An Ethical Issue of Placebo Effect

Placebo effect-a modern phenomenon first introduced by Mark Twain in the 1950’s. He claimed: “The power which a man’s imagination has over his body to heal it or make it sick is a force which none of us are born without. The first man had it; the last one will possess it”.

Though the definition is ambiguous, it can be described as an elusive “treatment” caused by the administering of treatment that has no intrinsic therapeutic value in the healing process. As a clinical phenomenon, it is distinguished as symbolising the interpersonal constituent of healing, discrete from spontaneous natural healing dependent on physiologically active pharmaceuticals or procedures. Over the years, the astounding advancements in medicine and effective procedures have enhanced the longevity of lives. Many researchers claim that part of this improvement stems from placebo effect, and many studies reveal that a degree of plasticity of the human brain.

My research in this area stems from an interest in the neurobiological implications of such studies with a desire towards understanding the psychological vs. physiological aspects of the brain-body relationship. In this paper, I will investigate the placebo effect while outlining the research done by researchers in the past. The placebo treatment is often utilised to test a myriad of new drugs or medication, and examine the effect it might have on a patient with a particular condition. For example, in a study with a group of people with the same disease, a test of the effectiveness of the new drug is carried out. In the group of people, some people will be given a placebo, and others will be given the new drug. The researchers who carry out this experiment then dictate how valuable the drug is, considering its side effects as well as effectiveness of the drug on the disease itself.

The placebo effect is known as the response the patient has towards the placebo treatment. The response is often unpredictable and unclear for every patient, it can vary from positive responses such as the reduction of symptoms in the patient or negative responses such as an exacerbation of the disease. Research illustrates the the treatment has also caused a plethora of symptoms such as depression, pain, sleep disorders, irritable bowel syndrome and menopause to certain patients. However, placebo treatments has increased the mental health of certain patients, allowing them to entertain a more positive mindset. Often, the latter can be hoped for but not predicted. A case study example of the placebo effect includes a study involving asthma. In this study, people with asthma were given a placebo inhaler. They were given breathing tests whilst they were stationary and after they inhaled from the placebo inhaler, the results did not improve. However, when they were asked about how they felt, their response reported that the placebo inhaler imparted alleviation. Research into the placebo effect is still ongoing. It is said to focus on the “relationship of mind and body”.

There are many theories formed regarding this effect as there is still no definite answer toward this unexplained phenomenon. One of the most common theories of this effect is one’s presumptions of the effects of the treatment, if the patient believes certain effects will happen, then it is plausible that it can happen through the biochemical actions of the body. Although the placebo treatment is intriguing, it portrays an extremely complicated effect. In recent studies regarding this unexplained effect, a large amount of attention has been paid to neurobiological mechanisms, in order to completely develop an extensive theory for this treatment and its effect. There are studies which suggest that the placebo effect operates mainly by producing relief of illness, eg pain and fatigues, rather than by modifying the pathophysiology of disease as a hypothesis for the effects of this treatment. There are experimental research which can form evidence for the placebo effect theory, including randomised placebo- controlled clinical trials of drugs and procedures as well as laboratory investigations to evaluate the placebo effect.

Significant improvement was shown in the results of randomised clinical trials involving patients in the placebo segment in comparison to their pretrial baseline. However, this experiment is limited since there is the possibility that the patient improved due to natural history of their condition or regression rather than the placebo treatment itself. Therefore, as a conclusion for this type of experimental research, a placebo effect is unable to be demonstrated without a comparison with a placebo group with a no treatment control group, which is not usually considered in a randomised trial. Despite this, even when no treatment control groups are included, these randomised clinical trials still have particular restrictions when establishing the placebo effect. This is due to how these investigations are normally designed to evaluate treatment efficacy, the trialists tend to express more interest in minimising the placebo effects. During these trials, the patients are told that they may either get a drug or a placebo masked to appear indistinguishable, creating a double- blind design. However, this fabricates a lower beneficial effect compared to when placebos are portrayed deceptively to be known as a beneficial treatment.