How does a Placebo Work?

A placebo is an inactive, generally harmless substance given in place of a real medication. Original use of the placebo could help doctors determine whether a suspected condition was of psychological or physical origin. Doctors would give a placebo to a patient, telling them it would cure their illness or lessen their pain. If symptoms improved, then the doctor might suspect hypochondria.

This use of a placebo is now considered extremely unethical. By law in the US patients are allowed full access to their medical records and must be given appropriate and true information from their physicians. However the “placebo effect” as it was called when patients actually improved has furthered the study of perception influencing health and wellness. Knowledge of placebo effect opened the investigative field of treating some conditions with cognitive behavioral therapy.

Cognitive behavioral therapy as used for people in chronic pain has been tremendously successful. This field does not use any type of placebo, but instead focuses on the knowledge that perception changes how people respond to pain. By altering thoughts and feelings associated with pain, chronic pain can actually be decreased.

Today the placebo is used in clinical double blind testing to examine the effectiveness of new medications. Unlike past use of the placebo, however, patients participating in studies are fully aware that they may not get the real medication. Usually half the patients in a clinical trial receive the real medication while the other half receive a placebo.

Early understanding of the placebo effect caused initial testing to lack adequate data, since if patients thought they were getting the real medication, their condition might improve regardless. With patients being aware they stand only a 50% chance of receiving the appropriate medication, evaluation of effectiveness is not diminished by the placebo effect. As well, side effects can be more appropriately measured, since those receiving the actual medication will show incidence of higher or lower side effects than those patients taking the placebo.

Some feel that double blind testing is valuable, but often these clinical trials can take a great deal of time. Those medications that might offer a cure to someone who might otherwise soon die, or who is undergoing excruciating pain, are withheld from half the patients in clinical trials. Those who do receive a placebo are apt to be unhappy that they could have been cured, or could have endured less pain, if the doctor had only given them the real medication instead of the fake.

In some cases, now, medication that might save a life or prevent extreme suffering can be tested by doctors on patients in need. The doctors then write up reports on the effectiveness of the medication. Usually the placebo is omitted, because to give a placebo can sometimes cause irreparable harm. However, most medications cannot be approved without double-blind testing, so until such testing takes place, these medications are referred to as trial or experimental, and most will not be covered by any type of insurance.