The ‘placebo effect’ may be described as a phenomenon where the symptom of a patient may be modified by ineffective treatment. Essentially the patient has been seen to receive some form of treatment that he or she believes will work. This is a psychological response that can reduce stress and panic thereby leaving the body’s true immune system with an improved chance of working. Placebos are not a cure but merely help to place the patient in a more relaxed and receptive state for treatment. In this regard all medicines essentially provide what is known as the ‘placebo effect’. In general terms the placebo has a positive impact if managed by physicians in a proper and responsible way. This is because stress and anxiety are known to affect the body in an adverse manner and possibly make the symptoms worse.
Researchers have found that large dummy placebo pills that are coloured seem to stimulate a more positive response from the patient’s. The important point to emphasise is that the ‘placebo effect’ is practiced in all medicines and whilst some consider it to be a bogus form of treatment, nevertheless, it accomplishes more good than harm. Counter arguments state that the feel good generation is purposely misleading and could create more serious conditions. The argument is somewhat flawed as very rarely is it ever used as a standalone form of treatment but more a precursor to getting a patient stabilized in a relaxed and more receptive state in order to receive proper medical attention.
The arguments of the placebo effect
Those arguing against the use of the placebos normally present the following arguments:  Introduction of the ‘Nocebo effect’ whereby patients state that they experience side effects from the in ineffective treatment [placebo]. In most cases this is restricted to clinical trials where placebos are used to test against real medicines.  The placebo response of a pain reduction may obscure the real disease and lead towards misleading information to the physician and thus return an incorrect diagnosis of the problem. This can be serious as the wrong course of corrective treatment may be prescribed  the illusion effect where the patient is led to believe that the bogus remedy may have worked. This in turn may result in an incorrect or wrong course of treatment to deal with the problem.
The medical journal ‘The Lancet’ provided on an article that stated “a new analysis of 110 placebo-controlled randomized trials of homeopathy, indicated there is no evidence that homeopathic tablets perform any better than placebos” (Goldacre 2006)  . Modern medicine has moved towards better patient relationships keeping the patient informed and moved away from the old paternalistic placebo doctrine. Most doctors are uncomfortable with dishonesty and perhaps this is one of the key distinctions against that of the homeopathy practitioners.
Adam Harrington stated in Hoboken that “the placebo is much more ado about nothing – the answer is NO because of the powerful therapeutic effects and YES because of the faddish exaggerations about placebo power.” (Harrington 1999). The term placebo is Latin and originated from the Catholic vespers for the dead and translated means I shall please. They emanate from the early medical practices where medical practitioners were unable to diagnose a specific illness and used a placebo essentially to buy time in order to allow additional medical investigations to take place. It was Arthur Shapiro  who reminded everyone in the 1960s that the physicians themselves were important placebos in their own right i.e. people were comforted by the fact of having an experienced medical practitioner take control of their medical issues.
Positive claims for placebos have been made by Dr. Robert Buchman  and Karl Salsbugh “they seem to have effect on almost every symptom known to mankind”, whereas Arthur Shapiro was much more sceptical stating placebos could have a permanent effect on medical disorders.” (Evans 2004)
One of the most convincing positive arguments for placebos resulted from the work of Dr. Henry Beecher  who was the American anaesthetist who treated US soldiers in a field hospital in World War 2. In one instance he was treating a soldier with bad injuries and was considering morphine as a pain killer but he was concerned about cardio vascular shock. Instead he put the soldier on saline solution and the result was the patient settled down, he felt less pain and the reaction was similar to morphine. It seemed that salt water could be as effective as morphing considered one of the most powerful painkillers at the disposed of the medical practitioners. Beecher later repeated the trick with the same results and after the war returned to Harvard University to continue his research. Similar studies were being carried out at Cornell University. The subsequent studies carried out by Beecher, gold and lasagne change the way the medical profession viewed placebos and by the mid-1950s doctors were thinking of this as their longer a fraudulent practice. (Evans 2004)
Figure : Total Drug Concept by ClaridgeThe complementary practitioners of alternative medicines have advocated that mainstream medicine should become more inclusive and doctors need to incorporate some of these methods into the overall approach to healing. The placebo should no longer be considered as a fake treatment but used where it may influence possible positive outcome on patient care. A model developed by Claridge (Peters 2001). In 1970 required a useful insight into close examination of the placebo effect [Fig 1 refers]. Here he separated the drug out into its very opponents;  the drug itself – color, shape, form, brand and attributes  the prescriber – attitude, beliefs, competence, and authority.  The recipient – the psychological side suggested intelligence, personality etc.  selling and clinical side – hope, clinic, hospital [physical settings]. Hence the doors former placebo is that so these items without the pharm logical presence of the drug. The concept of belief is considered a vital component towards a positive outcome of all forms of medical treatment i.e. Belief in the success of the treatment towards a positive outcome and the expectations in the efficiency of that treatment.
Belief lies very central to the persuasive ultimate for the use of placebos. The fact that placebos act on the mind creates an important psychological consideration in their applied use in medicine. Hence more studies in the use of the linkage to the neural system may be appropriate. The US government are taking placebos more seriously and recently the US Food and Drug Agency requires that “all new drugs undergo a double-blind, placebo control trial”. (Edin 2010). These testing different patient responses to the new drug with the controlled drug or placebo. Medical practitioners have stated that the placebo effect has already made significant contributions in the treatment of ulcers, postoperative pain, seasickness, headaches, colds, arthritis and hypertension. In the treatment of depression statistics have illustrated as high as 70% of relief has been achieved by the use of placebos. This would suggest that a lot more is going on here than pure deception. The belief concept may well influence the chemical releases within the body that are controlled by functions of the brain. Tests with depressive patients were conducted by doctors using brain scans and where there was an expectation by the patient that the condition would improve there was a marked increase in biological changes to the brain. Hence the biological stimulation of the brain is strongly linked to the potency of placebos. People who have been suffering postoperative pain have reported considerable improvement in pain reduction after a simple saline injection. These analgesic effects suggests suggest some form of reception by the brain; this has been referred to as “activation of the endogenous pain-relief system of the brain” (Connors W 2007). The brain itself manufactures morphine like substances called endorphins the brain can trigger or send these to those parts of the body experiencing pain. Hence placebos may be able to stimulate this part of the brain in order to enhance that stimulation process.
Placebo affects are not limited purely too chemical or drug treatments, they have also been included in both surgery and physiological therapies. A summary of the many literature works on placebos leads towards a number of preliminary conclusions:-  A significant number of patient show a therapeutic response from the administration of a placebo  There seems to be no uniform practice that sets itself out as a prescribed means of treatment in this area [ 3] It appears that any object with therapeutic intent can invoke similar circumstances  The mechanism of the effects remains relatively unknown and the conditions in which it operates are unclear. (Wickramsehera 1988)
The advantage that supports the use of placebos are essentially threefold:  the mind over matter concept – whereby the placebo acts as an assist to the body’s natural defence mechanism  the provision of a psychological boost or stimulus to the brain which may prove to be an important contribution to the overall recovery of the patient  A support to the central concept of ‘belief’ which is known to be a major contributing factor towards recovery.
The main disadvantages might be summarised as  In the area of chronic pain the patient may show an immediate spontaneous improvement and as such give cause to a false diagnosis of the problem  The element of deception may provide the patient with false hope or expectations and give rise to medical ethical considerations  The patient may provide the Doctor with erroneous information believing that the placebo has resolved the problem. This loses valuable time in the determination of the correct prognosis and could prove serious in certain cases.
There is also the strong argument that placebo’s can become habit forming. One example being the use of valium for strong headaches. These may essentially provide temporary relief but they are certainly not an ongoing solution. It is the unsettling notion that people are getting medical treatment from unqualified practitioners. The concept of non-medically trained people prescribing any form of placebo implies that the patient is ill and as such this can be a powerful message to the patient. The action of medication is not just controlled by the drug companies as the pharmaceutical companies have to undergo extensive clinical trials before they can release a product to the market place.
A lot of the controversy with the applied use of placebos is around the use of these in clinical trials. Many consider that the use of these is unethical but it raises the question as to whether the trials could be successful without them “Arguments against the use of placebo groups in clinical trials have been based on opinion rather than evidence. Ethical issues have been raised, but these are contentious.” (Martin Tramer 1998). The ethical consideration will continue to be debated in the medical profession but the continued use in clinical trials is likely to proceed at least for the foreseeable future “In clinical settings where no gold standard treatment exists and where event rates vary widely, trial designs without placebo controls are unlikely to yield sensible results” (Martin Tramer 1998).
The concept of Doctors saying the placebo is a nuisance variable has equally been contested by the medical profession – “There has been sharp disagreement on this point, due to the fact that medical literature includes a great deal of testimony that the placebo effect routinely works 30 percent of the time, with Dr. Herbert Benson of Harvard stating that it may work up to 90 percent of the time”. (World Research Foundation 2011).
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