Placebos: Threat or Menace?

[docorion]

So there's an interesting dilemma been brewing in medicine for some while now, concerning placebos and the use of the placebo effect in clinical practice. A recent study indicates that the strength of the placebo effect can be augmented by "a supportive psychosocial context". Now, the study is for patients with irritable bowel syndrome, a

Comments

[fj]

Placebos end up harnessing physiological processing the patient wasn't doing on their own. We need more science into that so that the response becomes understood and predictable. Which means giving the sugar pill will stop being a placebo, while having been a placebo. Which is why I ticked Yes, as long as you are on the road of healing.

[ruthling]

I think I've been prescribed placebos by my doctor, in the form of: try taking more vitamin B, try this fiber supplement, etc. Things that might help and are unlikely to hurt. I still take the fiber supplement, and I'm pretty sure it works (even if I change types, I start to have problems, which would be less likely if all I needed was to *think* I was taking something).

I don't have a problem with that. But I do worry about doctors lying to patients. And it's really hard now with the internet, I can look up whatever it is and find out if it's supposed to help whatever my problem is.

I'm fascinated by all the studies that have been done involving the placebo/nocebo effect.

placebo - pure morning

[wildraven]

I feel that if you are conducting a study where it is clear to all that there may be pacebos used, then I have no problem. However, if the patient is seeking a solution, giving a placebo can make them give up hope if it does not work. They may tell a doctor "never mind" and instead turn to other options that may be less clinically proven.

All, of course, IMHO. :-)

[mrf_arch]

I'm opposed to doctors lying to patients, because it muddies the waters, and because, frankly, if we want the patients lied to, there are plenty of other people who will happily take care of that for you, and they *all* have a placebo to sell.

I think it's entirely legitimate, however, for doctors to say "There is no known drug therapy for your condition, however, this vitamin, that vitamin, and that dietary alteration are generally known to improve health and may have a positive effect on your condition as a result. Go do that." Some people still want a magic pill and will succumb to quackery, but I can't say I mind - that's one way to sort for people on whom the placebo effect will work best. :-)

I am largely in agreement with mrf here

[drwex]

I think the missing context, which many of your respondents allude to, is that the patient and the doctor have (or ought to have) a relationship. For the doctor to introduce a deliberate lie into that relationship is potentially corrosive. If the patient discovers that the doctor has lied about this one thing, why should the patient believe that the doctor is not also lying about all those OTHER things?

Furthermore, if the doctor feels free to lie then why should the patient be expected to be honest?

Like many other relationships the doctor-patient r'ship tends to work better when both parties are striving for honesty and not the paternalistic idea that lying is for the other party's benefit.

[catya]

I think it would be interesting to see what would happen if docs started saying "in clinical trial, this drug was shown to be 25% more effective than a sugar pill, it's the best we have". Is the fact that we [mostly] don't hear that now from our doctors not also 'lying' ?

I think that the placebo effect is vastly underrated as a medical tool, and also that the issue is more complex than "giving placebos".

Or, put another way... we do this now, right? Assume that the patient is getting the good effect from the placebo on top of or as part of the medicine? If so, then the question is whether we should do it differently, neh?