Lewis – Year 10 Student
Editor’s note: Interested in studying medicine, Lewis, now in Year 11, has researched and written about the well-known but perhaps less well understood placebo effect. CPD
Overview of Placebos
Placebos are a means of testing the effectiveness and the usefulness of a drug and / or ailment. The ‘placebo’ itself has been used since the 16th  century as a means of ‘treating people’ from illness when genuine medicines were not available. ‘Placebo’ means ‘I shall please’ in Latin, linking to the frequent placebo effect that is often associated with it. In medicine, predominantly pharmaceuticals, when testing a new drug, half of the test subjects are given a placebo (an inert drug) and the other half are given the real thing. The idea behind this is that subjects will not know whether they have had the drug so any form of bias or false allegations about their body’s response to the drug will be proven to be genuine or not based on whether the subject has taken a drug or placebo. The test is most often blind so that the patients do not know whether they are getting a fake or a real drug. Rarely, it can be a double-blind test in which the professionals administering the drug aren’t aware of which they are giving out.
The Placebo Effect: Genuine or Fake?
The placebo effect has been determined as a psychological phenomenon where people that have taken an inert drug have experienced similar effects as the subjects that have taken the real drug. This could be one of the reasons why people claim homeopathy works. For example, heart rate, blood pressure, anxiety levels, pain perception and fatigue have all been reported to change with the consumption of the fake drug. In 2014, Kaptchuk for the Science Translational Medicine led a study where one third of people took a placebo migraine tablet, another third took a real one and the other third took nothing. The results showed that the people who took the placebo found that it was 50% as effective as relieving pain as the legitimate drug. There are two theories for this:
- People are simply claiming that they are experiencing these symptoms and there is no scientific proof behind it;
- There is a belief that people’s expectation of becoming well having thought they have taken the real drug stimulates physiological factors that relive their symptoms by releasing endorphins and dopamine, changing blood pressure and increasing heart rate.
However, there can sometimes be negative effects surrounding the placebo. Some individuals have reported to feel negative side effects such as headaches, nausea or dizziness. This other side to the placebo effect is referred to as the ‘Nocebo Effect’ .
The Positives and Negatives of using Placebos
The placebos are very useful for the purpose of testing the effectiveness of drugs; however, they can come with both physical and ethical negatives.
- With the placebo effect, some people can experience effects that make them relieve their illness for a certain amount of time;
- Medics can trial new drugs without the worry of people faking or any bias;
- People can test to see if the placebo effect can be used in other fields of medicine.
- People (because of experiencing the placebo effect) may feel that they don’t need to stay on their genuine medication anymore;
- It may not be considered ethical to some to fake having done something to someone (mainly placebo in surgery);
- The placebo effect doesn’t last long so if any pain relief occurs, it is short-lived;
- People can experience ‘nocebo’.
Overall, are placebos a success?
The use of placebos in medicine is a very useful way of testing the legitimacy and usefulness of a drug. The extent to which they are considered ethical is still very blurred as consent isn’t always given with the knowledge of a possible placebo; however, the placebos themselves cause no physical harm.
The placebo effect, however, is very much in its preliminary stages with most scientists knowing little about the phenomenon which causes these symptoms. A review of over 150 clinical trials showed that placebos had no major effect on illnesses. However, a review 10 years later found that in similar populations, placebos as well as treatments had similar effects. Therefore, the true meaning behind this placebo effect is yet to be discovered.
4) Howick J, Friedemann C, Tsakok M, et al. Are treatments more effective than placebos? A systematic review and meta-analysis. PLoS One. 2013;8(5):e62599. doi:10.1371/journal.pone.0062599
5) Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions Cochrane Database Syst Rev. 2004;(3):CD003974. doi:10.1002/14651858.CD003974.pub2