The Debate About Doctors Giving Out 'Fake' Medicines

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Scientific evidence accrued in the past decade has strengthened the idea that the placebo effect is a very real and potentially powerful phenomenon. In fact, studies of antidepressants and other medications indicate that roughly 20 to 30 percent of a treatment's benefit is typically due to the placebo effect, not from the treatment itself, says Tilburt. Some research even suggests that telling patients they're being given a placebo doesn't necessarily destroy the effect, notes Fabrizio Benedetti, of the University of Turin Medical School in Italy, who is one of the world's leading authorities on the science behind the phenomenon.

"It's pretty clear by now that the mind and the body talk to each other," explains psychiatrist David Spiegel, associate chair of psychiatry at Stanford University School of Medicine, who has researched the placebo effect. Brain scans have shown that by merely suggesting to patients that a treatment will work, such as by telling them that an inactive gel is actually a potent pain cream, doctors can get the body to release natural painkilling compounds and the brain to downshift its processing of pain signals.

Some of the most striking evidence of the placebo's power has been unveiled through clinical surgical trials. One study showed that a sham operation was as effective at easing volunteers' painful knee osteoarthritis as arthroscopic surgery, and that relief could last. (The number of arthroscopies, which used to exceed 650,000 annually, fell dramatically after the results appeared in the New England Journal of Medicine in 2002, Sade notes.) Another trial found that volunteers with Parkinson's disease, who believed they'd had an operation to implant fetal tissue in their brains, experienced significant improvements in their quality of life and their motor function, regardless of whether they actually received the fetal tissue; the benefits lasted for about a year.

Not all patients benefit from the placebo effect. But "when it does work, the power of the placebo can be virtually as effective as any pill that we prescribe," says Brody, who has authored a book on the subject. Still, he adds, doctors may be able to harness the phenomenon without ever dispensing medication—thereby avoiding any ethical issue surrounding the use of placebos.

"Doctors have a good alternative, and they don't have to give any pills or tell any lies," he says. "All they have to do is be encouraging and engaged with the patient" and be warm and supportive during the visit. The available evidence, he says, suggests that patients might be as likely to get a positive placebo effect from the doctor's attitude as they would get from a pill. He cites an acupuncture study, for example, in which patients who were cared for by a warm, compassionate provider reported more pain relief than patients whose providers intentionally behaved in an impersonal way. (Some experts, in fact, believe that the placebo effect accounts for the apparent effectiveness of alternative treatments such as acupuncture.)