Can we have the Placebo Effect without falsehood?

I’m both a big fan of truthfulness, and also of anything which benefits people in a practical manner. The fact that the Placebo Effect relies on the belief of the patient in the treatment, regardless of the pharmaceutical properties of the treatment itself, means that the effect is necessarily tied up with falsehood. It is belief despite the lack of pharmaceutical efficacy which is key. A sugar pill would fail to cure me of my ills as soon as the doctor owns up and admits it’s not a real drug, presumably.

If this is the case, is there any way to keep the benefits of treatments which rely on this (homeopathy springs to mind) without telling lies to the patient? Or are they irreconcilable?

Any thoughts?

IIRC, Irving Kirsch had published, many years ago now, some findings on effects for the placebo effect even when everything was known by the person. They weren’t as strong as under other circumstances, again going from memory alone.

When I took Psych the professor said basically what Hentor the Barbarian said. Even when you know its a placebo it can still have an effect.

I think Gettier is written all over this, but to clear up my own confusion: isn’t it the case that neither the patient nor the doctor knows whether a pill is real or a placebo? If so, how is anyone lying?

In a double-blind study design that is true. However, a double-blind design isn’t always used. If you’re referring to a clinical setting, the physician should know if they are prescribing a placebo or not.

Double-blind testing springs to mind.

You tell the patient that he may receive either a placebo or a real drug. The person who dispenses the drugs and the person who hands them to the patient are different, so no one in contact with the patient knows which one he’s getting. No dishonesty involved.

Of course, the point of such testing is to see if a drug works *better *than a placebo. Every drug has the placebo effect, if the patient knows he’s taking it and believes that it should work. It’s just that they also have a greater physiological effect. There’s very rarely a reason, outside of clinical testing, to use a placebo where an effective treatment.

Fair enough - I think I was aware that there was still an effect - but it would seem a pity to lose any effect though if a fully deluded subject gets better results.

I have no moral problem with double-blind testing - the ‘blind’ element is necessary to keep the trial fair. I do have a problem to some degree with doctors prescribing a placebo, or of people having treatments which rely entirely on the placebo effect, because by definition the patient is not in possession of the whole truth (even if that ignorance does lead to some pain-relieving bliss, say).

Do you know of any real-life instances of physicians actually prescribing a placebo?

Maybe hypochondriacs?

Yes. this article might be of interest to you. It mentions an ethics case where interns in a hospital ordered placebos for 10 patients over 2 years.

I do know a doctor who will occasionally prescribe a placebo to drug-seeking patients, or patients for whom there is no physiological reason for their distress. He generally says something like, “There is one more thing we can try. We’re not sure why it works, actually. The mechanism of it’s effectiveness is a mystery. But some people in your situation have found it to be of great benefit.” Every word of that is entirely factual, is it not?

Your local Walgreens stocks placebos in their pharmacy. They even have fancy chemical sounding names on them that the doctor writes down on a prescription pad for you.
ETA: Of course, maybe we’re all looking at this the wrong way…perhaps sucrose is a miracle drug! :smiley:

In reply to Hentor - I was under the impression that sometimes hypochondriacs were sometimes given placebos as Liberal suggests.

While I don’t lose any sleep over it, it’s more the phony health treatments I’m concerned about. Much as I’m into disillusioning consumers when it comes to hokey treatments, surely their popularity means that many people would lose the placebo benefits if the snake-oil manufacturers were shut down once and for all.

What made me think of this was the worry of losing one’s moral foundation if one rejects the (IMO) illusion of God. I don’t agree this is a problem, as morals can be derived from natural social instincts, ‘The Golden Rule’, etc. But placebos are reliant on ignorance of some part of reality it seems, so I wonder if there is a way one can be both disillusioned and not lose the benefits of placebo.

Wayne Dyer, a PhD in psychology wrote a book called “When you believe it, you will see it.” The placebo merely illustrates a spiritual principal. I read the story of a man with terminal cancer. There was a newspaper headline he read that said a cure for cancer had been found. He showed this to his doctor and demanded the cure, not having the cure his doctor gave him a placebo. His cancer went into remission until he read a few weeks later that the cancer cure didn’t work.

The principle of the placebo is behind faith healing and the positive effect of affirmations. It is the foundation of prayer and many other things. Too bad it isn’t taken more seriously.

Two interns were assigned a patient that was dying slowly. They ran all the tests and could find nothing wrong, so they asked the patient what was wrong with him. The patient explained that a witch doctor had placed a curse of him, and that was the reason he was dying. The young, quick thinking, interns told him curses were their specialty and set about to perform a made-up ritual using candles, powder, and pills than gave off different colors when burned. They came to his room at midnight and performed their ritual buring different pills until the last pill which burned green. Then announced to the patient that the green flame meant the spell was broken. The patient quickly regain his health and left the hospital. There are many, many events such as this.

I…means that the effect is necessarily tied up with falsehood. It is belief despite the lack of pharmaceutical efficacy which is key…/QUOTE]

Those are false assumptions. There is no reason that an effective cure can’t be enhanced by placebo effect. Consider the same pill given by, first, a doctor who says: “We can try these pills, but they probably won’t help much, if any…hey, whatever.” Vs. one who says “Your in luck! An amazing new cure for your condition has recently been found! Here, take this stuff, and expect to start feeling better within a day or two.”

Doctors generally don’t prescribe actual placebos in a clinical setting–at least no one I’ve ever worked with. If there are sugar pills with fancy-sounding names that I can write a prescription for, as WhyNot mentions, I’ve never heard about it. (That doesn’t mean it isn’t true.) Most doctors I know would consider a pure placebo to be unethical.

What we can do–and we do often–is prescribe a medicine that has a very slim chance of having some benefit. The classic example is to give antibiotics to someone with a cold, justifying it by saying that it could be an early acute bacterial sinusitis. (This is bad for many reasons, but 90% of primary care providers in the US do it. That includes me, though I do it far less often than most, and I’m always up front that it probably won’t help.)

The other example is B-12 shots for fatigue in people without B-12 deficiency. The studies taken as a whole show pretty clearly that there’s no benefit, but since plenty of anecdotal evidence to support it and there usually isn’t another quick fix for fatigue, a lot of docs (and patients) are big on it. (This one I don’t do.)

Obecalp is the most famous. cite 1: “Like thousands of other soldiers, Army veteran Mike Woods said he developed bizarre symptoms after serving in the first Gulf War – blackouts, chest pain and numbness in the extremities. Woods looked to the Veterans Administration for help. He said his VA doctor prescribed him a drug called Obecalp.”

anecdotal cite 2: “[Obecalp] was the drug of choice for nightly visitors to the emergency room at Los Angeles County-University of Southern California Medical Center back when I was an intern.”

My doctor friend, however, prefers to prescribe 325mg Sacchari lactis QID. Again, not something he does often, he tells me he’s only done it “a few times” in his 20something year practice, and always with clear information that he doesn’t know why it works.

Why ‘spiritual’? Isn’t placebo an illustration of a psychological process?

I think if the placebo effect could be shown to cure cancer, then the medical authorities would quickly weigh this up against their ethical concerns and roll out the sugar tablets across hospices worldwide. Cancers do go into remission all the time - obviously at least once in conjunction with a placebo.

So faith healing, prayer and sugar pills are all comparable? That potentially says a lot about the power of ‘mind over matter’, but also suggests that it doesn’t much matter exactly *what * you believe in as long as you believe in something. And this was my intended debate - how can we avoid throwing the baby (positive benefits of belief) out with the bathwater (objectively ineffective objects of belief).


I see your point, and agree that the spin a doctor in that position might put on ‘selling’ the pill might help the pill’s effect. But in real life presumably doctors have an idea of the effectiveness of a treatment; so in your example wouldn’t there be a certain amount of falsehood from one or other of them in their different descriptions?

I agree with the idea that spirituality is nothing more than placebo.

Got a list of those names? I’d like to check my medicine cabinet. :slight_smile:

So what happens when a placebo “works”? Does that mean that the pill with no active ingredient performed contrary to accepted laws of nature?

No, it means that first, a patient got a pill, and second, the patient had a beneficial turn in the illness.

The one thing we can be pretty certain about is that the placebo didn’t cause the beneficial effect thru known chemical or physical actions.

Maybe the patient’s mind cured him. Maybe a supernatural being {insert god of choice here} intervened. But more likely than not, the cause and effect were simply not connected. There is such a thing as spontaneous remission and there are other, possibly unforseen and as yet undiscovered, factors at work.

So anytime you say, “The placebo cured him,” you should be saying, “The result wasn’t caused by the applied treatment.”