Controversies Surrounding Placebo

What Are The Ethics and Controversies Surrounding Placebos?

Placebos are a form of treatment that is typically prescribed by medical professionals to benefit an individual’s psychological or physiological state. The placebo is a sugar-based pill that has no active ingredient, also known as a dummy pill. A Professor named Marcello Costa stated that “the substance may have a therapeutic effect on a person when in a doctor’s office or a professional in the medical field”. Placebos are also used as a control variable when testing new medicine in clinical trials. This is to help scientists evaluate whether the new drug produced is safe for a person to consume whilst ensuring it will work effectively and efficiently. A placebo is given to a person

who believes they are taking an active treatment, therefore the medication will work due to their psychological response to them believing it is an active treatment. Placebos can support people with depression, extensive pain, menopause, sleep disorders and irritable bowel syndrome (IBS). The topic of placebos is controversial as it may involve deception if the professional prescribing the medication does not tell the patient exactly what it involves. The ethical concerns are that the professional being the General Practitioner (GP) is not being honest with the patient and may in time break the trust between the two. Secondary sources and interviews with Dr. Oliver Frank, Professor Marcello Costa, Dr. Seetal Dodd, Professor Richard Upton, Professor Ross McKinnon, Professor Magne Flaten, Professor Ben Colagiuri and Professor Russell Scott have then been analysed to investigate The Placebo Effect.

The Medical and Scientific Reasoning behind the Use of Placebos
The medical and scientific reasoning behind the use of placebos is that when a placebo is consumed it causes measurable changes in neurobiological signaling pathways, which will result in pain relief.

This will activate pathways in the brain which will stimulate and release a substance called endorphins. This is quite similar to morphine. Endorphins act like morphine which bind and cause pain relief in the body. Therefore, when responsive to positive expectations of the treatment, the brain will be engulfed in its own supply of painkillers. If an individual is experiencing pain and a physician prescribes a placebo and has not confirmed it is a sugar pill the person will expect it to have a therapeutic benefit. Placebos are a sugar-based pill that contains no active ingredient. The Placebo Effect is utilised to discover whether the pharmacological drug will have an effect on the individual. The placebo is a mind over body effect that is utilised in clinical trials and by a general practitioner. Dr. Seetal Dodd also stated that “When an individual is in an environment such as a doctor’s office it will create a therapeutic effect on one’s self”. This will ensure the drug is utilised successfully and may work in its the correct way that it has been intended to do so. Figure 1 demonstrates the placebo being utilised by the

body.

Psychological and Physiological Effects
Placebos can have physiological and psychological effects as the mind has the ability to accomplish things it could not before.

Magne Flaten stated that this is because “all the systems are connected to the human body”. The physiological effect occurs via the autonomous system by affecting the brain causing aviation in areas that control pain or movement. This will ensure the pain vanishes as it would on morphine. Dr. Seetal stated that “Nocebo is the negative expectations of the effect of a placebo medication. This can occur when a person does not respond well to treatment for many different reasons”. Each individual has a unique genetic makeup, which means that all biological factors will react and be effected differently to another. This can be difficult for medical professionals that will need to support and cater to a wide range of unique individuals. The placebo has a physiological effect via the autonomous nervous system in our brain, meaning the relief of pain will be as if the individual has had morphine. Professor Magne Flaten stated that “This affects the brain causing aviation in areas that control pain and movement in the body”. All medical treatments are surrounded by psychosocial themes that will affect the therapeutic outcome of an individual. To accomplish this a placebo is given and the patient it made to believe it is an active pill that will be effective. The neurobiological mechanisms have been studied and the placebo has been demonstrated to be a

good role model to comprehend complex mental activity. The psychological effects of a placebo are that when a person is prescribed this dummy pill for a mental disorder the individual will believe it is a medicine that will work. Therefore, their mental state will be enhanced and will successfully alter their chemical imbalance so that they believe they feel better.

The Ethics and Controversies Surrounding Placebos
The ethical concerns regarding the use of placebos are deception and honesty between the General Practitioner and the patient. If a placebo is given to a patient, the GP will need to ensure they are honest about the medication. Placebos are not an active drug, which can be controversial as it is considered to be playing with the mind. If a person is told to take a pill because it will take their pain away most times it works. This can be deception and considered unethical. Professor Ross McKinnon stated that “Patients should be notified that they are consuming a dummy pill that is sugar based with no active ingredient”. The placebo is not promised to have a significant effect on a person, therefore the person should be told what they are about to take. Placebos should be given to patients alongside the active pill to ensure proper treatment is utilised. When placebos are utilised in clinical trials both groups are notified prior that they are going to be consuming either a new active pill that has been produced or a dummy pill that is sugar based. This allows for any individual to leave the trial if they do not wish to be a part of it. Double-blinded trials are undertaken to test a new drug but this time nobody knows who in the groups are consuming what drug. Professor Marcello Costa stated, “It is known that placebos are not allowed to be sold, in other words, companies cannot make money off of it due to it only obtaining sugar”. The topic of hidden placebos is controversial as they are used in research and not in clinical trials. As stated by Dr. Oliver Frank, “A hidden placebo is deceiving the patient, which is considered unethical practicing”. Openly labeled placebos are ethical due to being honest with the patient about what is been prescribed. If a GP discusses the sugar pill (placebo) with their patient there will be no ethical issue. On the other hand, if a GP prescribes a placebo to a patient and does not inform them that it contains no active ingredient they may be breaching the rights of the individual.

Prescribing Placebos to Patients
Dr Oliver Frank stated, “Placebos are prescribed to a patient if they have any of the following. Sleep disorders, mental disorders, menopause, and sexual performance can be”. This was supported by Dr Seetal Dodd. Professor Russell Scott stated, “When a GP uses a placebo to treat a patient they must inform them as to what they are consuming due to ethical reasons. Professor Russell Scott also stated, “The placebo can be used for many complications such as pain, confidence, stress, depression and many more”. Professor Richard Upton stated, “The main concern surrounding the prescribing or placebos is that the patient may feel as though they cannot function without it and will begin to rely on the medication”. If a placebo is utilised in a doctor and patient environment the doctor must notify the individual that what they are consuming is a sugar pill with no active ingredient, otherwise it will be unethical practicing on the Doctor’s behalf. Professor Ross McKinnon stated, “During the clinical trial, each individual is notified that either Group A or Group B will be given an active pill or a dummy pill. In this case, it is ethical due to the individuals being notified prior to consumption”. This allows each person to decide whether they would like to continue or withdraw from the clinical trial.

It is evident that The Placebo Effect is an ethical and controversial topic. The science behind this extraordinary drug is phenomenal and can be utilised effectively in most cases. As shown above, the individual consuming the placebo may experience several physiological or even psychological effects. This can be both positive and negative, depending on each individual. The person may feel nauseas during the course of the treatment. For example, if consuming the placebo was a positive outcome for the individual, the effect is that the pain will be reduced substantially. The ethics and controversies surrounding the placebo effect is that if a GP is prescribing a placebo drug the patient must be notified of what it is exactly. If this is not undertaken, it is known as deception. Deception can break the trust between the Doctor and the patient. In a clinical trial both groups will be told that, they may be consuming an active drug or a dummy pill. This is ethical as each person was told prior to the trial and could leave if the individual felt the need to. The term “alternate” should not be utilised when talking about the placebo effect. Placebo medicine should only be used alongside the active drug to ensure the patient is obtaining the correct medicine needed to recover. Due to the active medicines already produced, that have been proven to work, there is no need to not utilise them. This may cause harm to an individual that may need the active ingredient within a pill. There has not been enough studies or research conducted to prove that placebos are better than active medicine. There are many reasons why placebos are utilised. GP’s may decide to prescribe their patient with a placebo if they feel as though their patient needs it. The Placebo Effect is currently an ongoing discussion and controversial topic regarding several ethical complications.