If you read Steve Silberman's excellent Wired story on placebos last year then you know that fake medicine can have some very real effects. Scientists are only beginning to ask the important questions here—why placebos seem to be able to alleviate certain medical problems, why they don't have much impact on others, and what all of this tells us about the human body.
But, looming behind those questions is a nagging, clawing beast. Even if placebos can be medicine on a technical level, could we ever ethically use them? Most of us agree that it would be wrong for doctors to lie to patients, even if it might help the patients feel better. And most of us assume that lies are part of how placebos work.
But that may not be true.
A small study, recently published the journal PLoS One, looked at what might happen if the irritable bowel syndrome patients who received a placebo knew they were taking nothing more than sugar pill. Amazingly, the placebo group improved. In fact, they improved as much as the people taking the real drug. These results aren't comprehensive. As Silberman explains in a nuanced and fascinating blog post, this is the first word on ethical placebos—not the last. But the questions it raises are important ones. The research that will come out of this line of inquiry could change the way our children and grandchildren think about medicine and health. And it opens whole barrels of worms …
Its modest sample size and brief duration leave plenty of room for followup research. (What if "ethical" placebos wear off more quickly than deceptive ones? Does the fact that most of the volunteers in this study were women have any bearing on the outcome? Were any of the volunteers skeptical that the placebo effect is real, and did that affect their response to treatment?)
Before some eager editor out there composes a tweet-baiting headline suggesting that placebos are about to drive Big Pharma out of business, he or she should appreciate the fact that the advent of AMA-approved placebo treatments would open numerous cans of fascinatingly tangled worms. For example, since the precise nature of placebo effects is shaped largely by patients' expectations, would the advertised potency and side effects of theoretical products like Placebex and Therastim be subject to change by Internet rumors, requiring perpetual updating?
Read More: Meet the Ethical Placebo by Steve Silberman