How would you respond if you found out that your doctor has been prescribing a placebo for your condition? According to Dr. Howard Brody at the University of Texas Medical Branch, Galveston prescribing drugs like antibiotics or supplements like vitamins as placebos is now a widespread practice. Brody is the John P. McGovern Centennial Chair in Family Medicine and Director of the Institute for the Medical Humanities at the University of Texas. A placebo is a substance like a sugar pill which is not medicine, and which doctors don’t expect any health benefits from. It’s often given to patients who demand medication when none seems necessary. For years, doctors thought that placebos like sugar pills were totally inert, just something to be given out to mollify a demanding patient without any expected health benefits, writes Brody for Discover Magazine. But, here’s the thing. Over time physicians and medical researchers came to realize that such treatments can sometimes cause substantial improvement of symptoms, even when there’s no chemical or other biomedical explanation for what occurs—a phenomenon called the placebo effect, says Brody. Here’s the key point that you may not be aware of. According to a commentary in the Journal of Medical Ethics, a summary of the data from recent surveys of the use of placebos in clinical practice in several nations shows that the prescription of drugs like antibiotics or supplements like vitamins as placebos is now a widespread practice. And this is not all–it is happening without any public guidelines or regulations for placebo use, which raises an important question: How, exactly, should physicians be using the placebo effect to help patients? The understanding of the placebo effect is changing In the past, doctors thought that that placebos were completely inert and ineffective and that if any good effect occurred, it was only in the patient’s imagination. The newer surveys, reports Brody, show a big change in physician thinking about mind-body relations. Physicians today generally agree that placebos can actually have a positive effect on the patient’s body, and that mind-body medicine “works.” If placebos work, what are the implications for daily medical practice? Is it okay for doctors to now prescribe “impure placebos”—like antibiotics or vitamins given to people without bacterial infections or vitamin deficiencies? What about you, the patient? Shouldn’t you be told that you are being given a placebo? The problem with prescribing so-called impure placebos, is that they sow false ideas, says Brody, for instance that antibiotics are good for colds or that everyone should take vitamins for extra energy. There are also real risks—several of the categories of impure placebos favored in some of the recent surveys, namely antibiotics, sedatives, and analgesics, can cause serious adverse reactions. “Most studies of the placebo effect suggest that it’s an iffy sort of thing; it may occur when you want it to, or it may not. To expose a patient to a low but real chance of harm to secure an uncertain benefit seems highly questionable, especially without something resembling real informed consent or shared decision-making,” says Brody. Where to from here? The effectiveness of placebos depend on patients’ understanding that the placebo intended solely for its mind-body effect. To create the right mind set in the patient so the placebo will have the desired effect in the body, Brody outline several conditions in his book The Placebo Response: How You Can Release Your Body’s Inner Pharmacy for Better Health. For the placebo to work, the physician would listen carefully to the patient and be sure to explain the patient’s medical problem in easily understandable terms; would demonstrate care and concern while doing so; would help the patient feel more hopeful about and in charge of the bothersome symptoms; would do everything possible to create positive expectations about the effects of the treatment. “All these are proven ways to turn on the mind-body pathways that we believe to be implicated in the placebo response,” asserts Brody. So why all the deception? Why not go through the above procedure no matter what is being prescribed? This is exactly Brody’s point. “It does not matter whether the preferred treatment for the condition is a pill or other therapy that really works via chemical or physiological means; or just waiting it out and drinking lots of fluids; or getting more exercise. Whatever treatment—pharmaceutical or otherwise—that the physician is going to recommend, it can be accompanied by the same mind-body ‘pep talk’. What is the takeaway here? Many doctors today realize that placebos can actually have a positive effect on a patient’s body, so they are prescribing them and you are probably at the receiving end of this new practice without realizing it. Source
