Placebos: how’s that when you’ve a headache and a doctor gives a white tic tac saying it’s more effective than paracetamol, it works, but when it’s your mate giving you that dodgy looking minty medicine, it just doesn’t?
A placebo consists in any substance not known to have any medical effects (which means that doesn’t produce any meaningful chemical or biological change in the organism), but that it’s made to look like a proper drug. Sometimes, in fact, the act itself of swallowing a pill produces an effect if the person believes the pill is a proper medicine. For this reason, scientists often give placebos to patients in order to see if an effect is due to the active drug or only from the action of taking a pill prescribed by a doctor.
First of all, there are reasons to believe that when a patient gets better under the effects of a placebo, bodily healing processes are involved, but what’s impressive is that the processes of healing MUST be completely self generating. Although in the past the healing effect of placebo was considered to be only a patient mystification, now placebo research studies have demonstrated that there are neurobiological mechanism at its root. Neuroimaging studies have shown that placebo administration activates endogenous antinociceptive pathways when it is given to reduce pain, but also induces release of dopamine in the striatum in parkinsonian patients if given to reduce motor impairment. (Pollo & Benedetti, 2009).
The outcome of such studies are likely to remove the negative connotation which has been linked to the concept of placebo, but also to raise a new awareness on the potential exploitation of the placebo effect to the patient’s advantage.
If the placebo effect is a self –healing process initiated by psychological signals including conditioning, verbal and visual clues (Meissner, 2011) it is likely to work also in additive or even synergistic ways with conventional drugs. Therefore the therapeutic environment with a physician speaking positively about treatments, providing encouragement, trust and creating a kind of ceremony can completely modify the effectiveness of a drug.
In a holistic vision of mind body-interactions, the placebo effect is a powerful therapeutic tool especially for such conditions where existing treatments are only partially effective.
There are a variety of reasons why a scientist gives patients a placebo treatment including the promotion of the patient’s wellbeing, For example a doctor facing a woman with a newly advanced tumour which cure cannot be found, gives her a placebo intervention in order not to dash her hopes. Interestingly enough patients are also administered placebos for what it can be defined as a convenience reasons. Surveys have in fact shown how doctors often happen to give their patients “fake-treatments”, so they will stop complaining. Furthermore placebos are also given to patients to determine whether their medical conditions are ‘real’ or only psychological. What this last point is not taking into account though is that the actual placebo effect could be the reason why the patient feels better. However I think that when used in such way administration of placebo is unethical as it includes deceiving the patient.
Surveys indicated that between 51 and 100 % and between 17 and 80 % of respectively physicians and nurses have at a certain point in their professional career used pure placebos intentionally. But it’s important to take into account how the data also indicate that the overall frequency is quite low, since pure placebos are usually applied only once or a few times to a small minority of patients.
Pollo & F Benedetti. The Placebo Response: Neurobiological and clinical issues of neurological relevance. Progress in Brain research 175: 283-94, 2009
K Meissner et al. The placebo effect: Advances from different methodological approaches. J Neurosci.31:16117-24, 2011