One of the biggest bones of contention regarding the placebo effect is the premise that placebos have a very small effect. Some people argue that this effect is too small to ever be worth investigating. This is very much a widespread belief amongst the scientific community. However, as you may have guessed from the rest of my web content, I do not believe the placebo effect is something we should ignore. I’ll try and explain why…Argument 1. The placebo effect is negligible:
The placebo effect may at times be small, but that does not mean that it is not worth investigating. Drug researchers and pharmaceutical companies have to include placebos in their trials. Why do they do this? Because the placebo effect is not negligible. The placebo effect can be significant enough to destroy the positive results from decades of trials.
Argument 2. Not everyone responds to the placebo effect:
This is very true, research shows that not everyone does respond to the placebo effect. Studies also show that there are certain situations and personality types which can increase someone’s likelihood of responding. It has been said that ‘the history of medicine, is essentially the history of the placebo effect’ (Shapriro & Shapiro). Chances are that at some point in your lineage, your ancestors would have been given placebos, simply because there was nothing else available. Without records, we can never know the strength of that placebo effect, but it still a factor worth keeping in mind, because it does suggest that there may be an evolutionary basis for responding to the placebo effect. This is strengthened by the fact that even animals can respond to some types of the placebo effect (Ader & Cohen). Therefore, rather than using this as a reason not to study the placebo effect, we can instead explore the possibility that there may be ways to encourage and improve the placebo response amongst the population. This could mean that our drugs, treatments and procedures become more effective and that patient outcomes improve.
Argument 3. The placebo effect is on average too small or too short-lived to ever be useful:
This is the argument I take the most issue with. It is true that some studies have shown that the placebo effect is small and that most people don’t respond very strongly to it [sadly can’t find this study at the moment], however there are studies that suggest the opposite (i.e. Yeung et al.) . But even if we accept the premise that the placebo effect is small on average, that does not mean that we should ignore the people who are not average. There are many reports of ‘miracle cures’ and ‘faith healings’ around the world. I don’t mean to be disrespectful towards believers in those events, but many scientists would attribute such situations to the placebo effect. Therefore, for some people the placebo effect can be very strong – strong enough for them to leave behind their wheelchair or crutches, strong enough for them to reduce their symptoms, strong enough to change their life. These are the most interesting people when it comes to the placebo effect. What if we had the resources and opportunity to really investigate these healing events? They are far from typical, but what if we could identify why these people respond so well to placebos? Could we then perhaps learn how to help others – psychologically or biologically – to respond more strongly to the placebo effect? This has potential to help people in many different ways:
– Some conditions do not have very effective treatments, or their effectiveness diminishes over time i.e. chronic pain – perhaps the placebo effect could help improve their symptoms, or their long term outcome, or perhaps a placebo could work alongside conventional treatment, or after its effectiveness has declined.
– Not every disease has a cure or even an effective treatment. Could the placebo effect help people for where there is no conventional alternative?
– In poor communities around the world, many people can’t afford standard medical care and treatments. Could the placebo effect help the same drugs go further or could they help people for whom conventional treatments are simply not available?
One of the biggest problems with the placebo effect is that we know so little about it. The potential is huge, because we’ve still got so far left to go. I understand why many are resistant to the idea of exploring the placebo effect:
– some people think the placebo effect means something doesn’t work or it doesn’t work very well
– some are concerned that it’s just another alternative medicine or it’s a form of quackery and not based on science.
I acknowledge that the placebo effect is unlikely to be a panacea, but that’s not what we’re aiming for. It could be marginal improvements for people, it could be that some diseases work better than others, it could be that placebos can become a new clinical tool, it could be that we come to understand the mechanism behind the placebo effect and we can use that to develop newer and better treatments. It is early days and we don’t yet know where the placebo effect will take us, but if we don’t try, we will never know. Researchers in top institutions around the world including Harvard, Oxford and Turin universities are trying to learn more about the placebo effect and how it could help us. In the words of Shapiro & Shapiro ‘the placebo effect is simply too good to be left to the realms of alternative medicine’ (Shapriro & Shapiro).
[If there’s any other arguments you’ve heard, why not get in touch, so we can let you know our thoughts. We always welcome anything that could help expand our knowledge in this area]