Shedding Light on the Placebo Effect

I’m a trained scientist and researcher. I followed this path because I have always been the curious type and I’ve found that there’s always new ways to look at the same question. I like the challenge of simultaneously being independent, analytical and objective. I enjoy diversity in thinking, but expect people to behave reasonably. As a mom, one way I’ve shared my love of learning and discovery is by doing home science experiments with the kids. This is a great family activity that can be tailored for any age and any degree of interest. Ask the questions, get answers. Dissect the results. The insight that is gained from the new perspective can be invaluable. That’s why we should strive to listen, not just talk.


Recently and inadvertently, I was involved in situation that illuminated the placebo effect for me. Everyone knows the placebo effect is based on a belief that something is going to produce an effect, but that the something is not capable of actually producing that effect. The effect occurs because the person assumes that is what is supposed to happen. And that is what happens…at least initially. The classic example is that the doctor gives you a pill to cure an ailment and you take it and you get better. The doctor knows the pill contains only sugar or some inert ingredient but the patient thinks it’s a remedy. The patient feels better for taking it. Case closed. Next!! More rigorous studies involve groups of patients, some getting actual drugs, some getting placebo. Neither the doctor nor patient knows who is getting placebo. This is the classic “double blind” study which is designed to minimize the assumption factor for both the doctor and the patient.



Now for the new twist…let’s say now the patient knows and the doctor doesn’t. The patient reports that he takes the pills and that it has this effect. Doctor is happy the patient is compliant and the medicine is working. The skeptical doctor, of course, is always looking for tangible clues to support or deny what the patient reports and to confirm a diagnosis. If there is no measurable evidence to the contrary, the doctor would believe the patient and all is well. If the patient can fool the doctor, is it fraud or does the patient not need the medicine? Is it reasonable to assume that a patient would agree to take or do something when they had no such intention of doing so? Is this a difficult patient who needs to be classified as such? Is the doctor lazy or wrong? Is the doctor trying to address a problem to which he is not attuned or not entirely comfortable? All these questions!! Back to reality!

Why would the patient try to fool the doctor? Aside being incompetent or criminal, the patient may not want to take the medicine, the patient may want to please the doctor, the patient may not be able to pay for the medicine or the patient thinks the side effects are worse than the medicine itself. The answer could be a combination of these things. Typically, how do these patients try to mask evidence?

If a patient goes to the doctor with a complaint and the doctor tries to address it, how much responsibility does the patient have if he ignores advice but reports he complies? How much time should a doctor spend with a patient who won’t follow advice? How many treatment choices should a doctor give a patient? What are the chances this problem will resolve on its own? How can anyone be sure a treatment doesn’t work if the advice is not followed? How many problems or options can a doctor address or dismiss in 15 minutes? How much follow up is required ...and... do you see the red flags?

If a patient agrees to try the medicine, is it fraud to fool the doctor and lie?

Good doctors ask questions that will give them helpful answers. Health insurance, in some respects, has forced doctors to ask questions that give varied answers and that’s unfortunate, but not the doctor’s fault. If patients actually value the doctor’s advice they should continue to seek that advice and take that advice, otherwise, they should move on. Deceiving the doctor is always a bad call. If you find yourself doing this, you should ask yourself what the motivation is. Most people would not jeopardize their health and well being by misrepresenting themselves. They would not attempt to undermine a partner in healthcare if they wanted to resolve real complaints. Denial is funny in this way. The obvious eludes people in denial.

Personal truth is as important as scientific truth, but more debatable. Personal truth can be difficult to define and defend because irrational thinking twists the facts, re-prioritizes the facts, or omit facts entirely.

Moral of the story: Deceiving yourself and others on purpose will harm you. If you at odds with your doctor, it’s time to find another one.