A placebo is a sham or simulated medical intervention by a doctor in which some patients experience actual improvements in their conditions. Although it doesn't work on everyone, these effects in patients are, by definition, non-drug/non-chemically induced effects. Scientists have even demonstrated that how the patient views a placebo (e.g., color or size of drug, packaging, price of drug, advertisement associated with drug) will make the placebo more or less effective (e.g., a higher priced placebo will have better results than a lower priced placebo).

There are even recent studies that prove drugs like antidepressants perform no better than placebos on most clinical situations that involve mild to severe depression. So if, in some cases, placebos and certain drugs are on par in delivering clinical benefits, what's going on?

And don't think that this happens only with drugs in psychiatry. For example, there are actually studies that even "sham surgery" can have real effects (i.e., real surgical procedures). As we've also discussed previously in this forum, bad sex has also been proven to be all in your head as one-third of women having sexual problems experienced a placebo effect from sugar pills.

Placebos aren't typically used in clinical care - or at least they're not supposed to be - because it's considered "bad form" on the part of physicians. Although physicians do use placebos, they don't discuss it much. Many consider the use of placebos unethical.

Do you think there are ethical issues to giving placebos to patients? Taking a consequentialism (i.e., the ends justify the means) viewpoint, is it ethical to give a patient a placebo if it works? Are doctors being deceitful using placebos? Should we continue to give monopolies to drug companies when some of their drugs don't even work? In what circumstances is it proper to use placebos? Do you think that our beliefs can yield physiological effects? Could this help explain why alternative medicines sometimes work?

A recent survey, led by McGill Psychiatry Professor and Senior Researcher at the Lady Davis Institute (LDI) at the Jewish General Hospital, Amir Raz, reports that one in five respondents - physicians and psychiatrists in Canadian medical schools - have administered or prescribed a placebo. Moreover, an even higher proportion of psychiatrists (more than 35 per cent) reported prescribing subtherapeutic doses of medication (that is, doses that are below, sometimes considerably below, the minimal recommended therapeutic level) to treat their patients.

Prescribing pseudoplacebos - that is treatments that are active in principle, but that are unlikely to be effective for the condition being treated, e.g., using vitamins to treat chronic insomnia - is more widespread than we may have thought according to the survey. Dr. Raz and his colleagues suggest that this may be because physicians have shown themselves to be more prepared to prescribe biochemically active materials even though at lower doses than might be effective.

The survey, which was also designed to explore attitudes toward placebo use, found that the majority of responding psychiatrists (more than 60 per cent) believe that placebos can have therapeutic effects. This is a significantly higher proportion than for other medical practitioners. "Psychiatrists seem to place more value in the influence placebos wield on the mind and body," says Raz. Only 2 per cent of those psychiatrists believe that placebos have no clinical benefit at all.

The power of placebos

DISCUSS!

Original posting by Braincrave Second Life staff on May 22, 2011 at http://www.braincrave.com/viewblog.php?id=560