The Dual Nature of Placebos

Placebos can be both helpful and hindering in medical practice. While they can provide relief and improve patients' lives, they also make it challenging to evaluate the efficacy of new drugs in clinical trials. The placebo effect plays a significant role in conditions like osteoarthritis, rheumatoid arthritis, and lupus, with reported placebo effects of up to 30-40%. The placebo effect is not merely the effect of an inert substance, but rather a complex interplay of rituals, symbols, and treatment contexts that activate the release of neurotransmitters like endorphins and dopamine. Placebos primarily work for subjective symptoms that rely on patient self-evaluation, such as pain, cancer-related fatigue, and menopausal hot flashes. However, placebos do not cure diseases or cause objective changes in pathophysiology. Understanding the placebo effect can help physicians consider ethical use in clinical encounters and explore strategies to minimize placebo responses in clinical trials.