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Inside Therapy: Give Placebos a Chance

Tuesday, July 03, 2012


If they work (and they do), then why aren't they offered as an alternative? The provocative placebo.

Over the last 15 years, I’ve spent a lot of time wondering why people react to the placebo effect with a cocked brow and a dismissive wave. I don’t get what all the scorn is about.

Placebos work. In fact, they work exceptionally well—most studies place their average efficacy between 35 and 75 percent, putting many “genuine” treatments to shame (antidepressants usually post success rates between 25 and 40 percent). And since placebos contain no drugs, they’re cheaper and come with fewer side effects than drugs do.

Still, Big Pharma and others with a vested interest continue to portray the “placebo effect” as some kind of illusion. This attitude causes most people to deride placebo treatments without understanding them. But when we pass over placebos, we miss the opportunity to heal in a less risky, less expensive, and more benign fashion.

To misquote John Lennon: “All I am saying—is give placebos a chance.”

The case for placebos

Many respected experts have suggested the same thing. Dr. Walter Brown, a nationally renowned psychiatrist based in Rhode Island has been recommending that doctors add placebos to their list of treatment options for over a decade. He understands that the placebo effect is useful not only with psychological conditions, but in literally any situation where one human being expects to be helped by another.

In an article in Psychology Today back in 1997, Brown wrote about an experiment in which a group of cardiac surgeons performed “internal mammary artery ligation in one group of patients, and in another group performed a ‘sham’ operation—they made a chest incision but did no further surgery. With the artery surgery 76 percent of patients improved; with the sham (placebo) surgery 100 percent improved. Internal mammary artery ligation turned out to be merely a rather effective placebo.”

Other studies have shown the striking effectiveness of “placebo” surgery for everything from arthroscopic knee surgery to the (non-)implantation of fetal nerve cells in patients with Parkinson’s Disease. In each instance, placebo surgery seemed to work as well as—or better than—actual surgery.

Even pharmaceutical companies inadvertently affirm the effectiveness of placebo treatments. When Merck or Pfizer or Glaxo get excited about the potential of a new drug, they’re required to test it. Rigorously. And to what do they compare the new drug’s effectiveness?

You guessed it. In order to find out just how good their shiny new money-maker is, they’re required to compare it to a placebo. In every case.

What's the problem?

So, why are people so skeptical of these things?

Maybe it’s that we don’t like being duped. That seems like a good explanation—except that the reason we don’t like being duped is that dupes come at our own expense: our trust is taken advantage of, and others benefit from the result (con men and medical marketeers come to mind). But what if the dupe was for our own benefit? And what if it wasn’t even a dupe?

Consider this situation: you’re suffering from terrific pain, and your healthcare provider tells you about a pill that contains no drug, is less expensive than other medications, is less likely to cause side effects, and—if you take it—your chances of improving are very good. If it doesn’t work, you can always talk about other treatment options. Would you try it?

There’s no scam here. Each of those statements is entirely truthful, in keeping with what we can scientifically confirm about placebos, and in accordance with medical ethics regarding informed consent.

The 'how' of placebos provokes us

Then again, maybe what concerns people about placebos is that science can’t yet say precisely how they work. What we do know is that they’re in part the result of a phenomenon called “expectancy effects.” These are effects that happen simply because people expect them to. Party-goers who drink punch thinking it has alcohol in it start to feel intoxicated—even when it’s actually alcohol free.

It’s precisely this ability of the mind’s expectations to influence the body’s reality that causes placebos to be such decisive agents of healing. The human mind is what gives placebos their potency.

Since these treatments rely on the mind's natural ability to heal, you can make a strong case that psychotherapy is based entirely on the placebo effect—dealing, as it does, with the mind very directly. And good psychotherapy takes that healing even further. Not only does it help relieve depression, anxiety, and a host of other emotional troubles, but many clients experience “spontaneous” remission from all kinds of physical symptoms when they begin to sort out their emotional lives in psychotherapy.

We ought to face facts even when we can’t explain them. Placebos work remarkably well. They are more cost effective and less risky than other treatments. They compare favorably in terms of effectiveness. They don’t need to be the only option, but they should at least be on the table.

The great Swiss psychiatrist Carl Jung once said, "I shall not commit the fashionable stupidity of regarding everything I cannot explain as a fraud." It's good advice for all of  us. The mind is a terrible thing to waste.

Archie Roberts is a psychotherapist, professor, and writer. He's consulted to organizations around the world and makes his home in Providence. www.archieroberts.net



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