What's Wrong with the Placebo Effect?

There’s a movie in which one of the characters is a sickly little boy who doesn’t go anywhere without his inhaler. When he gets short of breath, he takes a couple of hits off his inhaler, and within a minute or two he’s breathing easily again. Later in the movie it’s revealed that what’s actually in his inhaler is nothing more than aerosolized salt water. It’s a complete sham. Yet it still brought relief to this boy and his neurotic mother.

It’s a perfect example of the placebo effect -- benefit from a false treatment or intervention. It’s seen most commonly in situations where the symptoms are more subjective, such as pain or mood. In women, it's also seen in sex drive.

A recent study in the Journal of Sexual Medicine found that one in three women with diminished sexual desire who took a sugar pill as part of a control group reported an improvement in their symptoms. The study included 200 women diagnosed with female sexual arousal disorder; 150 of them took Cialis, the male erectile dysfunction drug, and 50 were chosen at random to receive placebo. Although the women taking Cialis showed no marked improvement in sexual arousal, a third of the women popping sugar pills reported restored sexual function. It seems that nothing had physically changed for these women, but psychologically a major shift had occurred.

At the end of the study, ethics would dictate that these women should be informed that they were taking a dummy pill and that any improvement they experienced had nothing to do with the supposed medication.  Presumably then, those that were enjoying more rolls in the sack were cut off from the placebo and sent on their way for therapy or a life of near-celibacy.

But if the medication (as it were) seemed to be helping, would it really be that wrong to continue it, provided both doctor and patient know that it’s baloney and side effects (including cost) are negligible, or at least tolerable? Antidepressants, for example, have a notoriously high placebo effect; some estimates suggest that upwards of half the reported benefit of these drugs is actually due to placebo effect. This particular type of medication can have significant side effects and can also be outrageously expensive, yet most are willing to accept them in exchange for their perceived benefits. But therein lies the problem inherent to the placebo effect:  would patients still perceive benefit if they knew with certainty that their medication was actually ineffective?

Many would not; however, I think many others still would. Over the year, several patients have told me they know research shows a supplement or vitamin that they’re taking doesn’t work, but it makes them feel better so they’re taking it anyway. They know it’s ineffective, yet they still perceive benefit. In other words, it’s still possible to believe in something even when facts argue otherwise. In that regard, several religious leaders are way ahead of the scientific community.

I think it comes down to honesty: patients need to know what it is that they’re taking, the likelihood that it will work, and its potential side effects. Withholding that information would be unethical. But after sharing that information, I suspect many people would be willing to forge ahead anyway.

Photo credit: erix!