Placebo, the elephant in the room

“A placebo is anything that seems to be a “real” medical treatment — but isn’t. It could be a pill, a shot, or some other type of “fake” treatment. What all placebos have in common is that they do not contain an active substance meant to affect health.”

WebMD.com

“A placebo is a medical treatment or procedure designed to deceive the participant of a clinical experiment. It does not contain any active ingredients but often still produces a physical effect on the individual.”

medicalnewstoday.com

“A placebo is a substance or treatment of no intended therapeutic value.”

wikipedia

“A remarkable phenomenon in which a placebo — a fake treatment, an inactive substance like sugar, distilled water, or saline solution — can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful. Expectation to plays a potent role in the placebo effect. The more a person believes they are going to benefit from a treatment, the more likely it is that they will experience a benefit.”

medicinenet.com

What is placebo?

The above are quotes from well respected online medical resources, they appear to be universally dismissive of placebo. Indeed for many years, the placebo effect was considered to be no more than a nuisance variable that needed to be controlled in clinical trials. However placebo has started to gain more interest in the last few years with programs like BBC Horizon investigating placebo with Michael Mosley. Research from top universities such as Harvard and Cambridge is helping. Books such as Doctor You by Jeremy Howick also lend credibility to a growing change in beliefs about placebo. Importantly researchers are starting to redefine it as part of the key to understanding the healing that arises from medical ritual, the context of treatment, the patient-provider relationship and the power of imagination, trust and hope.

Placebo fascinates me. It has done ever since I was a humble first year at chiropractic school and I was part of a group presentation on “The Power of The Placebo”. No, actually placebo has fascinated me ever since I started to investigate chiropractic as a career choice. Through my internet searches came across the term “Innate Intelligence”.

Is placebo ethical?

Unfortunately it has been considered to be ethically questionable to give someone ‘medication’ or treatment that you know to be a placebo. However,  just because the prescriber knows that there is no active ingredient does not mean that it is unethical – the prescriber knows that it has as much likelihood of being effective in treating the patient as a drug with an active ingredient. The placebo has the advantage of having a much lower risk of causing harm. So, in fact, it would be unethical NOT to try a placebo treatment before prescribing potentially toxic drugs that have a long list of side effects. After all a doctors mantra should be ‘do no harm’.

What the research says

Studies on the effectiveness of placebo at Harvard University found that a placebo treatment is effective even when the patient knows that they are receiving a sugar pill as long as they are told confidently that the treatment will most likely help reduce their symptoms (which we know it will because hundreds of placebo controlled trials have shown that placebo has equal benefits to drugs with active ingredients).

The elephant in the room

Complementary health professional like chiropractors don’t like to talk about placebo, in case it undermines our credibility. It is sometimes a criticism of our profession – that what we offer is a placebo treatment. We don’t really help ourselves when we happily talk about empowering innate intelligence, as this does sound a little bit woo. However, when you think about it, innate intelligence is really just placebo with a more fluffy name. The power of understanding and holding positive belief systems as well as feeling supported and cared for should not be underestimated when it comes to health and recovery. Chiropractors should be very happy to lavish on healthy doses of placebo with every treatment they deliver. I want my patients to get better as quickly as possible so I use all the tools at my disposal to assist them on their journey to health and wellbeing.

Links and references

http://news.harvard.edu/gazette/story/2010/12/placebos-work-%E2%80%94-even-without-deception/

http://www.theglobeandmail.com/life/health-and-fitness/health/the-placebo-effect-a-new-study-underscores-its-remarkable-power/article16281897/

http://stm.sciencemag.org/content/6/218/218ra5

Doctor You by Jeremy Howick http://www.jeremyhowick.com

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