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Maximising placebo-effects

Placebo-effects are real and they can help many patients. So why do we not make better use of them?

Placebo-effects are real and they can help many patients. So why do we not make better use of them?

Of course, I am not advocating treating patients with placebos such as highly diluted homeopathic remedies. For a whole range of reasons, this would be wrong (see my previous blogs). But I am suggesting maximising placebo-effects when prescribing effective treatments.

We often forget that prescribing a treatment – say a pain killer – will not only generate a specific therapeutic (ie pharmacological) effect but also a placebo-response. That is, if we are doing it well!

The evidence that this is so comes from controlled studies where all patients are given a treatment, eg a pain killer. In one group, patients know what is happening, while in the other group they don't. For instance, pain-patients who receive an opioid drug through an IV line can be quite easily deceived in that way. The results of such studies show that knowing what is going on enhances the therapeutic response. Part of the reason for a placebo-effect is expectation. So enhancing patients' expectation maximizes the placebo-response and thus leads to better clinical outcomes.

Complementary therapists are often very good at doing just that. In fact, some studies suggest that this is their main strength and patients often like them for it. In conventional medicine, we are often quite bad at maximising the placebo-effect. I think that this is rather regrettable and, in most instances, not in the interest of the patient. Should we not consider ways of changing this?

Professor Edzard Ernst Professor Edzard Ernst

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