Picture a placebo. You’re likely thinking of a sugar pill—a stand-in medication for countless clinical trials where one group gets the pill with the miracle drug and the other group gets the medical equivalent of Tic-Tacs.
Most people have a basic understanding of placebos and why they’re necessary in scientific experiments. However, placebos are also viable options for treating patients in clinical settings. It’s more than just a mind game: Placebos, researchers have found, “can stimulate real physiological responses, from changes in heart rate and blood pressure to chemical activity in the brain.”
"I think this comes from the idea that placebo effects are somehow ‘fake’ or illusory, and so someone who experiences a placebo effect has been tricked and is therefore gullible."
Despite their healing effects, the premise of prescribing placebos is ethically ambiguous. In some cases (but not all), patients can’t know that they’re taking a dummy drug, otherwise the placebo will have no effect. This deception means that both doctors and patients can feel uncomfortable with the idea of placebos as medical treatment.
Numerous surveys have asked patients whether or not they think placebos are ethical, and there appears to be no strong consensus. In a recent paper published in PLoS One, a team of researchers led by Felicity Bishop at the University of Southampton, England, examined the underlying beliefs that inform people’s decisions on placebo treatment.
Bishop, an experienced qualitative researcher, solicited a representative sample of 58 English adults and led multiple focus groups. She and her colleagues found—consistent with previous surveys—that people felt conflicted about placebos and could not agree on whether or not they were an ethical form of medical treatment. They also found a surprising amount of misinformation and negative attitudes toward placebo effects that weren’t based on facts:
- People “were unwilling to accept at face value” that placebos can benefit patients. Instead, they discussed “in some detail” whether placebos actually have an effect or not. (Hint: They do.)
- People were pretty judgmental about those who experience placebo effects, saying things like, "I don't think he is very bright." In an email, Bishop says, “I think this comes from the idea that placebo effects are somehow ‘fake’ or illusory, and so someone who experiences a placebo effect has been tricked and is therefore gullible.”
- Almost all the participants believed placebos are only effective if there is deception involved. While that’s not true, most participants agreed that deceptive placebo-prescribing by doctors was unethical in most scenarios.
- One situation where people were comfortable with deceptive prescribing was when the patient is a child; the “magic kiss” was one example of giving placebos to children.
While the findings can only be generalized to people in the U.K., it’s still strange that so many people feel ambivalent about a treatment that is effective, inexpensive, and unlikely to have side effects. “Ultimately, I think these attitudes may stem from the negative discourse that is quite prevalent in our society around placebo effects (e.g. it is just a placebo effect, this drug is no better than a placebo, etc.)," Bishop says. We'll need a concerted public health effort to dispel these fears of the unknown.