Placebos in medicine

BMJ 2004; 330 doi: http://dx.doi.org/10.1136/bmj.330.7481.45-a (Published 30 December 2004) Cite this as: BMJ 2004;330:45

Medical paradoxes need disentangling

  1. Zelda Di Blasi, postdoctoral fellow (DiBlasi{at}ocim.ucsf.edu),
  2. David Reilly, consultant physician
  1. University of California San Francisco, San Francisco, CA 94143, USA
  2. Centre for Integrative Care, Glasgow Homeopathic Hospital, Glasgow

    EDITOR—As Spiegel's editorial highlights,1 paradoxes around the placebo effect can be overcome by distinguishing between a dummy pill and the effects of thoughts, feelings, and human relationships.2

    Placebos may seem like a less toxic solution than pharmacological treatments for functional or chronic conditions but this carries side effects—disrupt trust, and outcome is disturbed. Doctors in Israel give placebo treatments without informing their patients, at trial closure investigators often don't tell people if they got placebo,3 and patients often turn to complementary medicine without informing their doctors.

    The issue should not be about prescribing placebos but rather about the need to increase our general knowledge around healing mechanisms,4 to harness directly what placebo harnesses indirectly, in an ethical and practical manner, encouraging a sense of trust and partnership between the public and healthcare specialists.

    Placebo effect research presents evidence of the extent to which individuals possess natural self healing capabilities that can be nurtured in a healthcare interaction.5 A medical system that does not place central value on doctors taking time to establishing safe, trusting and collaborative relationships, is not “evidence based” and ignores the obvious impact on outcome from the quality of human caring, becoming less cost effective in the long run.

    It is time we stop considering perceptions, feelings, and human interactions in health care as variables that need to be controlled in the pursuit of medical science but include and study these as critically meaningful mediators and moderators of therapeutic outcomes in clinical trials, and daily care.


    • Competing interests None declared.


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