Less Pain, More Gain: Should Placebo Be a Clinical Therapeutic?

Time to reflect on open-label placebos and their value for clinical practice

“…Recent expert commentaries have called for OLPs to become part of clinical care. 19,31 Although our best evidence is that merely offering placebos elicits small effects, surveys have found that the use of placebos in clinical practice does occur. Surveys from 2008, 2010, and 2019 conducted in primary care settings in Australia and the United States found that many doctors have prescribed a placebo at least once (from 55% to 80%).…”

“…The concept of an OLP is where the clinician delivers the treatment (a pill or procedure) with open disclosure that the intervention itself is not effective but that the patient may expect improvements because of the placebo effect. There is some enthusiasm for this approach, evidenced by recent commentaries, as it is thought of as a way of providing benefit to patients with conditions where there is no known effective treatment and avoids the unacceptable element of deception associated with undisclosed placebos 19,31 . Others say that OLPs should not be used because of a lack of unbiased research and that there are risks to patients including stigmatising and shaming (that have only been studies in self-selected research recruits and not in real patients), and may delay them from receiving real treatments.…”

Placebos in clinical care: a suggestion beyond the evidence

“…These placebo facts were presented in recent editorials, 3,4 but the studies cited as evidence did not measure the placebo effect. A review of treatment for dementia, for example, incorrectly calculated the placebo effect as within group change in the placebo arm 5 .…”

“…The clinical use of placebos is often justified by pointing to their important treatment effects. Proponents have also argued that the placebo effect can be amplified by manipulating the physical appearance of the pill, 2 that placebo effects vary across geographic regions, 3 and that placebos are getting more effective over time 4,5 . It has even been suggested that subterfuge is unnecessary; placebos can be honestly described as inert and still yield important clinical effects 1,6 .…”