Have you ever taken your mother’s sacred herbal tea for a common cold and felt much better only to find out later onward that there was really nothing special in that tea?
Well, you’re not alone. The placebo effect — defined as a beneficial effect produced by an inert treatment that occurs due to a patient’s expectations — can be powerful.
One extraordinary example, discussed in the Journal of Projective Techniques, describes a patient who was diagnosed with an advanced, terminal cancer called lymphosarcoma [1]. All previous treatments had failed with the patient, Mr. Wright, and he had tumors all over his body. When a new drug called Krebiozen was released, Mr. Wright begged his doctor for the treatment. Despite his doctor concluding that Mr. Wright was too sick to qualify for the treatment, Mr. Wright’s persistence finally swayed his doctor. Dr. West injected the drug into Mr. Wright on a Friday. On the following Monday, Dr. West was surprised to find that Mr. Wright’s tumors miraculously halved, and within ten days Mr. Wright was discharged. Yet, in the next two months, many clinical trials reported no beneficial results with the new drug. Upon reading this, Mr. Wright lost hope in his treatment, and his cancer subsequently returned. Dr. West, in an attempt to continue what he hypothesized to be the placebo effect, told Mr. Wright that a new batch of Krebiozen was ordered. It was supposedly more concentrated and effective, which gave Mr. Wright some hope. This time, Dr. West injected Mr. Wright with water. His second recovery was even more dramatic.
Within a few days, his tumors disappeared, his chest fluid vanished, and he could move again. Unfortunately, when Mr. Wright found out that the American Medical Association definitively concluded Krebiozen to be ineffective, he lost all faith in the drug.
His tumors returned, and he died two days later. While this story is one of the more extreme examples of the placebo effect at work, it still raises the important question of whether the placebo effect can be actively implemented in a clinical setting.
There are those who argue no for several reasons. For one, clinical studies that show the potential efficacy of placebo effects may be flawed because they do not consider the fluctuation of symptoms and the effects of natural healing [2]. For example, the February 2007 issue of Prescrire stated that, “it can be estimated that without treatment, 50-70% of cases of simple acute cystitis resolve spontaneously, usually after having been asymptomatic for several months [3].” Those clinical studies may have also neglected to consider the limited sample sizes [3], the patients’ subjectivity and honesty in reporting symptoms [2], as some patients may feel obligated to say they feel better, additional minor treatment along with the placebo [4], and scaling bias [4]. Additionally, there could be misrepresentation in the reports, especially if the studies do not cite the full statistical outcome. For instance, a 1941 study claimed that 20% of the patients with angina pectoris were successfully treated with placebos, despite the fact that 72% of the patients also got worse [4].
One may also argue against implementing the placebo effect by highlighting that its effects may be temporary and inconsistent [5]. Using a placebo as treatment may be viewed as unethical because the placebos have not been clearly shown to ameliorate symptoms.
On the other hand, one may also argue that the placebo effect should be implemented more often because actual medicine may not even be effective compared to placebos. A study in the UK actually found that in a survey of 800 physicians, 97% already prescribe impure placebos, defined as real medications that are unlikely to have an impact [6]. If these medications are unlikely to benefit the patients, one may argue that the doctors may as well prescribe placebo pills with no active ingredients instead since they are less costly and would result in less medication sideeffects. Additionally, to counter arguments claiming that placebos are deceitful and unethical, some studies show that warning a patient beforehand that they will be receiving a placebo may still be effective in treatments. In one experiment, 74 cancer survivors experiencing fatigue were randomly assigned into either a group with a placebo treatment or a group with actual medication. The patients in the placebo group reported a 29% improvement in fatigue severity and a 39% improvement in the quality of life, despite being told beforehand that they would be taking placebos [7]. If placebos could be useful even when patients are aware of their use, ethical concerns would no longer be a hindrance. It is also important to note that ultimately, the placebo effect does not need to be an isolated treatment, but can be incorporated as part of the healing and treatment process.
In fact, there are actually several ways to evoke the placebo effect, which include strengthening the physician-patient relationship, reassuring the patients, and speaking positively about treatments. By making the clinical environment more soothing and safe, the effectiveness of the placebo effect can actually increase from 42% to 82% [8].
While there are certainly many reasons to carefully examine the placebo effect, its causes and effectiveness, it may also be beneficial to consider integrating it into the treatment process for better outcomes.
After all, that tea did help you, didn’t it?
References
1. Klopfer, B. (1957). Psychological Variables In Human Cancer. Journal of Projective Techniques, 21(4), 331–340. https://doi.org/10.1080/08853126.1957.10380794
2. Placebo, Are You There? | Science-Based Medicine. (2015, February 24). https://sciencebasedmedicine.org/placebo-are-you-there/ von
3. Wernsdorff, M., Loef, M., Tuschen-Caffier, B., & Schmidt, S. (2021). Effects of open-label placebos in clinical trials: A systematic review and meta-analysis. Scientific Reports, 11(1), 3855. https://doi.org/10.1038/s41598- 021-83148-6
4. Kienle, G. S., & Kiene, H. (1997). The Powerful Placebo Effect: Fact or Fiction? Journal of Clinical Epidemiology, 50(12), 1311–1318. https://doi.org/10.1016/S0895-4356(97)00203-5
5. Maher, C. G., Traeger, A. C., Abdel Shaheed, C., & O’Keeffe, M. (2021). Placebos in clinical care: A suggestion beyond the evidence. Medical Journal of Australia, 215(6), 252-253.e1. https://doi.org/10.5694/mja2.51230
6. Howick, J., Bishop, F. L., Heneghan, C., Wolstenholme, J., Stevens, S., Hobbs, F. D. R., & Lewith, G. (2013). Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners. PLoS ONE, 8(3), e58247. https://doi.org/10.1371/journal.pone.0058247
7. Hoenemeyer, T. W., Kaptchuk, T. J., Mehta, T. S., & Fontaine, K. R. (2018). Open-Label Placebo Treatment for Cancer-Related Fatigue: A Randomized-Controlled Clinical Trial. Scientific Reports, 8(1), 2784. https://doi.org/10.1038/s41598-018-20993-y
8. Bystad, M., Bystad, C., & Wynn, R. (2015). How can placebo effects best be applied in clinical practice? A narrative review. Psychology Research and Behavior Management, 8, 41–45. https://doi.org/10.2147/PRBM.S75670
9. The importance of placebo effects to medical care. (n.d.). ScienceDaily. Retrieved March 15, 2022, from https://www.sciencedaily.com/releases/2015/07/150701171704.htm