowers their performance anxiety which, in turn, leads to the better performance outcomes.”

Read more here. And here.

Drug companies wine, dine and *educate* doctors about the drugs they prescribe

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If a drug company treats a doctor to a nice lunch and a presentation on their newest products, is prescribing affected? Doctors generally think not, but the research evidence overwhelmingly says yes. And if these events do affect doctors’ decisions on patient care, should we be worried?

Couldn’t they just prescribe placebos? Of course not! Where’s the profit in that?