Level with Clients about Placebos

What is a health care provider’s responsibility when selling a remedy that works, but the health care provider believes it is working only because the recipient expects it to?
     This is the placebo effect.

• Many Parkinson’s disease sufferers report less agitation after a regimen of a pill that contains no known bioactive ingredients.
• Saltwater injections often relieve pain nearly as well as does a morphine injection.
• Toothaches can be relieved by a procedure the patient thinks is an ultrasound, but in fact is nothing more than official-looking equipment making noises.

     Is it legitimate to use such pills, injections, and procedures as part of medical care? After all, the saltwater and sugar pill have fewer side effects than the morphine and L-dopa.
     For me, the ethicality depends on relative risks, candor, and inquisition.

• Another example of the placebo effect is that knee pain can be relieved by a fake operation, in which the leg is opened and then closed. Here, the potential risks from surgery are such that recommending a fake operation is, in my opinion, ethically wrong. Based on this logic, if there are less invasive methods for pain relief than a saltwater injection, those alternatives would be the legitimate choice.
• It might be that the placebo effect works even when the consumer is told the mechanism of action is unknown. At this point, it’s not clear exactly how mindful meditation reduces high blood pressure and relieves depression, but it seems to me quite legitimate to say, “Many people have reported positive results with mindful meditation, so I recommend you give it a try to discover the results for you.” Similarly, it would be okay to say, “Many people have reported relief from back pain after using this pill. Medical researchers don’t know exactly why it works. But because of the absence of known side effects, I recommend we try it as our first alternative.”
• As I see it, a spirit of inquisitiveness is necessary for use of what we consider to be placebos. We need to press for explanations of how the pill or procedure is working. Maybe saltwater is diluting the toxins causing the pain. Maybe as we carefully assess mindful meditation, we’ll see ways to simplify the routine without lessening the payoffs.

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