Tuesday, 26 May 2009

The Placebo Effect - a skeptical look

Over at the online portion of Skeptic Magazine, Harriet Hall shines the spotlight on the interesting placebo effect.  Among the highlights is the following list, most of which any experienced doctor can confirm! 

We not only know placebos “work,” we know there is a hierarchy of effectiveness:

  • Placebo surgery works better than placebo injections
  • Placebo injections work better than placebo pills
  • Sham acupuncture treatment works better than a placebo pill
  • Capsules work better than tablets
  • Big pills work better than small
  • The more doses a day, the better
  • The more expensive, the better
  • The color of the pill makes a difference
  • Telling the patient, “This will relieve your pain” works better than saying “This might help."
The entire topic is a source of much annoyance to many doctors; they view the placebo effect as something irritatingly "not real" and a factor "in the patient's head" that only serves to complicate matters.  I say: the placebo effect is definitely "real" - it has an easily measurable effect (see the above article's statistics, for instance).  Furthermore, since it is not only real but ubiquitous it should be harnessed, not shunned.  

Of course, there are often ethical problems associated with the placebo effect (e.g. is it right to knowingly prescribe a placebo to a patient?).  However, the placebo effect is not limited to prescribing frank placebos.  Every (real) drug, and indeed every patient interaction, offers an opportunity to increase our effectiveness as doctors by adding the placebo effect to our armamentarium.  For instance, as Hall notes, morphine works even better if you tell your patient that it's strong. 

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