January 24, 2008

Placebo Power: Is Your Doctor In On It?

[By Crabby]
Cartoon by Mike Bannon at Mordant Orange

So you go to your doctor with some painful or otherwise bothersome medical problem, and after perhaps running some tests and/or poking around, the doc nods and mmmh-hmmms a lot and finally takes out the prescription pad.

"Take this twice a day for the next two weeks. It may help your condition--and it certainly won't hurt."

Would you be upset if you later found out that the "medicine" you were taking (and paying for) had no active ingredients that could do anything at all for your ailment?

Because it turns out that 45% of doctors in a recent placebo survey copped to prescribing medication to patients as a placebo. Only 4% of them told the patient that's what they were doing--which kind of make sense. "Take this, it won't help you at all unless you think it will" is somehow not nearly as persuasive.

But is it ethical? It's sort of misleading. But it's not an easy question to answer, because, well, placebos work for a lot of people. That's why they have to have control groups whenever they test a new medication. If you tell people you're giving them something that may help their arthritis or their hemorrhoids or their ear-wax build-up or whatever, a good portion of them will obediently get better even if the medicine itself is useless. The freaky thing about giving people placebos it that it actually results in physical changes in the brain that make people feel better.

Can the placebo effect actually cause you to lose weight? Kateio at Sister Skinny recently alerted us to the hotel maids study. This was a weird one: maids who were told that their hard physical jobs actually burned enough calories to meet the surgeon general's definition of an "active lifestyle" started losing weight and lowering their blood pressure. Those who were told nothing... didn't. Can abstract knowledge actually burn calories? Wouldn't that be weird if it did?

(Note: I'm still a bit skeptical of this study, perhaps because it just seems so amazing. But I wonder: if you were an overweight maid who thought you weren't getting any exercise, and then you suddenly found out you were getting plenty, would that change your attitude about the food you were eating? Might that not be an incentive to make some dietary changes?)

Still, if it turns out to be true, the study has amazing implications. You can think calories away! I'm going along with Katieo on this one, and am going to repeat to myself every day: "blogging burns 300 calories an hour." Or hell, make it 700!

So back to the question we started with. Given that placebos can actually trick some people into feeling better, would you be annoyed to find out you're been given one by your doctor?

Unfortunately, as I mentioned before (in a post about placebo doping in sports), I'm just not a very good placebo person. Being a cranky pessimist, I usually expect things NOT to work. So if I shelled out money on a fake drug that didn't help because my doctor thought she could trick me into feeling better, I might be less than grateful.

On the other hand, I've been doing better with knee pain since I started wrapping ice packs around my knees. Is it the ice? Or is it my tiny little suggestible brain believing the ice is helping? Who knows? (It's the ice, I swear).

How about you guys--would you whomp that lying doctor upside the head with your big bottle of fake pills? Or would you give that doctor a hearty thanks for creative thinking about pain management?


  1. Hmmm... both. On one hand I would feel silly and embarrassed, like a teenager who unknowingly drank a bunch of non-alcoholic beer and then started acting drunk, and all his/her friends know about and are laughing behind his/her back.

    On the other hand, I would be pleased and amazed that my mind had the power to heal itself.

  2. The placebo effect is poorly understood and vastly under utilized. I suspect most people are stuck in the 'sugar pill' type of definition. Really, if you look at it as the body healing itself, it takes on a whole new perception. Sometimes I think every patient, if feasible, should be treated with a placebo before using dangerous medications. But then people have 'side effects' to placebos also...
    My dad did a study years ago with a "pain med" he called, Myolax. It was prescribed and had to be picked up at the hospital pharmacy. I believe almost 50% of patients felt it worked for their pain! As with food, presentation is everything!
    Dr. J

  3. Two responses: 1. If a doctor pulled this kind of a stunt on me I'd be annoyed as hell. A lie is a lie.
    That said, if I was in a great deal of pain and was told the little purple pill would give me a good night's sleep, well, I could find a way past the lie.

    2. Changes take place in the mind before they take place in the body. Your subconcious runs the show. Applied generally, if you are told that a pill will do the trick, then your mind sets up those conditions.
    I'm speaking generally. Really generally. Some folk are just too ornery to allow anything to work on them.

  4. I'm one of those wierdos who has a Medica Pharmacia reference book from one of the people I look for and look up everything I'm prescribed when I'm given it.
    I like reading up on it all...some of the "side effects" listed for some things crack me up...apparent'y death is a side effect!
    Altho - the "new new" stuff isn't in the old book I have t olook up stuff, so I'd probably think _"oooh! I'm on the fancy *new* drug!" and be all excited - and who knows. Maybe it would work? I thought you had to legally tell people if they were in a study and that they wouldn't know whether they got a placebo or not...maybe that's just up here in Canada.

    My family doctor used to tell us to soak any and all ailments in hot water...most of the time it helped.
    It's the power of positive thinking. I think it's why negative grumpy people always feel losuy. All I know is the mopre annoyingly happy I am the better I feel.

  5. The Bag Lady can't get past the "blogging burns 700 calories" part...would that be per hour? (please please please!)

    As far as being given a placebo, the Bag Lady would be embarrassed if it worked, and pissed off if it didn't. No-one likes to be tricked, and Keri said it better than the Bag Lady.

    Is there a study out there about old, fat, ex-dental assistants-turned-ranch-hand losing weight because they work so hard? :)

  6. Give me the fake pill! I wouldn't care he lied, I like having as little medication in me as possible.

    (Dr. J, Isn't myolax a laxative? Or is it just a brand name?

    and Bag Lady, you could make it 700 calories per minute if you wanted, lol!)

  7. Well...I find this a little hard to answer because I hardly ever go to the doctor, so if I do go I usually have a good reason. Also, the doctor I have is pretty no-nonsense, and I think if he thought you didn't need medication, he'd tell you so and send you on your way.

    However, I guess if you go to the doctor to seek relief from a problem, the most important thing is to feel better. So if they give you a placebo and it works, you've still achieved your objective. Seems reasonable, as long as they are not charging barrels of money for the placebo.

  8. Keri, great comparison to the drunk teenagers--I suspect it's a similar mental process.

    And I agree Dr. J! But I didn't even know you could get placebo "side effects!"

    Leah, speaking as one of the ornery ones, I have to agree! (Not that EVERYTHING doesn't work, but I generally don't expect much from any medicine).

    Geosomin--good for you for checking out what you're taking. And actually, this wasn't research dr's, this was practitioners admitting they used placebos. I think in US studies you're told you may be getting a placebo, and find out at the end whether you got the real thing or not.

    Bag lady--actually, you're the perfect person to benefit from this study--because I bet you get a lot more exercise than you think. If it's true, you just have to realize that and you'll lose weight.

    javachick--yeah, I agree, it depends on how much they're charging for the fake pills!

  9. Both. I have long wondered if the placebo effect would work on me, after all the things I've taken that didn't work very well. My expectation level is really low.

    Side effects: My father is on two medicines that have possible side effects that the other one is supposed to be treating--how can you tell????

    And the lousy/grumpy relationship is circular.

    Mary Anne, grumpy, in Kentucky

  10. If the doctor gave me something, and I felt better, then it worked didn't it? Does it matter that is was psychological?

    I wouldn't be mad, I think I'd be mad that she told me, because I would be afraid it would stop working :)

    And is it lying? Or is it part of the medical treatment, since if you DID know it was a placebo, it wouldn't work, would it?

  11. Nobody likes to feel they've been made a fool of. If my Dr. gave me a placebo, and it worked, which it might well- I am exactly the kind of suggestible person who that would work on- that would be fine with me. I mean, they'd have solved the problem, right? Which is the whole point? But if they gave me a placebo, I felt better for a little bit and then plateaued, I would then feel self-conscious about returning to the doctor, which is problematic, because not everything is healed by the mind. If I did go back, I would expect my doc to take the problem seriously. I would also expect that she not conclude that because the placebo worked, I am some kind of suggestible idiot, or a hypochondriac who makes up symptoms. Another qualm: I hate going to the doctor, and my insurance is not so great, so I avoid it whenever possible. If I am sick, for example, and I half-way suspect it is strep or something, I will wait a ridiculously long time before going to the minute clinic for a strep test, in the hopes that it is not. I tend to assume that if it does not require antibiotics, it's something that they won't be able to help with. I mean, they'll just tell me to get some rest and drink plenty of water, right? Which I can tell myself. Similarly, if my knee is hurting, what can they do? Tell me to RICE it? Tell me to buy a brace? Recommend surgery? Only one of those options requires a doctor, and I don't think the problem is bad enough that surgery wouldn't be worse than dealing with the knee, you know? So if I went and received a placebo that did not work, I would chalk that ailment up as one more thing it is not worth going to a doctor for, because they can't do anything about it.

  12. Thanks, Katieo - 700 calories per minute works!!
    Crabby - now if the Bag Lady could just convince her body that it doesn't really need to store all those calories for the day it has to run away from the sabre-tooth tiger...

  13. Well, I've never been tricked by a doc into this (that I know of) but I generally believe my reaction to St. John's Wort for anxiety may just be a placebo effect. But hey, I feel better, so what?

    Then again, a doc giving out placebos may also not be digging deep enough to uncover a real physical problem and could have the "it's all in her head" philosphy which can be dangerous.

  14. katieo!
    My dad called it Myolax as in "Muscle Relax". This was a while ago and I think you may be right in a company now using the name. It was a research project on the effectiveness of placebos. Fortunately, it was "directed" at voluntary muscles. If dad had gotten the smooth muscle effect of the laxative, his office would have needed a lot of serious cleanup :-)
    I would like to make a couple of comments on the comments:
    First:Do you guys have any idea of how much lying patients do to us? This has been studied and the rates are very high!
    Secondly: People who already "know" what doctors will do, so they don't go to them with problems that can be helped are being very foolish.
    Also: There is no separation between "mind and body". If someone uses the unfortunate expression "it's all in your head" it doesn't always mean it isn't real for you. It just may mean that treating it as a mind/body problem will give us a greater chance to be successful.
    I realize it's all the rage to bash doctors, but there are many of us who went into medicine with a sincere desire to help people. It is not our fault that so many people feed at the trough of self created diseases then blame everyone and everything but themselves.
    Dr. J

  15. Dr. J, lol! We used "Myolax" a couple of months ago to treat constipation in our little one. He was onto something with muscle relax! ;)

  16. Well, all the "real" drugs the doctor has given me hasn't cured this cough I have had for days and days...I would take a placebo if it works!

  17. blogging burns 300 calories an hour -YAY!

    Being given a placebo to find out if you can manage pain or some other condition without possibly addicting or damaging drugs could be a good thing. Too bad that I think most people would get pissed instead of realizing, "hey, I have the power to help myself get better in this instance." Not for everything, but I think a little use is beneficial.

  18. i think it is almost funny that so commonly a study seems to say one thing and the media switches it up. it seems to me that the study points to the idea that if someone thinks that they are not exercising when they in fact are that they can reap the benefits of the exercise they are actually doing if they realize that it is indeed exercise. somehow that has been twisted to the idea that you can get benefits from exercise you are not doing by thinking that you are doing it. those two things seem very different to me...anyone else? i mean, those maids were in fact working out tons, it isn't like they were lying around doing nothing and then started to lose weight when they were tricked into thinking that they were doing exercise.

  19. I try to avoid the doctor as much as possible because I usually hear things like "I've never seen that before," or "we don't know what to do about that." Ok, thanks for taking my money and doing nothing for me.

    I'd be really p.o.'d if I spent hard-earned money on a sugar pill. Although there is something to be said for the power of positive thinking. If you believe it will work, it will work.

    I believe that by blogging about my weight I will lose those extra pounds and have a smokin' hot bod!


    It hasn't worked yet. How many blogs to I have to read or posts do I have to write to burn those 700 calories?

  20. Oh, I just heard about a study the other day saying that cold medicines do not work. If you take cold medicines you will feel better in a week; if you don't take the medicine you will feel better in 7 days. :)

  21. I think it would be awesome if my doctor could prescribe a safe weight loss drug for me (that was actually a Smartie or baby asprin or something!) and the mental switch in my brain would 'make it true'.

    As the opposite of you (an extreme optimist by nature) I think it would likely work! ;)

  22. In response to Dr. J, I don't think that anyone's bashing doctors, but a lot of times they don't give any advice other than the more "common sense" advice of rest and drink water. I once went to the doctor for knee pain, which started after a yoga class, and the (male) doctor kept wanting me to explain the position I (possibly) was in when I hurt it. He even went so far as to suggesting that I demonstrate the position that I was in when I hurt my knee, and when I said i was using a heating pad and motrin for the inflammation, told me to save the heating pad for my period. I left massively offended, and was only told to rest it more and "let pain be your guide" as to when i could resume working out.

    As a college student, I'd be pissed if I shelled out lots of money for a sugar pill, but if the doctor gave it as a free sample or something, I'd probably be ok with that.

  23. Yeah, I know it is foolish, but really, I do go when it DOESN'T go away on its own. The last time I went to the doctor was after I'd been hit by car, and then a few follow-up appointments when the pain from that wasn't going away. My doctor checked it all out and renewed my painkillers, because there really wasn't anything to be done but let it heal. It was nice, because it let me sleep at night when my shoulder was bad, but honestly it was not anything that toughing it out wouldn't have dealt with in the same amount of time. I did go to the ER and then the doctor after the accident, though. If I had appendicitis or something I wouldn't wait forever for it to heal. But really, what do doctors actually do for basically healthy, active 20-somethings who just have flu-like symptoms? Is there some miracle cure? If you are a doctor and are reading this, and you know that there is one, let me know and I will re-evaluate! However, in my experience, there is not. You might as well save your money and skip the anti-smoking lecture and just take some advil and get some rest.

  24. Good post Crabby, you have everyone talking! I prefer a Doctor that will tell me there is nothing to do but tough it out, or will actually give me a real prescription if there is one that will help.
    Being on (almost) every asthma drug imaginable, what angers me more, it having to go in every three months to get the prescription filled when he doesn't even listen to my chest or ask questions. WTF that is just a way to bill for more money!

  25. I like the idea of prescribing placebos, as long as they're not charging too much for them (does insurance cover placebos, since technically they're not medicine?). I think that there are way too many unnecessary prescriptions floating around these days - people get prescriptions for a normal cold that will go away, then they don't finish the pills and voila, superbug!

    On the other hand, there are definitely some doctors who go too far with the "all in your head" thing. My mother was in pain for a year and the docs kept suggesting she was going through menopause and prescribing her massive amounts of motrin, until finally her appendix burst (she's fine).

    So I think that chalking things up to psychosomatic symptoms (or symptoms which can be cured by thinking you're getting treatment) may work for smaller, non life-threatening issues. But if it's something like appendicitis or severe asthma, that kind of thing, it can just put a fuse on the time bomb.

  26. I'd be pretty upset if I had to pay a lot of $$$$ out-of-pocket for a placebo. It's bad enough paying for all of our 'real' prescription meds that don't work, either.

  27. Wow, what a great discussion! Thanks, everyone, for your great comments.

    Note: I'm going to be playing with the template tonight so there's going to be some SERIOUS weirdness around here, with things coming and going, while I try to change things around.

  28. On the placebo, one question I want to know is do I still pay full price for the pill? It obviously doesn't cost as much as a "real" pill. But I guess one could argue that the psychological benefit is worth the price. Putting placebo asides, the fact that doctors can "sell" you a pill that isn;t what it really is is a scary thing in my book. Makes you wonder what is truly in the pills you get.

  29. Some thoughts from a MD:
    This study wasn't about real placebos, it was about real medicine given for its placebo effect - there is a difference. And even if you understand the difference you have to understand there is more going on here than docs choosing to give a pill solely for it's placebo effect. Patients demand that they be given something. You who are reading this may not feel that way, but I can tell you with great certainty that many patients that come to me with a problem that does not require treatment somehow feel cheated that they had to pay for the office visit unless they walk away with a prescription in hand.
    If you don't want to be given medicine when you don't need it ask your doctor if he/she thinks you can get better without taking medication. Ask about alternatives and things that you might be able to do on your own. Almost all medications are poisons, in fact that's the whole point - to kill the germ or blunt the effects of disease. The disease is a poison too, and only when the risks of the disease are greater the risks of taking medication should you want medication.


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