What is the "placebo effect," and how does it relate specifically to alternative medicine?

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A placebo effect occurs when a treatment or medication with no therapeutic value (a placebo) is administered to a patient and the patient's symptoms improve. The patient believes and expects that the treatment is going to work, therefore it does. The placebo effect is also a factor to some degree in clinically effective therapies, and explains why patients respond better than others to treatment despite similar symptoms and illnesses.

The placebo effect takes place when a patient is given treatment of medicine (often called a “sugar pill”) which has no actual therapeutic value, but the patient improves nonetheless. The pill or treatment “works” because the patient thinks that it will work, and therefore, it does.  Even when the treatment or drug is legitimate, the placebo effect may “boost” that overall effectiveness of the intervention. The placebo effect, in these cases, explains why patients with similar symptoms may improve more so than others, depending on the individual’s believe that it will work. (It is not only the patient who can create a placebo effect; the doctor’s enthusiasm also has been shown to be an influential factor in achieving positive results.)

The word “placebo’ is Latin for “I shall please.” In eras prior to modern medicine, the placebo effect was greatly relied on by physicians, who, in many cases, could offer their patients only reassurance and attention. Even today, in many cultures rely on shamans who heal not through medicine but through ritual (this is why placebos are sometimes called “sham treatments.”)

As medicine was moving to the modern era, placebos were greatly used in nineteenth century trials.  These trials used blind assessments to test controversial methods of treatment, such as “mesmerism” (a form of hypnotism) and homeopathy (where a small portion of medicine is greatly diluted in the hopes that the body’s natural healing mechanisms will get a jump start).  Some of these patients were literally, not just metaphorically, blindfolded when they were given a placebo treatment. For others, the information was simply withheld. Records from as late as World War II show that some 80% of patients received placebos; these placebos were usually in the form of either saline injections, sugar pills, or both.  Records also show that patients who were deemed “difficult” were likely to receive a placebo treatment.

In the United States, the first clinical trials involving placebos took place in 1937 at Cornell University Medical School.  The researchers conducted a study on angina (a condition when the heart is not receiving an adequate supply of blood, causing pain in the chest, shoulders, arms, and neck) and used a placebo in a blind assessment.  The results were that patients who were given placebos experienced improvement in their symptoms. Cornell was the first to publish their findings regarding placebos in the United States. Since that time, continued research has found similar results:  if patients believe their treatment will help, it does.  Placebos have been used to treat a wide variety of ailments, everything from headaches to hot flashes. There are no diseases, illnesses, or injuries where positive results of placebo use have not been observed, even if that improvement is not a relief of symptoms per se, but improved peace of mind.

Placebos can be quite helpful in scientific trial and treatments of new medicines, where there use can determine the efficacy of the real drug. In these “double blind” trials, a random group of people are selected: one group is the “control group.” The control group is given a placebo; the rest are given the actual drug. (Note:  everyone in the trial must consent to the possible use of placebos during the course of the trial. Each group knows they have only a fifty percent chance of receiving the drug in the study.) The patients do not know which group they are in, and the researchers do know which group is which, hence the “double blind” moniker.  Conducting double-blind studies lets researchers see if new treatments actually work or are working because the subjects expect them to work. Over years of clinical trials, it has been determined that the placebo effect occurs roughly thirty-three percent of the time.  Knowing that this is the case, a new drug must have a significantly higher success rate in order to be deemed medically effective.

Sometimes there are ethical dilemmas for doctors, who must struggle with knowing that there is no therapeutic benefit to a patient who is in desperate need.  A patient who has a life-threatening illness might be receiving a placebo in a double-blind trial, when he or she could possibly be on another course of medicine that might improve their health. In other cases, patients might endure unnecessary surgery; incision and other invasive procedures are undertaken, and can sometimes result in serious complications, which can range from infection, to hemorrhaging, or even death.

It should be noted that the placebo effect is not always positive; it can have negative results as well.  This is negative reaction is called a “nocebo.”  If a patient thinks that a treatment or drug might actually be harmful, he or she might actual develop symptoms that reflect this negative belief.  In indigenous cultures, placing a curse on someone can lead that person to believe they are being physically harmed, and symptoms will appear.

As for "alternative medicine," without clinical trials, or approval from the Food and Drug Administration, many "alternative" medicines must be considered placebos, for there is no peer-reviewed proof of their efficacy.  They may be effective, but without research, study, and trials, it is impossible to know. 

SourceEncyclopedia of Alternative Medicine, ©2006 Gale Cengage. All Rights Reserved.

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The "placebo effect" refers to experiments involving medical patients who are divided into two or more groups, with some provided legitimate medicines and the others, unknown to the test subjects, are given fake medicines, or placebos, instead.  The idea is to verify the effectiveness of certain treatment options by taking into account the propensity of some individuals to psychologically "heal" themselves by honestly believing that they are taking real medicine.  The improvement in health, or, at least, the sensation of healing, on the part of those given placebos is the "placebo effect."  The risk, of course, is for those genuinely ill individuals provided the placebos who do not demonstrate a marked improvement in their health and may become more ill by virtue of the delay in legitimate treatment.  

Placebos can be comprised of any harmless substance, including sugar or variations of legitimate medications altered to ineffective by removal of a key chemical.  The concept of alternative medicines is grounded in no small part by the large -- as much as 30 percent -- of a test group that shows improvement while taking the placebos.  Alternative medicines, including homeopathic medications, may involve the use of ingredients from nature that have been demonstrated to positively interact with substances in the body, or they may prove useless by harmless.  In any event, the interactions between pharmacological substances and homeopathic medications can prove harmful to some patients.  Placebos made up of completely inert substances, however, are simply harmless without concerns regarding chemical interactions in the body.

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