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The word "placebo" comes from the Latin for "I please." This is because the
primary effect of placebo drugs is to "please" patients, rather than to have an
effect by virtue of active ingredients: the act of having taken what appears to
be medicine can help people feel better if they are imagining symptoms of some
illness. A placebo can have an even stronger effect of making a person with a
real ailment more optimistic about his/her recovery, which can actually speed up
said recovery. A drug can be an unintended placebo (designed to have a certain
effect, failing to actually have that effect, but “curing” patients anyway
because of their belief in it) or a placebo by design (a pill, syrup, etc. that
was carefully concocted to have no significant active ingredients whatsoever).
Medical trials also tend to take the possible placebo effect into account. When it is time to conduct trials on humans, a placebo might be given to one of the trial groups, just to make sure that the effectiveness of the drug is really due to its composition, rather than people’s belief that the medicine will work. One of the most famous instances of the placebo effect is discussed at the beginning of a February 2009 Scientific American article by Maj-Britt Niemi. Niemi details the case of “Mr. Wright,” a cancer patient in the 1950s whose disease had progressed to its late, terminal stages. In 1957, he was injected by a drug called Krebiozen. His tumors soon began to shrink, unlike most of the other cancer patients who tried the drug and experienced little or no significant improvement. What distinguished this patient from the others who tried the drug was that, unlike them, he was very optimistic about its effects and was convinced that it would make him better. Here, it appears that belief in a drugs supposed effects can help bring those effects about—the placebo effect in action, even in as grave a case as late-stage cancer. However, simply believing or wishing for effects from a medicine will not ensure a cure. According to the American Cancer Society, only a third of people given placebos experience the placebo effect. It is not clear whether this estimate refers only to cancer patients or to the patient population at large, or if the statistic includes people who report physical improvement where doctors see none. Furthermore, the placebo effect is usually short-term. The patient may feel better for a short while after taking the placebo, but symptoms are likely to return. The Society does, however, assert that the placebo effect can be very real: it should not simply be taken as "proof" that the illness was imagined by the patient. Of course, in some cases the illness is indeed imaginary. Many hospitals have arrangements that actually take advantage of the placebo effect. These are specifically for patients who are convinced they are ill despite the absence of real symptoms. The doctor may prescribe medicines without active ingredients, or will inject them with water, perhaps using coded phrases in instructions to nurses, so that the patient will not realize that he/she is not being given real medicine. Some people may object to this kind of “dishonesty” towards patients. However, it can often be the only way to calm down severely agitated hypochondriacs and prevent them from poisoning themselves with unnecessary or inappropriate medication. Placebos can even be given to pets, often to placate owners who insist that veterinarians administer or prescribe medication where it is not needed. The placebo effect might be used in cases where patients are found to "shop around" for doctors in order to get more medication. In other words, a particular doctor prescribes a certain amount of medicine, but this is not enough to satisfy the patient, so he/she approaches other doctors, thus procuring multiple prescriptions. If doctors detect that a patient is doing this, they may prescribe him/her placebos, so that the patient will think that he/she is receiving the desired amount of medication, and will not try to use underground channels in order to get more. Of course, monitoring a patient’s interactions with other doctors or sharing his/her prescription information with other physicians would be a tricky issue: doctor-patient confidentiality is a matter of both legality and principle. However, it cannot be denied that sometimes this sort of confidentiality is sometimes abused by the patients themselves, and may even lead to their death. This debate goes to the heart of questions about what the relationship between a doctor and a patient should be, and placebos have a place at the center of the debate. So, how can placebos be made more effective? Since the key is, by definition, not in the active ingredient, the most important factor is presentation. The drug has to look convincing, of course. However, this is often not a problem, since pills can be made of sugar, and injectable drugs can be simply distilled water or mild saline solution. Placebos must also be administered in a way that convinces patients they are taking "normal" medicine. Doctors, nurses, pharmaceutical staff, or whoever else is involved should not give any indication that a deception is happening. Thus, the personnel involved should know how to “act” a little—not necessarily a common skill in the medical professions, so the selection process for placebo procedures must take this into account. All in all, the placebo effect is one that cannot be discounted in terms of immediate pronouncements about medicines, or avoiding poisoning patients with drugs they do not need. However, as was said above, the placebo effect does not necessarily last very long. A person with real and serious ailments might feel better for a little while, but the disease is likely to undergo a resurgence. In other words, the prescription of placebos should not be used as a substitute for real medicines where the latter are required. Furthermore, the concept of the placebo effect should not be used (alone) as a reason to junk conventional Western medicine in favor of alternative therapies.
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