What’s wrong with treatments that act like placebos?

In the lively discussion about homeopathy and placebos following a Lib Dem Voice op-ed several people made comments about treatments which rely purely on the placebo effect such as: “If a placebo works and is safe and cheap, why on earth should we stop funding it?”

The more general issue of placebos was raised by Lynne Featherstone in an op-ed back in early 2008:

The placebo effect is seen when people are given treatment, such as pills, where the psychological impact of thinking that the treatment will make you better actually does – even if the pills are inert, containing no health-giving recipe at all. Give people a “medicine” that is really nothing such, but tell them it will make them better – and, lo, it can do.

It’s a weird display of the power of the mind when given a suggestion; a happy flip side perhaps of the power of the mind over the body you so often see when one of a couple who have been happily married for decades passes away – and then the other slips away shortly afterwards as if their mind simply no longer has any desire to keep their body going.

Of course it doesn’t work for all people in all circumstances (that would make the NHS’s job easy if it did!), but it’s a real, solid, verifiable effect – and one that medical scientists have to take into account when testing new medicine because, without allowing for it, their tests may otherwise fool them into thinking that some possible new medicine really does have health-giving properties when in fact it is only the placebo effect at work…

Which brings me to the dilemma. If a GP telling me that a treatment is extremely likely to work makes it actually more likely to work (because of the placebo effect) then shouldn’t they perhaps lie to me and tell me that even if it isn’t really that likely to work?

Ben Goldacre (I think) made the point well in The Guardian a little while back that this perhaps helps explain some of the popularity of alternative medicines compared with traditional medicine. For traditional medicine, GPs have shifted hugely in their outlook – being told to tell patients the full range of information about possible treatments, their chances of success and possible side-effects – and thereby sowing doubt into patients’ minds. But alternative medicine is often presented by its practitioners with absolute confidence – and so (regardless of any other benefits) scoring an immediate win on the placebo front.

Now – there are all sorts of benefits about keeping patients properly informed, including keeping a checking on conventional wisdom or vested interests getting out of control.

Yet here is the riddle: if doing that means they are actually less likely to get well in that immediate here and now case, who wouldn’t be tempted to shade the information? Would you be tempted to tell you child or partner a small fib about how sure you are the treatment is to work even if you know otherwise? And would that really be wrong?

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