The placebo is one among science’s greatest mysteries. The pill that is not a pill. The medical illusion that some-how becomes real.
The mind-boggling weirdness of placebo effect is certainly a weird thing, nobody doubts that.
But just because placebo effect occasionally delivers unexpected outcomes does not mean, we should overestimate how powerful it is, nor try to find a place for it in the medical aid of patients, scientists are now warning.
In a new perspective article, researchers from University of Sydney, argue that recent suggestions placebos could play a role in clinical care are unfounded and are based-on flawed evidence.
“Much of the current discourse on placebo seems to focus more on enshrining placebos as mysterious & highly effective and fewer on making a practical difference to patient care & outcomes,” a team led by first author & physiotherapy researcher Chris Maher writes in the commentary.
Observations of the placebo effect can often traced-back to the 18th century and the reputation of placebo has grown ever since: the thought that an inert, sham treatment, taken unknowingly by a patient, can sometimes deliver therapeutic effects just like the real thing.
That reputation is usually underserved, Maher & his co-authors say, noting that if you look closely at much of the evidence, placebos tend to only offer very modest effects and even-then only in a small minority.
“A Cochrane review of placebos considered 234 trials and concluded that, generally, placebos don’t produce major health benefits, apart from some small & inconsistent effects on self-reported outcomes as pain or nausea,” researchers explain.
Not everybody holds this view, however.
In recent times, many commentators have suggested placebos could be worth exploring as substitutes for use in the medical aid of patients, on the basis that we might be able to exploit the placebo effect for clinical outcomes.
In their new article, Maher & colleagues list a number of the issues with these arguments, pointing-out that a number of the experiments investigating the placebo effect have significant limitations to bear in mind such as very small samples of participants or have flawed designs that do not make for strong evidence or practical application.
For example, some studies repeatedly primed patients on the effectiveness of placebos for lengthy periods, which might not be feasible during a typical short medical appointment.
None of this is often to mention that the placebo effect itself is not an observable phenomenon.
But until there is real, firm data to suggest otherwise, placebos haven’t any place being given to patients in clinical scenarios, researchers argue, not when actual medicine is an option on the table.
“Placebos remain important for clinical trials, because they help achieve blinding and thus, control of bias,” team writes.
“When administered in a blinded fashion, placebo will provide a small effect but the important treatment will normally provide better outcomes for the patient. It may be better to dismiss placebos and instead of manage patients with evidence-based treatments.”
The perspective is published in Medical Journal of Australia.