The Placebo Effect

If you have read Paulo Coelho’s Veronica Decides to Die, you would have possible found a literary illustration of one of the most miraculous methods of healing called the Placebo Effect. In this, the doctor treats his patients with ‘fake’ medicines and yet cures them of manic depressions. The word Placebo comes from Latin meaning “I will please”. It can be defined as a therapeutic and healing effect of an inert medicine or ineffective therapy.

Basically, a placebo is an inert substance that has no inherent pharmacological activity. However, it looks smells and tastes like the active drug with which it is compared. Recall your biology lesson from school on the nervous system and then recall Pavlov’s experiment in which the dog salivated at the sound of hearing the bell even when he was not given any food. In a similar manner, patients who have had past experience of getting better with active medication may be conditioned to anticipate improvement by any subsequent prescription, where actually a placebo may be given. In reality, they are sugar pills that look like real pills but actually have no effect.

Placebo has always been administered by the doctors to patients who tell them that it is a powerful drug, when actually it is an inert drug. Shockingly, if one goes through the pharmacopeias, which is the list of the substances used as drugs, it will be discovered that most of them are actually placebos! So the question arises as to how many of these expensive drugs which we buy and hope to cure ourselves with may actually be, mere placebos. In fact, most of the doctors are not even aware of placebos!

Two ideal examples of the Placebo Effect can be described. One is the case when some scientists tricked runners into thinking that they were drinking oxygenated water when in reality, the runners were drinking regular tap water. It was observed that they actually performed better. This was because they believed that they were drinking oxygenated water. The same goes for the “sugar pill.” When people trick their bodies into thinking that they are sick, doctors may give them a basic sugar cube, disguised as a regular tablet of medicine. The patients assume that what they would be taking would make them feel better but really, they trick their bodies once more into getting beter.

It is rather strange that till now scientists have not been able to figure out how the Placebo functions. Nevertheless, the power of the Placebo Effect has led to an ethical dilemma. Any doctor’s aim is to render the patient free from his suffering. However, is using placebos, which mask the real nature of the ‘drug’ and deceive the patient ethical? I had an opportunity to talk to some doctors on this issue. According to them, it is justified to use a placebo in those types of cases where a strong placebo effect has been shown to have taken place and where distress is an aggravating factor. Most feel that as long as treatment is effective, what could be the harm of prescribing a placebo?

But at the same time we do have research evidence which shows that not all placebos are beneficial. There is an opposite effect called the nocebo effect which also comes into play. In the nocebo effect, recipients of the inert substance nullify the placebo effect by simply having a negative attitude towards the effectiveness of the substance prescribed. This is caused primarily due to the patient’s mentality towards his or her ability to get well, or even purely coincidental worsening of symptoms. In such a case, the patient-doctor relationship can suffer. It is also argued that administrating placebos can delay proper diagnosis and treatment of serious medical problems.

Hence it is necessary that even if we are moving towards applying Placebo effect in curing patients in day to day life, one should not overrule how it can counter attack its own functioning.

Ayushi Uberoi

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