Reviewed May 2015
Hi, I want to talk to you about how powerful placebos are, but first of all, I want to tell you about a new study that just came out in the British Medical Journal, and a couple days ago, I was talking with a reporter from CNN who wanted my take on this. The name of the article is Prescribing Placebo Treatments: Results of the National Survey of U.S. Interests and Rheumatologists. And the study starts by saying the following objective, to describe the attitudes and behaviors regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations, and not from the physiological mechanism of the treatment, itself.
Now, when the reporter called me, I said, the study is flawed from the get-go, because they define a placebo whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment, itself. And what I told her is that the placebo effect is a physiologic mechanism.
We think of a placebo as a sugar pill, or a dummy pill that doesn’t have any effect, but because the mind and the body are a unity, anytime there is a positive expectation that there will be an effect, there is an effect, and it’s measurable and it’s physiologic.
Dr. Herbert Benson at the Harvard Center for Mind Body Medicine feels that the placebo effect is most likely mediated by nitric oxide. Nitric oxide is the odorless, colorless gas that is produced in the lining of every blood vessel in your body by pleasure, by positive expectation, by a healthy diet and so on.
And interestingly enough, in a study on Viagra, and of course we know that the major mechanism by which Viagra works is an increase in nitric oxide in the blood vessels of the penis, in a study on Viagra where a placebo was used as a control, 35% of the men who are on placebo experienced a reversal of their erectile dysfunction. So obviously they got more blood where they wanted it from the so-called placebo effect. But the placebo effect wasn’t a dummy effect. It actually increased nitric oxide in the same place the Viagra did it, only it did it through the positive expectation that something good would happen, and it did.
So therefore, I want you all to know that you can use placebos in your life, and they have absolutely no downside. In this particular article, the head author was apparently saying that it was unethical for doctors to use placebo. They felt that it was absolutely wrong, because it was tricking the patient. But in this case, you see, there was no downside, and they defined placebos here as vitamins, sometimes like a B12 shot, sedatives, antibiotics, this sort of thing. I don’t consider those placebos at all. A placebo is something with no downside risk.
I took an oath in medical school called the Hippocratic Oath, and it was first, do no harm. And so—I have often prescribed treatments that do no harm, and have at least some evidence of benefit—but possibly not the rigorously studied benefit that science is based on. Expecting a good outcome is the placebo effect. As a matter of fact, I think that listening to these podcasts is a placebo effect, because I tell you positive things that will affect your health and have no downside risk.
So I say, long live the placebo effect. It’s good medicine.