The truth about placebos

The word placebo is Latin for “I shall please.” For a word rooted in pleasing, it can stir up quite a bit of unease. A placebo is some form of treatment, such as a pill or other intervention, given to a patient that contains no active substance yet may generate physical effects. That’s fairly simple. The trouble comes in with the notion of placebos and how they’re used.

It’s actually more helpful to first explain how they’re not used. “It’s not something that physicians do actively,” explains Rami Rihani, administrator of pharmacy and chronic disease management for Downers Grove, Ill.-based health system, Advocate Health Care’s physician groups.

“Basically, physicians don’t generally order a placebo tablet from a pharmacy. It’s not an intervention regularly employed in day-to-day care,” Rihani says.

Rihani, a registered pharmacist, adds that in most circumstances where there are effective treatments, prescribing a placebo would be unethical for a physician to do. “It’s not appropriate to give a placebo when you know there’s an effective therapy that works for the diagnosis. If we have an intervention that works, we use it,” he says.

Role playing
Now that you’re not in danger of being hoodwinked by your doctor, let’s explore when placebos really are used. Researchers have a long history of using placebos in controlled clinical studies and trials to help determine the true effect a particular drug or treatment has on a specific condition or disease.

Placebos are used to weed out clinical and adverse effects that can just occur by chance or as a result of the body’s ability to heal itself. For example, if researchers studied a drug for the common cold, they may find that a patient’s colds resolve on average within four days. To determine whether the cold resolved on its own or as a result of some activity from the treatment being studied, a placebo would be used.

In a clinical trial, some patients would be treated with the experimental drug (the experimental group) while others would receive placebo (the placebo group or control group).

Neither the experimental group patients nor the control group patients would know which intervention (active drug or placebo) they were receiving. Often the doctor treating the patient would not know either. This blinding of a study prevents introducing the power of suggestion (or the placebo effect) either from the patient or the doctor evaluating the patient.

At the end of the study, the two groups would be compared. If both groups of patients had their colds resolve on average within four days, researchers would know that the drug was not effective. However, if the experimental group had their colds resolve in two days while the placebo group had their colds resolve within four days, researchers would conclude that the experimental drug may be able to reduce cold symptom duration by two days.

The same ethical concerns discussed earlier still apply for placebo use in clinical trials. In most circumstances, if there’s an effective treatment, patients will not go untreated. The exception is when a strict process is put in place that ensures the patient is well informed of the potential to receive placebo in a study. Often, instead of a placebo, the new drug or treatment will be compared to a current effective treatment or the standard of care.

Power of thought
Interestingly enough, in the majority of studies using placebos, some patients will respond to a placebo. This is referred to as the placebo effect. Some suggest that this effect can be caused by the relationship between the mind and the body. If a person expects that the treatment will have an effect, then the body may mirror this expectation and produce an effect similar to what the patient thinks the treatment would produce. This can include both positive and negative effects.

Studies have shown that placebos can affect such conditions as:

• Depression
• Irritable bowel syndrome
• Menopause
• Pain
• Sleep disorders

Although the jury is still out on the cause of the placebo effect, Rihani says placebos  definitely have their place. “Without placebos in clinical trials, it would be difficult for us to determine whether an investigational therapy provides value over the body’s ability to naturally heal.”