Being lied to is not a good thing. At least, not for most things. In medicine, it is unethical for a medical professional to lie to a patient. There is, however, one good reason why some medical professionals have chosen to lie to their patients.
When doctors lied, it was to convince their patients that they were giving them medication (when it wasn’t medication at all) to ease their pain. Despite the fact that patients weren’t actually ingesting medical pills, they were still experiencing relief from their symptoms. This is what is known as the placebo effect.
You would assume then, that if a patient knew that the medication he is being given is not really medication, then there would be no placebo effect. Turns out, this is not the case. Researchers have found that even when a patient knows the pill being taken is there only as mock medication, the placebo effect is still experienced.
Professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, Dr. Ted J. Kaptchuk has been studying placebos for over 20 years. His most recent study is shedding lighting on this interesting phenomenon. Kaptchuk has been working on open-label placebos, where patients are aware that they are ingesting a "sugar pill".
In one particular study, Kaptchuk gathered people who suffered from irritable bowel syndrome (IBS). The participants of this study were told that they were being given open-label placebos. Despite the fact that they were getting a “sugar pill” and not proper medication, Kaptchuk saw a “dramatic” improvement in the participants’ IBS symptoms.
Even though there was a palpable change in the participants’ symptoms, Kaptchuk explains that placebos won’t work for every type of condition. Open-label placebos can’t lower a diabetic patient’s sugar level or cure chronic disease such as cancer. Placebos work on medical conditions that are described through “self-observation” such as queasiness and pain.
“People can still get a placebo response, even though they know they are on a placebo,” he says. “You don’t need deception or concealment for many conditions to get a significant and meaningful placebo effect.” This means that even when we know that we are taking sugar pills, we can still experience relief from pain.
One of the participants in Kaptchuk’s study, Linda Buannono, had been suffering from IBS for many years. At times, the pain was so bad she couldn’t leave her house. The open-label placebo helped Buannono significantly. “I never felt better in my life.” Of course, the minute the study stopped, and the open-label placebos, her pain was back and as bad as ever.
Although the study proved the effectiveness of open-label placebos, Kaptchuk says how more work needs to be done on these “sugar pills.” The doctor is conducting another study, this time at the Dana-Farber Cancer Institute studying fatigue caused by cancer. “If placebo works for chronic pain, explains Kaptchuk, it could allow patients to reduce their doses of opioid medications and help prevent addiction.”
There is an important reason why Kaptchuk is studying the effects of open-label placebos. “Our hope is that in conditions where the open-label placebo might be valuable, instead of putting people on drugs immediately — for depression, chronic pain, fatigue — that people would be put on placebo,” says Kaptchuk. “If it works, great. If not, then go on to drugs.
Senior researcher of placebo effects, epidemiology, evidence-based medicine at the University of Oxford Jeremy Howick is also studying the effects of open-label placebos. “I led a team that recently conducted a systematic review – considered to offer the highest quality evidence – containing data from five trials of open-label placebos (placebos that patients know are placebos),” Howick writes. “We found that open-label placebos seem to benefit patients with back pain, depression, allergic rhinitis, irritable bowel syndrome (IBS) and attention deficit hyperactivity disorder (ADHD).
Open-label placebos have been around for a few decades, Howick explains, “traced back to at least 1965.” Back then, two Baltimore doctors, Lee Park and Uno Covi, told 15 neurotic patients that they were handing them open-label placebos. They told them that “many people with your kind of condition have been helped by what are sometimes called sugar pills and we feel that a so-called sugar pill may help you too.”
These doctors were working with neurotics and the latter’s neurosis led them to believe that the doctors had lied to them. These patients thought they were being given real drugs. Most of the patients felt better.
14. Participants Were Fully Aware Of The Open-Label Placebo
Howick writes how the trials in his group’s “systematic review were all quite small and weren’t ‘blinded’. (Blinding is where the participants and/or the researchers don’t know who’s getting what.) In these types of trials, participants and researchers need to know who is getting the open-label placebo and who isn’t, so it’s not possible to blind them.”
“Trials that are not blinded are considered to be somewhat biased,” Howick writes. “However, the trials were consistently positive.” “We also know a bit about how open-label placebos work,” Howick adds, “suggesting that bias cannot explain away these results.”
There are two probable reasons why open-label placebos work. “The first is expectation,” Howick explains. “This positive suggestion creates a positive expectation, which can activate the reward mechanisms in the brain and help the body produce its own substances, such as painkilling endorphins.”
The second reason is conditioning. As Ivan Pavlov’s dogs would secrete saliva at the sound of the bell because they associated it with food, so do patients feel better with a sugar pill. “Even though we know a pill is a placebo, our bodies may react in a way that helps us heal. There have been several studies, including one in humans, showing that the immune system can be activated much in the same way that Pavlov’s dogs salivated at the mere sound of a bell,” Howick writes.
Even though open-label placebos have proved that they work, Howick writes that it would be “unwise” to start sending them out like Smarties. It could lead to a culture mentality of “pill-popping.” Still, “placebo effects are real for many common conditions,” Howick writes, “and we can benefit from placebo effects without actually using placebo pills. Doctors who give positive messages and take time to communicate with enhanced empathy to patients can have positive benefits whether or not they give pills. Far from being unethical, since placebo effects can benefit many patients it is probably unethical not to exploit them.”