Powdered mummy, crab's eyes, viper's flesh and pearls. These are some Medieval medicinal cures and few would question the fact that they worked as a placebo.

But how many drugs in modern science might also be ineffective? The US Office of Technology Assessment estimates that only one fifth of modern medical treatments in common use have been proved effective. Modern placebo effects include prescribing antibiotics for colds and flu, evidence that placebo use still has a place in modern medicine.

A study by Baylor College of Medicine in the States, found that surgery carried out on people with osteoarthritis of the knee produced no better results than in dummy operations. Patients who underwent placebo surgery were as likely to report pain relief as those who underwent the real thing.

Recently, the reputation of placebos as a deceitful fraud has undergone a dramatic change. To alternative medical practitioners, the placebo response represents the self-healing forces produced by the mind-body connection.

The placebo effect is the perceived improvement in health not attributable to treatment. A placebo is a medication believed by the administrator to be harmless.

The word placebo comes from the Latin, meaning 'I will please', and by the 19th century, it was a medicine given 'more to please than to benefit the patient', according to A.K. Shapiro, author of The Powerful Placebo: From Ancient Priest to Modern Physician.

Although it's not fully understood how placebos works, three major reasons may explain the effect. For many patients, taking a placebo causes the release of endorphins, opiate-like substances naturally produced by the brain in times of stress.

There's also the conditioning response to medical treatment, the belief that a drug administered by a doctor will do you good. Irving Kirsch, a psychologist at the University of Conneticut, believes the effectiveness of drugs such as Prozac may be attributed to the placebo effect. He analysed 19 clinical trials of antidepressants and concluded that the expectation of improvement accounted for 75% of the drugs' effectiveness.

And lastly, the expectancy that taking a drug will have a powerful effect on your body. In one study, subjects given sugar water were told that it was an emetic. Over 80% of patients in the study responded by vomiting. As Asbjorn Hrobartsson, author of the study the uncontrollable placebo effect puts it, "Any therapeutic meeting between a conscious patient and a doctor has the potential of initiating a placebo effect."

Many thousands of patients report relief from pain while taking placebos. Just because there is no medical explanation for this, is their recovery any less real?

The debate for and against placebos rages on. For many, it's a question of asking what difference does it make why something works, as long as it seems to work.

Dr Richard Tonkin of the Research Council for Complementary Medicine says, "The problem with the placebo effect is that it is regarded by most people as a nuisance or fake. But it isn't. It is a practical and positive effect that acts by catalysing the self-healing mechanisms within a patient."

Arguments for

# Mind over matter. The body has powerful, natural recuperative abilities and a placebo could help facilitate this.

# Acts as a psychological boost, that a person's positive attitude may be important in recovery from illness.

# The placebo effect may be a measurement of changed behaviour affected by a belief in the treatment.

Arguments against

Placebo-related changes could be over-estimated because:

# With chronic pain conditions or mood disorders, patients may show spontaneous improvement.

# Placebo effects can result from contact with doctors, perhaps a diagnosis or simple attention from a respected professional alleviates anxiety.

# The patient, in order to please the doctor, might report benefit when no benefit has occurred. In other words, the 'politeness effect'.

I think all medications have an inherent placebo effect anyway - regardless of whether or not they do or don't have medicinal qualities.

If I have a banging headache and take a painkiller, I immediately feel better the second the pill touches my tongue.

The interesting question is not whether or not there is such a thing as a placebo effect - I think few doubt its existence - but rather if it would be ethical for doctors to use it to get results. I personally would say no. The fact that it might end up being beneficial to the patient does not outweigh the fact that it is a fraud. The most fundemental building block for the relationship between a doctor and a patient is trust, and that should definitely not be broken.

retina said:

Do you think that doctors always know what's wrong with a patient and prescribe the right medication and that is what gives the desired results? Isn't prescribing the wrong meds which miraculously still have the desired effect essentially the same as the placebo effect? I think doctors "wrong" more often than some of us would want to know, but when the treament helps there's no way you're going to find out, so how would that trust be broken? Speaking of trust, the fact that you trust your doctor and believe that he can cure you is part of the placebo effect. If you don't have faith in your doctor/treament than that can even limit the effects of real pharmaceuticals and possibly make the difference between a success and a failure.

When I'm going to the doctor I'm looking for a cure, whether he's giving me subtance X, substance Y or a placebo doesn't matter to me as long as I get better and the medicine doesn't do any permanent damage to my body.

Even though they're not allowed to give placebo's anymore, 2 out of 3 GP's in the UK say they still regularly prescribe them because they work.

eikonoklastes said:

If he unknowingly gives you the wrong type of medicine and it still has the desired effect that's one thing, but if he tells you that you will get real medicine and then gives you placebo, that's fraud. And yes, the trust will then have been broken. No trusting relationship of any sort can be maintained if lies are involved.

retina said:

What if the pros out weigh the cons? Say a doctor cannot find anything physically wrong with a patient yet the patient complains of aches and pains etc, he sends the patient for blood tests which turn out normal. At this point giving the patient a placebo may be one alternative in treating them. If my doctor prescribed me a placebo and it had the desired effect, I wouldnt mind as as my priority would be getting better. Maybe Placebos work in the same way as other alternatives to medication, i.e counselling. I cant imagine a doctor would prescribe a placebo for a medical problem that requires real medication, at least I hope not!


The doctors priority may be healing the patient rather than issues of trust. just a thought.
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[Edited 9/27/05 3:15am]

There is no ethical way to get around this problem.

eikonoklastes said:

If he unknowingly gives you the wrong type of medicine and it still has the desired effect that's one thing, but if he tells you that you will get real medicine and then gives you placebo, that's fraud. And yes, the trust will then have been broken. No trusting relationship of any sort can be maintained if lies are involved.

LleeLlee said:

I'm sure some people agree with you, but I think you're leading yourself onto a dangerous path if you allow for deception as a means to an end, especially in a medical context like this one. Not only is it fundementally unethical, but it also might have unwanted consequences down the line. What if, for example, you have a deadly disease that your doctor can't discover. He thinks you're healthy and therefore prescribes placebo while telling you it's real medicine. In this situation you couldn't even defend your health by getting a second opinion, since you think you're already being properly treated. The results could of course be disastrous.

And even though some people would still want to run this risk, others don't. How will you be able to seperate the two categories? If you ask them you will have automatically ruined any potential placebo effect in the future. There is no ethical way to get around this problem.