The Curbsiders Internal Medicine Podcast #81: Placebos, nocebos, and the doctor as a placebo
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Feb 5, 2018 Mark W. Green, Director of Headache/Pain Medicine at the Icahn School of Medicine, explores the fascinating world of placebos and nocebos. He dives into how sugar pills can significantly impact treatment efficacy and discusses the ethical implications of their use in medicine. Listeners learn about the extraordinary power of patient perception and expectation in shaping treatment outcomes. The conversation also touches on open-label placebos and the complexities of the nocebo effect, making it clear that belief truly matters in healing.
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Delivery Shape Stronger Placebo Effects
- Surgery and injections elicit larger placebo responses than pills, with bigger, bitter, or colored interventions working better.
- Brand-name, costly, and frequent treatments amplify placebo compared with plain white tablets or generics.
Trials Can Inflate Placebo Signals
- Study design inflates placebo: trials select severe outliers and frequent measurements cause regression to the mean.
- A high placebo in trials doesn't guarantee durable, long-term clinical benefit.
Balance Risks With Benefits To Avoid Nocebo
- Spend as much time explaining the harms of not treating as you do listing side effects to avoid inducing nocebo.
- Emphasize benefits and set positive expectations when you recommend therapies to amplify outcomes.
