Everybody lies says the neurotic Dr House when a very unlikely diagnosis would…
The New Journal of Medicine’s article titled: ‘Placebo Effects in Medicine’, published on July 2, 2015, begins by saying ‘The effects of the Placebo are often considered as the ones of an inert substance, but this categorization is deceitful’.
So as to provide a broader and comprehensive picture we shall go through the etymological origin of the words we use daily: pharmacology, drug and placebo.
Prefix medicine, in Spanish fármaco and in English pharmaco, derives from the Greek word fármacon, this word encloses a big ambivalence since it means both a remedy to cure and a poison to kill.
Drug derives from the Arabic word ḥaṭrúka which literally means charlatanism. However, most of the sources state that its origin is unknown and that can derive from the Dutch word droge-vate (dry barrel), which were the ones that carried herbal medicine.
Placebo derives from future form of the Latin verb placere which means I shall please, I shall like, I shall satisfy.
This provides an empathic view of the primitive man who in order to cope with the pain and suffering used empirical and religious practices. When dealing with medical dilemmas, present day science undergoes the impotence and uncertainty of our ancestors facing the decease.
Most of the listing of drugs, medicines and prescriptions of: Chinese emperor Huang Ti, the sumerians, assyrians and babylonians, Ebers papyrus, ancient India, the Hippocratic Corpus and Galenic Pharmacopoeia were placebos (it is very likely that most people believed in the ‘true’ therapeutic effect).
The NEJM’s article states that the placebo effect involves complex neurobiological mechanisms in which neurotransmitters and specific areas of the brain take part (those which can be quantified).
Lots of regular medications work through these via.
Up to date we know three elements of the placebo effect.
Firstly, Placebos ease but do not heal.
Secondly, the effects of placebo are not just dummy pills: the effects of symbols and the interactions with physicians and other healthcare personnel play an important and remarkable role.
Thirdly, the psychosocial factors that motivate the placebo effect also have the potential of causing adverse consequences, known as the nocebo effect.
Placebo controlled Clinical trials must be ethical and a justification must be given for its inclusion.
The abovementioned leads to differences between Sponsors, Cros, Quality Assurance departments, Principal Investigators, Ethics Committees, Teaching Committees, regulatory authorities (FDA; EMA; ANMAT; COFEPRIS; MSP).
Medicine has used placebo to put into question, refute and reject ineffective and harmful treatments.
According to this article the placebo effect is another thing. It is often considered illegitimate and without any merits. This philosophy is juxtaposed with the basic principles of medicine: to heal, to control the decease, to ease symptoms and to provide well-being and comfort.
When there is no cure available, the primary task of medicine is to ease unnecessary suffering.
This is why, according to the authors, it is needed to design studies that include clinical interventions so as to obtain placebo effect in participants, without any deceptions and with an informed consent. These studies will help us to know exactly when and how it acts and in which time sequence these interventions can provide therapeutic effects.