FAITH HEALING WITH LAB COATS:

Enhancing the Placebo (OLIVIA JUDSON, 5/03/10, NY Times)

[T]he most reliable source of a strong placebo effect appears to be: the doctor.

Placebo treatments are more powerful if your doctor believes in them. They are also more powerful if the doctor tells you so. In one study, for example, patients who had just come out of surgery were given a saline infusion, and — whenever they asked for it — the pain killer buprenorphine. However, some patients were told the saline infusion was a powerful painkiller, others that it might be one, while a third group wasn’t told anything. Over the course of three days, those in the “know-nothing” group asked for more buprenorphine than those in the “maybe” group, who in turn asked for more than those told they were getting a real drug.

Which highlights a problem. Since deception of patients is unethical, some argue that the placebo has no place in the actual practice of medicine.

But the matter is more nuanced. As the morphine example shows, the placebo effect also enhances “real” treatments. So the key is to figure out how to maximize that enhancement without lying. One idea would be to deliberately increase the element of formal ritual in medicine. Studies of “alternative” therapies show that strong placebo effects can be induced by ritual. Indeed, in mainstream medicine, surgery is the treatment most surrounded by ritual; perhaps this is one reason it appears to be the most powerful placebo.