Health News

Are 'Dummy Pills' a Dumb Idea, or Do They Really Help?

May 23, 2001 -- For decades, doctors and scientists have believed that treatment with a dummy pill -- a placebo -- can sometimes ease the symptoms of a variety of ills, from asthma to pain to high blood pressure, and even to heart attacks.

Early research has even suggested that the 'placebo effect' could have therapeutic results on a whopping 35% of patients, but a new study casts doubt on the placebo's power to cure. It's a study that might leave many doctors, and patients, rethinking their beliefs.

"I think many people -- physicians, patients, and others who are concerned with these things -- find the story about placebo very appealing," John Bailar III, MD, PhD, tells WebMD.

"It is really kind of comforting ... to believe that we can improve the patients' circumstances by giving something harmless, even in cases where nothing else can be done. ... It is hard to throw away that whole idea," says Bailar, professor emeritus at the University of Chicago, who was not involved in the study but wrote an accompanying editorial.

But is the so-called "placebo effect" based at all on fact?

To determine the clinical effect of any kind of placebo -- a pharmacologic placebo (a dummy pill), a physical placebo (a procedure done with the machine turned off), or a psychological placebo (a neutral discussion with a healthcare provider) -- two Danish researchers identified 114 trials published between 1946 and 1998 involving more than 8,500 people. Those studies compared patients who had received a placebo to those who had received no treatment, and to those who had received active treatment.

In general, the Danish researchers found little evidence in these previous trials to support the assumption that placebos have a powerful clinical effect.

"They could not find improvement in most kinds of patient symptoms and complaints," says Bailar. "The one exception was pain, where they did find a very small placebo effect, but even that is in question because of some difficulties in the kinds of research studies they were able to look at."

The two authors conclude that because the therapeutic effect of placebo seemed so minimal, use of placebo outside of clinical trials -- where it is used for comparison -- is not recommended.

In his editorial, Bailar calls the conclusion "too sweeping" and writes that there may still be another role for the placebo.

"I am advocating much more careful thought on the part of physicians who are using placebos about what they are doing and why, and the likelihood that it will benefit the patient," he says.

But Bailar says too many doctors are writing prescriptions for placebos for the wrong reasons.

"It is extremely common," he says. "They are not always called placebos; it may be something that has an active component, though the doctor knows very well it isn't going to help this patient."