Margaret McCartney wrote about the placebo effect on this blog earlier in the week, in the context of the Commons Science committee recommending that the NHS should not pay for homeopathy.
Coincidentally The Lancet has a fascinating long review of placebos, looking at the clinical evidence and ethical considerations.
The authors, led by Damien Finniss of the University of Sydney, point out that placebo effects are “genuine psychobiological events” which can be produced in both laboratory and clinical settings.
A key conclusion is that there are many different placebo effects, depending on circumstances.
Most research into the biological mechanisms of placebo effects is concerned with pain relief. Sometimes these are mediated by “endogenous opioids” released by the brain, sometimes by other mechanisms.
There are other placebo effects across the body, including changes in heart, lung and hormone function.
The most important message of the paper is: “You don’t need to give a placebo [an inert pill or dummy procedure] to create a placebo effect. Placebo effects are part of routine medical practice and are potentially active every time a patient enters a therapeutic context.”
Or, as Margaret put it, “The placebo effect is not a nuisance. It is our best friend, and it needn’t be deceptive.”
Every doctor should work to maximise the placebo effect, to make his or her treatment of the patient as effective as possible.
Margaret McCartney
Clive Cookson
Andrew Jack