How strong is the power of the mind? In class we always talk about how double-blind placebo trails are a more accurate way to get results; but if the patient believes he/she is getting the correct medicine, could it effect the outcome of the placebo patients? In a randomized double-blind placebo-controlled trial, only about half of the participants are given the treatment, while the other half are given fake treatments, or placebos. In these trails the researchers, doctors, and the participants do not know who received the actual treatment until the end of the trail. But could the mind trick the body into healing by believing that the correct treatment is being given to them?

The placebo effect is the process by which believing that you are being treated therefore causes your symptoms to improve. The amount of times the placebo effect is effective varies based on the trial. For some trials, it could range from 0% of the placebo patients healing to 70%.

In an study, de la Fuente-Fernandez et al scanned patients with Parkinson’s disease. The patients with Parkinson’s disease were blindly measured under two conditions, one being a placebo drug or an active drug, including apomorphine, a dopamine receptor agonist. With the placebo patients, a decrease of raclopride binding potential was found in the striatum compared with baseline observations. The placebo effect in the Parkinson’s disease study seems to have made a difference by increasing the synaptic levels of dopamine in the damaged patients system. In more clearer terms, the placebo effect healed patients more than the actual treatment. De la Fuente-Fernandez and Stoessl assume that “the perception of clinical benefit must be rewarding” and have proposed that “dopamine is released within the ventral striatum with respect to the expectation of reward.”

In the article published by M. Beauregard / Progress in Neurobiology 81 (2007), multiple studies are shown to prove the existence of the the placebo effect. They concluded that

• In their first experiment, “the placebo treatment significantly decreased reported pain in over 70% of volunteers.”
• “Expectation of analgesia prior to the placebo intervention and the analgesic effectiveness of the placebo were rated at 51%.”
• And even during a trial when they promised the volunteers that 50% had a chance of receiving the treatment, but yet they all received placebo. “The placebo produced a significant bilateral dopamine release in the thalamus, which was reflected by a 15% reduction in thalamic.”

This data analysis shows not only how the placebo effect works but also, it shows that it does in fact work. But is using deception on patients ethical, even if it bears results?

An example of deception in medicine is the practice of prescribing methylene blue to patients as an active placebo. The placebo does nothing but pass the kidneys and turns the urine deep blue. Doctors told the patients that their condition was caused by a benign tumor but that the treatment (placebo) would eliminate the tumor. The patients were told that they would know the treatment has worked when their urine turns blue. The purpose of this deception was to convince a patient that they were healed, so that their symptoms would heal. This type of placebo trail seemed less ethical though because the subject was “tricked” by being told lies used by a doctor/physician.

Although there are specific regulations, strict ethical rules, and people put in charge to oversee those rules, there is really no such thing as “full” disclosure. This means that some doctors/physicians use judgement to decided what  patients need to know and what he/she doesn’t need to know. In the article “The Ethics of Deception in Medicine”, Steven Novella says “It is therefore difficult to impossible to have a workable system of medical ethics within an unscientific sectarian health care belief system.”

Ted Kaptchuk, from Harvard University, and Andy Avins, from University of California, found that the use of deception in research on the placebo effect prompted the development of an Authorized Deception. They state that “Subjects are not informed in advance about the use of deception but are “debriefed” at the conclusion of research participation.” Is this ethical? 68% of physicians who answered the survey said that when they recommended a placebo treatment they described it to their patients as “a medicine not typically used for your condition but may benefit you.”

The use of deception is still questioned to be either ethical or nonethical, but if you were a sick patient in those shoes, would you want a doctor “lying” to you?