The Placebo Effect

The placebo effect is well-known in medicine.

Give people a sugar pill, they have shown, and those patients — especially if they have one of the chronic, stress-related conditions that register the strongest placebo effects and if the treatment is delivered by someone in whom they have confidence — will improve. Tell someone a normal milkshake is a diet beverage, and his gut will respond as if the drink were low fat. Take athletes to the top of the Alps, put them on exercise machines and hook them to an oxygen tank, and they will perform better than when they are breathing room air — even if room air is all that’s in the tank. Wake a patient from surgery and tell him you’ve done an arthroscopic repair, and his knee gets better even if all you did was knock him out and put a couple of incisions in his skin. Give a drug a fancy name, and it works better than if you don’t.

Placebos are frequently used in randomized controlled trials to assure that new drugs work better than these sham medicines.  But are these placebos really shams?  They do after all work.  The point of doing these trials is to show that new drugs work better than placebos.

But should physicians be actively prescribing placebos?  The N.Y. Times has an interesting article on the topic of placebos. Although physicians would like to claim placebos are never used, having fancy hospitals, physician betside manner, and other ritualistic events do improve a treatment’s efficacy than say buying it at the local 99 cents store. The N.Y. Times writes of Ted Kaptchuk who believes that:

…rituals embedded in the doctor-patient encounter…are fundamental to the placebo effect, and…embody an aspect of medicine that has disappeared as scientists and doctors pursue the course laid by Franklin’s commission.

Kaptchuk also writes:

Rituals trigger specific neurobiological pathways that specifically modulate bodily sensations, symptoms and emotions,” he wrote. “It seems that if the mind can be persuaded, the body can sometimes act accordingly.

For instance, there are numerous stories of patient health improvements after acupuncture, many of which may be due to a very strong placebo effect.

If placebos work, however, should physicians prescribe them?  The problem is, that placebos are more likely to work if physicians believe in them and convince the patient that they are effective therapy.  If physicians do not disclose this information, however, the patient-physician trust relationship may be suffer. Short-run gains in the placebo effect may result in long-run smaller placebo effects if patients are less likely to trust their physician.

I am not a physician but clearly the interaction between, medicine and ritual does play an important role in treatment effectiveness.  Quantifying the importance of ritual, however, is often difficult.

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