Implications of the placebo effect for physicians

The placebo effect is somewhat of a mystery in modern medicine. Wikipedia calls a placebo  “a sham or simulated medical intervention.” Commonly, when we refer to a placebo we mean dummy-drugs, but the placebo effect has further applications in medicine, such as sham surgery or false information.

Now, a great video produced by an Australian journalist from the ABC Science Show has compiled an animated infographic that sums up some puzzling and fascinating facts about placebos.

The video explains the subtle effects of placebo medications. The facts in the video are incredible and whenever we see such facts we want to believe that there is more to medical interventions than mere biochemistry or pharmacokinetics. Also, in comparison to other (more lucrative) fields of medical research, the the placebo effects is not being investigated by many scientists. That’s one reason why our knowledge on this interesting topic is rather limited.

However, placebos are pivotal to modern medical research and practice. Doctors reading this know this for sure, but let us recap the current gold standard of clinical research: double-blind, randomized, controlled, trials or RCTs. A study-group of people is defined by certain set of parameters (age, sex, etc.). These parameters are the so-called inclusion criteria. The participants are then randomized into two branches, one group gets a real medical drug or intervention and the other one gets a placebo. The drug has to perform better than the placebo, otherwise it won’t be allowed to enter the market.

Now, my knowledge of placebo research, effects and philosophical implications is rather limited and I’ve already written enough about something I do not fully understand. But here are some facts from the video below that are incredible:

  1. The same placebo can treat pain half as well as aspirin, but at the same time treat it half as well as morphine
  2. The effect of placebo is bigger when the pill is bigger
  3. A syringe is more powerful than a pill
  4. Plain pills work better than branded pills
  5. Blue placebos work better than other colors

Giving placebo to a real (i.e., non-study) patient has generally been considered to be unethical since you are essentially lying to the patient. However, research has found that placebos even work if the patient receiving it knows that it’s a placebo! That is stunning.

What are the implications for us physicians? We think that doctors should study the different effects of placebos more thoroughly, they should think about ways to use the placebo effect to their patients’ advantage. Furthermore, we think that the placebo effect has a lot to do with the doctor-patient relationship, the patient’s thoughts and attitudes. Prescribing, treating and consuming drugs is a psychological thing. In German there is a saying “believing can move mountains” and that’s certainly also very true for placebos.

If doctors want to include the placebo effect in their clinical armamentarium, they will have to train their soft skills. A tough challenge but well worth the effort.

Lukas Zinnagl is a physician and co-founder of MedCrunch, an online magazine covering health, medicine, entrepreneurship and technology all centered around new trends and the challenge of being a physician.

 

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  • http://fertilityfile.com IVF-MD

    The concept of placebo in infertility treatment is particularly complex. Suppose a couple is childless for 10 years and through some sort of medical treatment she ends up giving birth. How do we say to her, “We’re not really sure if the treatment helped you become more fertile or if it just made you THINK you were more fertile”? Either way, as she’s holding her new baby, she’s not going to care.

  • Leo Holm MD

    I should patent the placebo. Based on the available medical evidence: it should be FDA approved, paid for by Medicare, Medicaid and insurance, worked into treatment guidelines and considered unethical NOT to prescribe it. Once it goes generic, I will come up with the extended release, then the patch, then the infusion. Why didn’t I think of this sooner?

  • Finn

    Don’t forget the big-arse scientific-looking machine; you can get truckloads of money for that one.

  • Oz

    A phenomenon, not an effect. More hype than actual influence.
    http://www2.cochrane.org/reviews/en/ab003974.html

  • http://www.linkedin.com/in/johnvalenty John Valenty

    Interesting facts-especially about the color and size of the pill.

  • http://www.bestpanacea.com/ BestPanacea

    @ Oz, “Placebo interventions for all clinical conditions” is too broad a topic to evaluate the effectiveness of placebos, and therefore their conclusions are too dismissive.

    Science says that some people (not all) with certain conditions (not all) can benefit from placebos. The problem is of course who and what condition. The answer can only be found in specific research and not broad general overviews.

    It is of course ridiculous to say that placebos can effectively treat “all clinical conditions”, but it is equally ridiculous to say that placebos are of no significant value.

  • gzuckier

    On the one hand, every med must be proved more effective than placebo, an implicit acknowledgement that placebos are signficantly more effective than no treatment; on the other hand, placebos are not routinely prescribed, even in the absence of other treatments. This would seem to constitute a de facto undertreatment, no?

  • http://www.consentcare.net Martin Young

    And here lies the whole value and/or controversy, depending on your point of view, over homeopathy.

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