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The placebo effect.

Article Excerpt
JANE D. WAS A REGULAR VISITOR TO OUR ER, usually showing up late at night demanding an injection of the narcotic Demerol, the only thing that worked for her severe headaches. One night the staff psychiatrist had the nurse give her an injection of saline instead. It worked! He told Jane she had responded to a placebo, discussed the implications, and thought he'd helped her understand that her problem was psychological. But as he was leaving the room, Jane asked, "Can I get that new medicine again next time instead of the Demerol? It really worked great!"

What's going on here? What is the placebo effect and how does it work?

The term "placebo effect" is unfortunate; it leads to misunderstandings. Placebos themselves don't have any effect. They are inert: that's what placebo means. The word placebo comes from the Latin for "I please." You can think of it as the opposite of "I benefit." What we really mean by "the placebo effect" is not some mysterious effect from giving an inert treatment, but the complex web of psychosocial effects surrounding medical treatment. Those effects occur with effective treatments too, not just with inert treatments.

Mark Crislip, MD, thinks the placebo effect is a myth. "I think that the placebo effect with pain is a mild example of cognitive behavioral therapy; the pain stays the same, it is the emotional response that is altered ... Ain't no such thing as a placebo effect, only a change in perception." (1) He's correct in saying that the placebo effect does nothing to change the pain signals in the nerves. But most people think the change in perception is the placebo effect and is worth pursuing.

There is a big difference between pain and suffering. A woman's labor pains hurt, but with a joyful end in sight she may not suffer as much as a man who has milder pain sensations but is worried that his injured leg may need to be amputated. Some people say that morphine doesn't relieve pain so much as make you not care about it. The experience of pain and the meaning of pain for the patient matter as much as the strength of the pain stimulus. If the placebo effect can do anything to divert the patient's attention or help him reframe the meaning of his pain, his altered perception can reduce his experience of suffering.

Beecher Says Placebos Are Powerful

In 1955, Dr. Henry Beecher published a seminal paper entitled "The Powerful Placebo" in the Journal of the American Medical Association. (2) He reviewed studies that compared an active treatment to a placebo, and found that on average 35% of patients improved with the placebo. So any study that doesn't have a placebo group for comparison is likely to give a false positive result. The placebo-controlled trial is now one of the cornerstones of medical science. It's...

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