The Power of the Placebo Effect - Part 2

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15 Jul 2023

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You’re in for a treat as I continue my 3 part series on the Power of the Placebo Effect. If you haven’t read the first part yet, you can find it here:
The Power of the Placebo Effect - Part 1

You won’t want to miss this amazing journey into the mind-body connection and how it can heal you in surprising ways. Let’s dive right in!

What are the challenges and controversies of the placebo effect?

The placebo effect is not without its challenges and controversies. Some of the issues that arise when dealing with the placebo effect are:

Ethical dilemmas: The use of placebos in clinical practice raises ethical concerns, especially if they are disguised as an active treatment, as this introduces dishonesty into the doctor-patient relationship and bypasses informed consent. The placebo effect confronts physicians with two conflicting ethical imperatives: to relieve their patients’ suffering, and to tell their patients the truth. Placebo use is criticized as being unethical for two reasons: they are supposedly ineffective, so their use violates the ethical requirement of beneficence and nonmaleficence, and they allegedly require deception for their use, violating patient autonomy.
Negative effects: The placebo effect is not always positive or beneficial. Sometimes, it can have negative or harmful consequences, such as worsening symptoms, inducing side effects, or interfering with other treatments. This is called the nocebo effect, and it is the opposite of the placebo effect. The nocebo effect can occur when a person expects a negative outcome from a treatment, or when a person receives negative information or suggestions about a treatment. For example, if a person is told that a pill may cause nausea, they may experience nausea even if the pill is a placebo.
Cultural differences: The placebo effect is not universal or uniform. It can vary depending on the cultural background, beliefs, values, and preferences of the person receiving it. Different cultures may have different expectations and attitudes toward treatments, as well as different symbols and rituals associated with them. For example, in some cultures, injections may be seen as more powerful and effective than pills, while in other cultures, pills may be preferred over injections. Similarly, in some cultures, red pills may be associated with energy and vitality, while in other cultures, blue pills may be linked to calmness and relaxation.
Scientific validity: The placebo effect is not easy to measure or control. It can pose methodological challenges and limitations for scientific research and clinical practice. For instance, it can be difficult to isolate the placebo effect from other factors that may influence the outcome of a treatment, such as natural history, regression to the mean, Hawthorne effect, observer bias, or reporting bias. Moreover, it can be hard to determine the optimal dose, frequency, and duration of a placebo, as well as the best way to administer it and to monitor its effects.

These issues show that the placebo effect is not a simple or straightforward phenomenon; it is a complex and controversial one that requires careful consideration and evaluation.

Conclusion

In this second part of the article, we have explored some of the challenges and controversies surrounding the placebo effect, such as ethical dilemmas, negative effects, cultural differences, and scientific validity. We have seen that the placebo effect is not a clear-cut or uncontroversial phenomenon; it is a nuanced and contentious one that raises ethical questions and scientific problems.

In the final part of the article, we will look at some of the ways to harness the placebo effect for our own benefit, such as open-label placebos, placebo rituals, and placebo education. We will also discuss some of the implications and future directions of the placebo effect for health care and society.

Question for you

What do you think about the ethical issues of using placebos in clinical practice? Do you think it is justified to use placebos if they can help patients feel better? Or do you think it is wrong to deceive patients even if it is for their own good? Share your opinions in the comments below.