Re: Use and misuse of the placebo effect

[jaya shreedhar]

Thanks Prakhar and heres a link related to your mentl health assignment - http://www.who.int/mental_health/mhgap/en/index.html

Jaya

On Wed, Mar 16, 2011 at 11:39 AM, Prakhar Jain <talking...@gmail.com> wrote:

This article in today's The Hindu also talks about use of placebos for
Mental Health condition like depression.


Use and misuse of the placebo effect
Link:http://www.thehindu.com/opinion/editorial/article1541032.ece

Are placebos inert substances with no real therapeutic effect?
Placebos go back to the origins of medicine as a science and as an art
and have been part of the stock-in-trade of charlatanism and quackery.
Today they are routinely used in human clinical trials for comparing
the efficacy of experimental drugs; this is based on the premise that
placebos containing inactive substances have nil therapeutic
potential. But, although their use in clinical care for treating
patients with imaginary or real ailments is reportedly showing some
promise, their undisclosed use is considered questionable and even
unethical — and hence is not formally approved by medical authorities
anywhere in the world. Yet doctors in several developed countries are
using them even when effective medicines are available. Anecdotal
evidence suggests that many doctors in India have long been doing so.
A recent study by the German Medical Association (BAK) found that half
of German doctors were prescribing placebos to ‘treat' depression and
stomach complaints. The percentage of general practitioners taking
advantage of the placebo effect to treat their patients shot up to
nearly 90 per cent in Bavaria. That nearly 60 per cent of patients who
had upset stomach and about a third of those with depression stood to
gain shows that the placebo effect could be real. The placebo effect
was maximised when administered as an injection, and factors such as
size and colour of a pill determined the success rate. Being convinced
that doctors understood their concerns and were taking them seriously
played a major role.

This is not the first time placebo effects yielding positive results
in clinical settings have been documented. A 2008 study covering
nearly 680 U.S. internists and rheumatologists found that about half
of them had prescribed placebos (without the patients being aware of
it) over the past one year. Though the intent was to promote positive
therapeutic expectations, it was considered unethical as the patients
were kept in the dark. Withholding information amounts to cheating and
threatens trust, so very central to clinical practice. Advocates of
placebo treatment note that positive results can be achieved even
without deception. But whether it can be adopted in clinical care
after eliminating all kinds of deception is not fully known. Placebos
given along with drugs in trials produced positive results but at
reduced levels when patients knew of their doubtful efficacy. Evidence-
based practice must wait for further research and for the formulation
of clear guidelines for placebo use.

[Prakhar Jain]