The placebo mystique : biomedical implications

The 'placebo effect' is a medical enigma. It lies at the heart of modem medical research but remains an amorphous concept; used either as a weapon to dismiss the subjective successes of alternative therapies or to bolster medical claims to scientific 'truth'. In a paradoxical fashion, mainstream medicine overtly rejects the significance of the placebo effect, whilst simultaneously using its existence as justification for the use of placebos in clinical trials. This study aims to explore the complex relationship between biomedicine and the 'placebo effect'. Specifically, I aim to understand how dispute about the meaning of the 'placebo effect' developed and how it currently impacts upon clinical and research work. The study is structured in two parts; the first part contains a discussion of the historical background to confusion about placebos; the second part contains a report on a survey conducted to assess current understanding(s) of the placebo effect amongst Australian medical practitioners. The survey demonstrates that confusion persists amongst clinicians and researchers as to the nature of placebos and the placebo effect. There is disagreement about when placebos should be used, when placebo effects are involved and what conclusions should be drawn from the studies that are performed. The survey made it clear that many doctors are uncertain about the indication for placebo use in clinical trials; many doctors were under the mistaken impression that placebos are essential to control for the placebo effect. I argue that this misconception may well have its origins in Henry Beecher's incorrect assertion that the placebo effect makes placebos an essential component of randomised controlled trials. I discuss the implications of this, mostly particularly in influencing researchers to use placebo controls in situations where they are not methodologically essential