An ethical placebo
There is an unresolved ethical issue concerning the use of placebos, inert pills routinely prescribed to patients because their effectiveness is long proved and understood, especially in cases where illness is psychosomatic. But is it really acceptable to lie to you patient?
In a recent study of sufferers of chronic back pain, carried out by researchers in Portugal and published in the journal Pain, scientists discovered that when patients were made aware they were taking a fake drug, there was still a reduction in pain of about one third.
Back pain is the cause of more disability and worker absenteeism than any other condition – 40% of workers in the UK suffered from back pain in 2015 and its treatment costs the country more than £1 billion every year. When lost earnings are factored in, the bill reaches £12 billion.
The researchers concentrated their study on 97 adults who had been suffering from low back pain (the most common type) for at least three months. They were assigned at random to groups. Those in the first group received three weeks of treatment that consisted of their usual medication alone. Those in the second group got their usual medication as well as placebos. A third group was given only their usual painkilling drugs.
However, unlike usual studies of this nature, the patients were actually told they were taking a placebo and also informed as to how their bodies might respond to the fake pills. Intensity of back pain and disability were then compared between the two groups.
After the three weeks was up, the patients who were initially given only their usual medications were also offered the chance to take the placebos and the results showed greater reductions in pain in those patients.
On a scale of 0 to 10, patients in the placebo group experienced a significant 3 point improvement in pain, compared to little or no significant change for patients who took only their usual drugs.
Overall, honest and open placebo treatment reduced initial pain and disability scores by around 30%.
The results may have been slightly skewed because some volunteer patients may already have had an interest in alternative treatments, thereby increasing suggestibility and expectation. Placebos tend to be more effective with individuals who are suggestible!
Placebos can work even when patients are told the medicine is fake and informing patients they are getting nothing more than a sugar pill does circumvent the ethical dilemma.
More important, even when people know they’re taking a placebo, they still experience improvement.
In another study, people with asthma were given a placebo inhaler. Even though subsequent breathing tests revealed that their health was no better after using the inhaler, the participants did report that it had brought them relief. Obviously, suggestion plays a great part in this process and the way a doctor interacts with patients can have an impact on the perception and belief in the treatment – genuine or otherwise.
The placebo effect is being studied more than ever before as interest in the phenomenon gains ground. More recently, researchers from Harvard University and the University of Basel treated participants in their study with a ‘topical cream.’ Half the subjects believed the cream was a genuine healing agent while the other half were told it was a placebo. Those who knew the cream was a placebo believed in its healing powers just as much as those who believed it was genuine.
The analysis has again brought into question the necessity of deceiving people prescribed placebos by telling them they are taking active medicines, and has expanded on previous research that shows placebos really can heal ailments.
In the study, researchers observed 160 healthy volunteers aged between 18 and 65. Of the volunteers, 68% were women, and all participants were randomly assigned to one of four groups. The volunteers placed their left forearms against a heated device used to measure pain threshold.
One group received no treatment. A second group was given a placebo and told it was a topical cream containing Lidocaine, which numbs the skin and relieves pain. A third group was given a placebo without being told it was a placebo, and the fourth group was given the placebo after the scientists took great care explaining the ‘placebo effect’ to them. This is known as an ‘open placebo’ as opposed to a ‘closed placebo.’
The researchers explained to the group members that the effect was ‘powerful’ and that it has been found to cure pain, migraines, depression, asthma, and symptoms of Parkinson’s disease. Members of this group were also told that their bodies could automatically respond to placebos. Then after the cream had been applied, the researchers asked each participant in the group how they were feeling.
Participants who were told they had been given a medicinal treatment and those who knew they were being given a placebo but also told about placebos healing properties reacted in the same way following their treatments. Both groups reported they experienced less unpleasant effects after they had the topical creams applied to their forearms. Pure suggestion!
The report was published in the Journal of the International Association for the Study of Pain.