The Placebo Effect

Placebos (an inert substitute for a real drug) are often used as a comparison when investigating the effectiveness of a medicine; however, are these little sugar pills necessarily a good thing?

A placebo control group provides a baseline with which the treatment group can be compared to, and can give a clear insight into the effectiveness of a drug, due to the participants taking the actual drug faring significantly better than those on the placebo. However, these studies involve a certain degree of deception. Participants are told that some people will be given a placebo rather than the real drug; however, they are unaware as to who gets what. Although this ensures that the research is as ethical as it can be, this can result in problems. Melton, Levine, Koocher, Rosenthal, and Thompson (1988) studied the effectiveness of AIDS medication, in which the participants were told that some would be given a placebo but wouldn’t be aware that it wasn’t the real drug. This resulted in participants sharing their medications, believing that everyone would eventually have some of the real drug.

Another problem with using placebos as a comparison against drugs is the placebo effect. This is often thought of as a trick that our mind plays on us, where we respond to the placebo just by believing and expecting to feel better. An example of this is that pacemakers improve congestive cardiac failure after they’ve been put in but before they’ve been switched on! Another example is in the Big Bang Theory. Raj can only talk to women when he’s been drinking alcohol, and so after drinking a beer, finds the courage to talk to a woman. However, when he realises that it was actually non-alcoholic, he quickly returns back to his fear of women. This shows how Raj believed that he was actually taking the real thing and so expected the effects of alcohol.  This effect causes a problem as it can reduce the difference bewteen the real drug and the fake one. If a drug can significantly reduce the effects of an illness, yet the placebo also reduces the effetcs for a short time, then the real drug may be deemed as less effective.

Placebos don’t just create positive effects. The nocebo effect is when a participant responds negatively to a placebo, for example Dr. Ben Goldacre explains how half a group of asthma patients who are put on a saline nebulizer (salt water mist that does absolutely nothing to those with asthma), and are told that the mist contains an allergern (even though it doesn’t) will have an asthma attack because of the saline nebulizer. This shows that because the participants believed the placebo to be harmful, they expected it to be harmful and so suffered an attack. This is dangerous as these sort of experiments can cause many negative side effects such as headaches, nervousness, nausea etc.

Although placebos can give a good basis by which drugs can be compared to, there are problems which can negatively effect both the participants and the validity of the research.

 

Thanks for reading 🙂

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21 Comments (+add yours?)

  1. psuc0f
    Feb 07, 2012 @ 22:28:54

    It does not necessarily mean by given one group a placebo you are being deceitful. If the participants know one of two groups is getting the placebo then their not being deceived also a double blind could be used during the study meaning neither researchers or participants know who is on the placebo or the actual drug. In the study mentioned above supervision should have taken place in order to make sure participants were taking the medication accurately.
    I love that you referred to the Big Bang Theory (I am addicted) but if the sample size was large enough and treatment was undertaken over a prolonged period of time the placebo effect shouldn’t have such a great impact on the results.
    Giving a group of participants can be extremely beneficial as a point of comparison and if the real treatment proves to have a significant effect all groups would then receive the treatment due to ethical reasons like in the study below.
    Here a treatment for prostate cancer produced such high results that the study was stopped and Dr Parker concluded it was “unethical not to offer the active treatment to those taking placebo”.

    http://kundeweb.aggressive.no/users/algeta2.no/downloads/ASCO%202010%20Ph1%20and%20Ph2%20Safety%20Poster.pdf

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  3. psychmja1
    Feb 08, 2012 @ 13:25:47

    Whilst placebos can have negative effects, they do not appear to have the same effects as taking many drugs. For example antidepressants can cause anxiety, nausea, sweating etc., whereas a simple sugar pill (placebo) does not carry such negative symptoms (http://helpguide.org/mental/medications_depression.htm).
    It has been proposed that the mean differences in the effectiveness of antidepressants and placebos is extremely small and almost insignificant. According to Kirsch, Moore and Scoboria (2002) 57% of pharmaceutical trials failed to find a significant difference between the use of placebos and actual drugs, suggesting that the release of symptoms may be psychological rather than a result of the drugs.
    57% though? Yes in the studies this was high enough a percentage to be considered significant, however would you want to take the chance of being in that 43%? If the placebo did not work for some people in the trials then surely it’s not going to work for everyone in the real world? Which could possibly lead to people becoming more depressed because they are taking a placebo and not an antidepressant!

    Reference:
    Kirsch, I., Moore, T. J., & Scoboria, A. (2002). Antidepressants and placebos: Secrets, revelations, and unanswered questions. Prevention and treatment, 5(1), (no page numbers given).

    Reply

  4. psuaa6
    Feb 08, 2012 @ 14:22:10

    It is extremely unethical to give a placebo drug to someone and prevent them from having the real care. The Tuskegee syphilis experiment studied the natural onset of syphilis when untreated and how it developed within poor black men. It was highly unethical due to the fact they thought they were getting free healthcare when in fact they were receiving placebo healthcare for what they thought was “bad blood” they did not even know they had syphilis! (AWFUL deception). Eventually the press had found out and the study was shut down, however, unfortunately many of the patients died from the syphilis. The study also resulted in wives catching the disease and passing it on to the children. Such a horrific story of ethics gone wrong! Placebo’s aren’t always this extreme of course, but this gives you a hint of what could happen when giving a placebo rather than the real drug to specific participants.

    For those who want to read even more into this study here is a link:

    http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

    Reply

  5. psud6d
    Feb 08, 2012 @ 14:32:37

    I really like your blog and find this topic to be really interesting. While I agree with all of your points I would also add on another way that placebos can be unethical. If we go back to your examples of HIV/AIDS or Asthma. Imagine suffering with one of these diseases/illnesses and being asked to partake in a clinical trial only to find out that you are not being helped at all because you are being given a placebo while others may be being cured by and effective drug. Who has the power to decide whether or not someone receives help or not. Surely if something can be done to help someone with such a serious illness as AIDS surely it should be done. For this reason I don’t think placebos can be seen as ethical even if the placebo group are then given the actual treatment after. It just shouldn’t be the decision of a doctor/scientist to decide who gets a potential treatment or not. Sorry that I just had a massive rant but I dont agree with it! Great blog though!

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  8. psuc0e
    Feb 08, 2012 @ 14:48:10

    Placebo pills are widely used and are still controversial (57% is a very high figure to see no difference between real drugs and placebos). We can argue all we want about the ethical issues surrounding giving people a drug or a placebo, but do we really actually know how placebos work?

    It is suggested that it is the expectation that the placebo will have an effect which causes those taking it to show positive effects. But to have what is pretty much nothing more than a smartie tell your brain you’re going to get better and have it send out all the right messages to stop that pain is quite impressive. Herbet (2012) suggests that one reason could be that the brain redirects attention away from the area that is causing a problem, making it stop hurting.

    Because this is a pretty intensive cognitive task, an experiment was carried out to see if it did effect cognitive processes. You can have a gander at the paper by clicking the link below. They subjected participants to painful heat and measured whether the placebo, which should interfere with the cognitive process if Herbert is correct, would effect how well they did on memory tasks.

    The results showed that there was no effect to cognitive function and it did not effect the scores. It doesn’t explain how placebos work, but it shows how that regardless of what is going on in the brain or how it deals with the stopping of the pain from an administered placebo does not appear to be a conscious or even subconscious decision.

    Yeah, where was I – placebos may be controversial, but they help see how effective a drug really is, and how placebos work in general is quite fascinating.

    http://pss.sagepub.com/content/early/2012/01/18/0956797611427919.abstract

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  10. Sinae
    Feb 08, 2012 @ 15:04:19

    Interesting blog, love your example of Big Bang Theory lol!

    Even though you argue that the placebo effect can be decieving and you explain the negative issues, the placebo effect can be extremely benefical. Placebos have been used in real life circumstances and astonishing results have been produced: patients have believed that certain drugs given to them by health professionals have helped alleviate pain, depression, anxiety, Parkinson’s disease, inflammatory disorders and even cancer!!!

    A real life example: patient Mr. Wright was bedridden and suffering with cancer of the lymth nodes. Tumours has spread to his neck, groin, chest and abdomen. After all the usual treatments, things were looking unfortunate for Mr Wright, yet he was offered a new anti-cancer drug ‘Krebiozen’ (unaware to Mr Wright this was actually a placebo drug). Just 3 days after taking the drug Mr Wright had a huge turn around and became cheerful and acting very positive. His tumours had even shrunk and he was diagnosed from the hospital.

    The placebo effect can occur from the patient (or participant)’s conscious belief in a drug, so if they convince themselves that it’s going to have an effect then it will. The placebo effect can also be an effect of the person’s subconscious associations between recovering and the experience of being treated.

    😀

    http://www.scientificamerican.com/article.cfm?id=placebo-effect-a-cure-in-the-mind
    http://www.what-is-cancer.com/papers/newmedicine/placeboandcancer.html

    Reply

  11. larabarker
    Feb 08, 2012 @ 16:44:34

    The placebo effect can be described as a positive change in health, which is not as a result of medication or treatment. However it can de difficult to determine the reasons for this improvement in health. One reason, as mentioned in the above comment suggests that your brain persuades your body to get better by altering your internal state so that the problem area becomes less problematic through a reduction in pain for example. There are other possibilities for an improvement in health after taking a placebo, which have nothing to do with it. It could be a spontaneous improvement or recovery. It could also be due to regression to the mean, a reduction in stress or even classical conditioning. While placebo’s are seen to have a positive effect most of the time, it could be something else causing this effect but it’s assumed to be the placebo.

    Info from: http://www.skepdic.com/placebo.html

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  14. emily2904
    Feb 09, 2012 @ 18:58:21

    I believe that the trues effect of the placebo is sometimes affected by todays ethical considerations. For example as a psychology students, we are all aware that it is not ok in a degree study to supply the participants with an actual drug. When partaking in experiment i think we too are aware of this, and it will effect our performance in the study.
    This is to say that surely the situation will effect also how effective the placebo effect will be. Just as the effectiveness of Milgrams study was down to how convincing the participants found the set up of the experiment. One of the most effective tools proving to be Milgrams lab coat.
    Also what the placebo is meant to be effecting is a contributing factor, and it will only ever really effect the participants behaviour, or mental state about such effects.
    I believe that to make a placebo truly effective and measurable, the situation should be highly convincing and what the placebo is effecting something the participants believe can actually be altered, Such as we know we can get rid of a headache with a pill, we don’t generally know that we can improve memory indefinitely with a pill. (even though i’m sure the marketing con is out there somewhere)

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  17. psuc2c
    Feb 10, 2012 @ 20:20:49

    I agree that placebos sometimes can effect the outcome of an experiment due to the placebo and nocebo effects that you mentioned. But if the participants are told (as they should be) that some of them will receive the placebo then participants should be aware that there is a chance that nothing will happen hopefully reducing the chance of these effects. The nocebo effect is an interesting one, also one that I was not aware of before I read your blog and when the actual drug may be cause problems then it should be stressed to the participants that they will not have these effects if they happen to be in the placebo group. I think that the use of placebos is effective but should be managed in such a way that participants are less likely to show placebo or nocebo effects.

    Reply

  18. PSUD00
    Feb 10, 2012 @ 21:02:52

    I agree that that use of placebos can cause a lot of issues ethically. It is a form of deception when a placebo is used, even if you are told there is a possibility that you would get one, simply because you do not know if you are taking a placebo or a real drug. This may be a necessary deception to test the effectiveness of a drug, but even this can open us new issues. Looking at your example of the AIDS patients, it seems unfair that some patients would receive medical treatment that has the potential to cure or improve their condition while others were given a placebo that would have no real effect.
    However, there are cases where prescribing a placebo may be desirable. Although a placebo should have no effect they do show evidence for a “mind over matter” cure of issues. Many people that have taken a placebo say that they feel better or happier or in less pain though there is no cause for this. It is simply the act of taking something that they believe may be a real drug that should help them that causes them to feel better. Dr. Kenneth M. Prager has argued that in some cases placebos are desirable. He argues that within the medical world there are countless doctors that will run unnecessary tests on a patient simply to make them feel better once the possibility of something being wrong is removed. This is very similar to prescribing a placebo that will have no effect just to soothe a patient. Also, allowing a patient to take a placebo that causes no harm but may cause the patient to feel better may be very useful when all other options have been exhausted. (http://www.acsh.org/healthissues/newsID.678/healthissue_detail.asp)
    According to the guardian, In Bavaria “88% of GPs have sent patients home with prescriptions for placebo drugs” as they can prove to be highly effective treatments in some cases. They can maximise the effect of medication and reduce side effects. Also when placebos were used to treat depression they were as effective as anti-depressants in a third of cases. (http://www.guardian.co.uk/science/2011/mar/06/half-german-doctors-prescribe-placebos)

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  20. ksgs
    Feb 17, 2012 @ 15:33:26

    An interesting topic. I enjoyed reading it!! 🙂
    In modem times the idea of placebo originated with H. K. Beecher. During he evaluation of fifteen clinical trials concerned with various diseases, he found that 35% of 1082 patients were relieved by placebo alone satisfactorily (The Powerful Placebo, 1955). There are also some other studies thats showed that placebo were effective in 50% to 60% of subjects with certain conditions, e.g. depression, pain,etc.
    As usual there were arguments against the evidence of effectiveness of placebo by some like Kienle and Kiene (1997).

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