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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