One of the great black boxes in medicine is the placebo effect — we know that it works, but we don’t know why. The fact is, if you give a large enough set of people a phony medical treatment for some disease they share, a percentage will experience some degree of genuine recovery.
And that has led to an interesting new discussion:
[T]he accumulating data have sparked a renewed interest in the placebo as a treatment in its own right. Numerous studies have shown that it can trigger verifiable changes in the body. Brain scans have shown that placebo pain relief is not only subjectively experienced, but that in many cases the brain releases its own internal painkillers, known as endogenous opioids… Another study, published in Science in 2009, found that patients given a topical cream for arm pain showed much less pain-related activity in the spinal cord when told it was a powerful painkiller. A 2009 study found that patients benefited as much from a fake version of a popular spinal surgery as they did from the real one; asthma patients have shown strong responses to a mock inhaler.
If doctors have available to them a treatment with neither side effects nor worrisome drug interactions, and that “works” between 20-30% of the time (a rough average of the placebo effect), why not take advantage of it?
Of course, that raises an important question: The placebo effect only works if the patient believes it’s a genuine treatment. Is a physician therefore permitted a small deception to produce a real improvement? We may not do evil to bring about good, of course, but is there a moral way to take advantage of the placebo effect?
[One] approach may be to integrate placebos with real treatments, and to reconsider whether this should still be viewed as fakery. A groundbreaking study published in February in the journal Psychosomatic Medicine found that in one group, psoriasis patients who received a topical cream treatment, alternated with placebo “reinforcements,” did as well as patients who got up to four times more of the active drug. The authors hypothesized that the effect was due primarily to conditioning — the brain learned to associate the cream with healing and sent the same signals even when the cream was inert.
This is just one study, but the implications could be profound. It suggests that in some cases doctors could essentially dilute medications, perhaps dramatically, and get the same results.
What do you think? Is there a morally permissible way ahead here?
[The original story comes from Sunday’s Boston Globe.]