4 thoughts on “Placebo Medicine”

  1. Thanks for the link, Gem…..

    although I agree with Novella’s central thesis….promoters and stakeholders in CAM are essentially shifting the goalposts, and by stressing the potential role in which complementary/alternative therapies may play in harnessing the power of the placebo effect, are trying to save their seat at the table of medical legitimacy…..

    Still…..there are portions of this piece where Novella unfortunately uses straw-man arguments to bolster his case….take the example of the comparison of albuterol to placebo for the treatment of asthma….yes, there is a disconnect between the magnitude of the subjective benefit and the objectively measured outcome among subjects who received placebo…..but I don’t think many right-thinking physicians are looking to use placebos for the treatment of asthma…..

    however, there are numerous medical conditions which are not life threatening, are diagnosed purely on the basis of patient-reported symptoms, and negatively impact quality of life…..as examples, consider fibromyalgia, irritable bowel syndrome, migraine headaches, chronic fatigue syndrome……for many of these conditions, there are no effective medical therapies, or the medical therapies which are availbale have themselves not been vigourously tested, or have only marginal benefits in most patients…..As a physician, it is my responsibility to try to reduce their symptom burden and improve quality of life…once again, we’re not talking about herbs instead of chemotherapy, or Reiki in place of an angioplasty……there are no medical therpaies to be withheld, or all other reasonable options have been exhausted….then what?

    Patients with irritiable bowel syndrome and related functional gastrointestinal syndromes easily comprise 75% of my practice……..and many of them approach me asking what I think about a variety of alternative therapies (most commonly probiotics, but occasionally other types of naturopathy, acupuncture, etc)….and while the skeptic in me would really like to put the kibosh on any type of unproven therapy, the physician recognizes this as a potetnial opportunity to harness the placebo effect……while I don;t directly endorse any specific therpay, I do provide permission in a way to explore unproven options (with cautions about avoiding potentially harmful therapies, and reminding patients to be mindful of their wallets….

    in any case, I’d be curious what Dr. Novella’s approach would be for the patients in his field for whom proven medical options are unavailable or trialed and failed……

    laura

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    1. The idea of placebo medicine certainly does have interesting ethical implications. I’d recommend asking Dr. Novella.

    2. Ah! I see that you did!

      For interested bystanders, Dr. Novella’s brief reply can be found here:

      Even for subjective symptoms – placebo effect may be mostly statistical effects and reporting bias – not a real (if subjective) improvement in symptoms.

      Those studies that have tried to separate out the various placebo effects indicate that a real subjective improvement is a small component of the placebo effect and is generally short-lived.

      In any case – whatever component of the placebo effect for subjective symptoms is useful can be gotten with science-based treatments. You don’t need to lie to patients or pretend magic is real.

      Laura then responds again here.

      This is an interesting topic, and one in which I have no expertise. I recommend that interested parties follow the discussion over at Neurologica.

  2. Apparently there are placebo’s that are made to give side-effects as this alters the expectations of the patient and by extension the effect the placebo has. I forget what the two types are called unfortunately.

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