Do we really understand Placebo?

A recent article in the USA Today discussed “the placebo effect” and the debate surrounding it. According to the American Medical Association “a placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated.” Perhaps more important to the understanding of the placebo effect is the belief of the patient.

According to a national (USA) survey in 2008 as many as 50% of physicians prescribe placebos at least once a month. The interaction of mind and body that underlies the placebo effect has been known for many years. Tension exists regarding the placebo as some believe it is unethical for doctors to deceive patients by not telling them about the placebo intervention. However, 1 in 20 doctors who prescribed placebos explicitly described them as such to patients. The question is do placebos actually make patients feel better and does this outweigh the responsibility to inform patients about their use.

Across studies with different medical conditions results suggest there is an active treatment effect of placebo and in some cases this may be significant. Factors such as warmth, empathy, duration of doctor-patient interaction and communication of positive expectation might play an important role in healthy outcomes. If these factors are indeed important and contributory to a positive outcome for a patient, the need to deceive is removed.

Perhaps placebo reflects the long held belief that our brains can have an impact on the condition of our body. Perhaps a message delivered by a person that the patient perceives as knowing and within a context the brain perceives as credible can lead to our own body helping to solve the medical issue. Further, given the rather consistent positive impact of “placebos” on patient outcomes it seems time to begin rethinking the therapeutic effect of mind over matter and to integrate such care into the standard regimen of our “health care system.”