[Paleopsych] NYT: This Pill Will Make You Feel Better, but We're Not Sure Why

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Tue Sep 28 14:48:46 UTC 2004

This Pill Will Make You Feel Better, but We're Not Sure Why
NYT September 28, 2004

Most people have heard of the placebo effect, in which
patients given sugar pills feel better because they think
the pills are medicine. But few would like to be on the
receiving end of a placebo: a person who asks for a
painkiller wants the real thing.

The medical profession, at least officially, frowns upon
prescribing placebos, because it usually involves lying,
implies disrespect and can destroy trust in doctors. Some
hospitals ban placebos, except in experiments, and then
participants must be told that they might be given inert
pills or shots.

A new survey, though, suggests that the profession may not
always practice what it preaches. In the survey, of 89
doctors and nurses in Israel, 60 percent said they had
given patients placebos. Many said placebos could sometimes
work, and more than a third reported prescribing them as
often as once a month.

The patients given fake medicine included women in labor
and people suffering from pain, anxiety, agitation,
vertigo, sleep problems, asthma and drug withdrawal. Most
had no idea that they were getting placebos. Among the
prescribers, 68 percent told patients they were receiving
real medicine, 17 percent said nothing at all, 11 percent
said the medicine was "nonspecific" and 4 percent told
patients the truth.

Asked why they prescribed placebos, 43 percent said
patients had made "unjustified" demands for medicine; 28
percent did it to test whether a patient's symptoms were
real or imaginary; 15 percent hoped to buy time before the
next dose of real medicine; and 11 percent said their
reason was "to get patient to stop complaining."

The doctors who conducted the survey said they had expected
that no more than 10 percent of those who responded would
have used placebos.

"This is apparently a common practice," said Dr. Pesach
Lichtenberg, a psychiatrist at Herzog Hospital and Hadassah
medical school in Jerusalem.

He conducted the survey, with Dr. Uriel Nitzan, at two
large hospitals and various community clinics in the
Jerusalem area. Their report was published online Sept. 17
by BMJ, a British medical journal (www.bmj.com).

The notion of a placebo effect dates at least as far back
as Hippocrates, who observed that certain gravely ill
people seemed to recover through sheer "contentment" with
their doctors. Thinking the mind could heal the body, later
physicians sometimes tried to help it along by giving inert
pills or powders to sick people they could not otherwise

Today, some researchers are studying the placebo effect,
while others doubt that it even exists.

In a telephone interview, Dr. Lichtenberg said he thought
the placebo effect was real, could sometimes help patients,
and could do so more safely than many drugs.

"I think the placebo has a legitimate place in medical
treatment," he said, but he added that it was wrong to lie
to patients.

"There are certain ethical questions," he said. "Do you
tell a patient, 'I'm giving you an antibiotic or a
painkiller,' when it's not? Or do you tell them, 'You are
getting an agent which has been proven effective repeatedly
in research, which will help you feel better; we're not
exactly sure how it works, but it has been shown to cause
changes in brain imaging, to have physiological effects in
the body and we are confident you will get relief?' Do you
say something like that?"

Dr. Lichtenberg said he became interested in the placebo
effect because he had been helped by it himself. He had
suffered for years from repeated throat infections, and
consulted a friend who practiced alternative medicine.

"He spoke to me for five hours," Dr. Lichtenberg said,
recalling that he free associated about his throat and
described being made to sing as a child for his elderly
aunts. The friend told him that he would become slightly
ill and then recover. That was exactly what happened, Dr.
Lichtenberg said. The experience convinced him that there
was something to the placebo effect.

He said: "People in our day and age are surprised that a
nonpharmacologic intervention could be useful, and I think
that ultimately is the message of the placebo effect. There
are other ways of bringing comfort and succor to a
suffering patient."

A survey of Danish doctors published in 2003 also found
that many of them prescribed placebos, but Dr. Lichtenberg
said it was not known whether doctors and nurses in other
countries behaved the same way as those in Israel and

Dr. Robert M. Wachter, chief of the medical service at the
medical center at the University of California at San
Francisco, said in an e-mail message, "The use of placebos
in day-to-day clinical care is virtually unheard of in the
United States."

He continued, "They are thought of as a subtle form of
deception - both unethical and potentially creating a small
risk of a malpractice suit."

But Dr. Wachter also said that every doctor knew about the
placebo effect and that it accounted for much of the
benefit people got from antidepressants and all of the
benefit from antibiotics taken for viral infections, which
are not affected by the drugs.

" 'Take this - I'm sure you'll feel much better' is a
placebo maneuver," Dr. Wachter said. "But in the U.S., it
would be accompanied by a real medicine, not a sugar pill."


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