In the last post we discussed how research on the placebo effect complicated a lot of assumptions about pharmacological research. But if the manifestations of improved health are not a result of physiological effects, it’s fair to ask: if we’re not the disease, are we fooling the patient? If so many drugs show statistically insignificant results, can we do better than a placebo or at least make the most of the placebo effect?
Professor Maureen Simmonds, of Texas Woman’s University, Department of Physical Therapy, while reviewing the history of the term placebo and its usage in medicine, argues that since traditional health care is primarily based on physiology and pathophysiology, treatments are developed and targeted using a physiological approach. It is therefore not surprising that this framework is used to explain specific treatment effects.
“In this context, non-physiological or placebo effects of treatment are regarded as artifacts. However, this simple categorization of physiological versus non-physiological effects is an oversimplification”(Simmonds, 2000). The “use of a single term (placebo) to describe disparate phenomena is potentially misleading because it creates a spurious impression of homogeneity and stability of response,” argues Richardson (1989). “It is now evident that this non-physiologic ‘noise’ has physiological effects.” (Hashish et al., 1988; Simmonds, 2000)
Herbert Benson notes the three components necessary for the placebo effect:
The belief and expectation of the patient;
The belief and expectation of the doctor;
The doctor-patient relationship.
When it comes to using a placebo, does the end justify the means? Some would argue that deliberately giving a patient something that we know does not work is misleading, whereas giving something we believe would benefit the patient because of the placebo effect is ethical. What really determines the answer here is whether helping or serving the patient is paramount.