By definition, a placebo is “a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any psychological effect.” While a placebo is used to create a mental state that does in fact promote well-being and healing, it can be argued whether it is “harmless.” Remedies for physical illness benefit from a positive mental outlook, at the same time a pessimistic outlook can make people feel increasingly sick. Even terminally ill patients can alleviate their suffering if they commit to a belief in their own cure. While no reputable physician would lay hands on a patient and advise him or her to assign a cure to a higher power, providing patients with a placebo has much the same effect in patients whose commitment to the curative power of the therapy is strong enough. The placebo effect effectively deceives patients into believing that they are receiving medication to heal them while leaving the actual work to their psychological systems. In addition to this, the inconsistency of studies regarding what’s called the placebo effect and the ethical issues surrounding the use of “illusionary medicine” by medical professionals create a moral ambiguity surrounding placebos and their uses.

The placebo effect has been around for many years, but with the use of deception and ignorance, people don’t even notice it. A placebo should cause “clinical improvement” according to the Journal of Neuroscience. Typically, this treatment is used for cases dealing with the psychological part of the body. People that benefit more from it usually have a sort of expectancy. They expect that whatever is inside this pill, will make their pain go away. When patients are unaware they are taking a placebo and believe they are taking “real” medicine, the placebo effect usually has a positive outcome. But what happens when they know it is a “fake” drug? Harvard Medical School Professor and Director of the Harvard-wide Program in Placebo Studies, Dr. Ted J. Kaptchuk did a study on people with irritable bowel syndrome (IBS). This is a condition that causes pain in the abdominal area and diarrhea or constipation. It is more a disorder than a disease because it’s not as severe. Half of the study is getting an “open-label” placebo, while the other gets no treatment at all. The results showed that there was a vast improvement with the placebo group’s symptoms even though they knew they were taking a placebo. This group also fell that their symptoms were lessened in severity and relief was much more prominent, which in turn improved the quality of life. So is it better for the patient to be given an “open-label” placebo or to not take one at all? Or is there a more beneficial effect on a patient who receives a placebo without their knowledge? According to the results of this study particularly, an “open-label” placebo gives patients a better benefit to their symptoms than ones who didn’t take anything at all. Keep in mind that this was a study for just IBS, which means not all open-label placebo treatments will work for every disorder or disease.

What happens when you give a placebo to a person with Parkinson’s disease? A disease that involves the central nervous system, motor functions and dopamine production. For this study, patients were given a placebo, but were told that it was an antiparkinsonian drug that would help with their movements. They were injected with a saline solution that had no confirmed effect. Neuronal activity in the subthalamic nucleus was recorded before and after the procedure. The people who felt an effect showed actual bursting activity of neurons in the body, while the non responsive group, didn’t show anything. Now this raises the question of does a placebo show psychological changes, which causes physiological relief? In other words, if a placebo is only supposed to be therapeutic, is it possible that a person’s mental abilities are strong enough to make themselves cured? Placebos may in fact just be dependent on each patient. The patient who has the desire to feel better will have more of a lasting effect than the one who doesn’t even when both take a placebo.

The Journal of Neuroscience did studies on different mechanisms of the placebo treatment. “The study of the placebo effect, at its core, is the study of how the context of beliefs and values shape brain processes related to perception and emotion and, ultimately, mental and physical health.” Fabrizio Benedetti says that if we want to see how a placebo affects a person in a psychosocial context, the placebo has to act as if it’s a real treatment. The patient will most likely listen to the doctor’s order, so a sham treatment is given to them in place of the real deal. In their mind, they believe it is effective. The response that the patient gives depends on each independent person. Since a placebo isn’t supposed to have any physiological outcome, it depends on the mind of the patient.

“It has been defined as the ‘positive physiological or psychological changes associated with the use of inert medications, sham procedures, or therapeutic symbols within a healthcare encounter'” according to Franklin G. Miller. There are many mechanisms on how to go about a placebo treatment. The most positive one in patients is the one referred to as “response expectancies.” Brain imaging techniques are being used to reveal the neurophysiological part of these expectations and the different mechanisms underlying placebo effects in many ways that depend on each individual. A National Institutes of Health requested applications that stated, “understanding how to enhance the therapeutic benefits of placebo effect in clinical practice has the potential to significantly improve healthcare.”

It is required to trick patients into thinking their health will improve. This creates an ethical concern for medical professionals. While some argue that placebos don’t require the use of malignant deception. The “major driving force” as Miller recalls is “response expectancy.” A common aspect of research focuses on deception. Some may say it is necessary to deceive patients by manipulating their expectations. The therapeutic outcomes reveal positive results after modifying patients’ assumptions. Both scientific methods and ethical standards are considered when using deception.

References

Benedetti, F., Mayberg, H. S., & Christian S. Stohler, J. Z. (2005, November 09). “Neurobiological Mechanisms of the Placebo Effect.” Retrieved from http://www.jneurosci.org/content/25/45/10390.short

Kaptchuk, T. J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., Singer, J. P., Lembo, A. J. (2010, December 22). “Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome.” Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015591#references

Marshall, M. (2016, June 23). “A placebo can work even when you know it’s a placebo.” (H. LeWine M.D., Ed.). Retrieved from https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926

Miller, F. G., Wendler, D., & Swartzman, L. C. (2005). “Deception in Research on the Placebo Effect.” PLoS Medicine, 2(9), 853–859. https://doi-org.ezproxy.rowan.edu/10.1371/journal.pmed.0020262