Milan Mikul‡ät’k

Placebo 

Medicine distinguishes between the
direct effect of a drug and those
effects that are produced by various
other influences, which are often
referred to as suggestion. The function
of suggestion in such circumstances is
better known as the Òplacebo effectÒ
(the Latin word placebo can be
translated literally as Òyou will like
itÒ). Western European countries have
been doing research on this effect for
decades.

What then can produce this placebo
effect? It can be the drug's appearance,
its color, size, consistency, flavour,
smell, reputation, suggestive wording,
the opinions of important people, how a
doctor behaves, the atmosphere in which
the drug is prescribed, and so on. Some
of these factors may have a very direct
effect (a bitter taste, for example,
increases the secretion of saliva and
stomach juices). The working of the
placebo effect can be seen from the way
in which the same drug will have
different effects for different doctors.
Different packaging can also produce a
different effect, and a drug may well do
good to a patient who it was not
intended for. The placebo effect is even
clearer with the pure or inactive
substances (i.e. the simple placebos) by
which doctors can assess the
effectiveness of a drug. 

One group of patients is given the real
drug and the other receives a placebo,
and all other factors are kept as
similar as possible. Through the placebo
effect it is possible to discover
whether a drug is more effective as an
injection than in tablet form, whether
drugs prepared in the pharmacy are more
effective than industrially produced
ones (since the patient may have a
greater sense of individual care),
whether colored medicines are more
effective than uncolored ones, whether
those with a strong taste are more
effective than tasteless ones, and many
other possible factors.

Balint (1996) characterizes the placebo
as the psychological, physiological or
psycho-physical effects of a medicine,
which has no significant link with the
pharmacological effects of the drug or
other treatment. Even before the actual
nature of the placebo was known, it was
used unconsciously not only by doctors
but also by magicians, priests, popular
healers and charlatans, who are still
using it today and generally describe
the unknown effects of the placebo in
magical or mystical terms. The placebo
effect goes beyond simple medicines and
can be seen in physical therapy or
operations (as when a patient shows
radical improvement after a purely
exploratory operation). 

Some doctors may even produce negative
placebo effects by prescribing a drug
which is intended for the condition in
question, but which the patient has
already had a bad experience with. This
is all the more likely when a patient
gets a prescription without any
explanation and only finds out what it
is for when they reach the pharmacy. On
the other hand the placebo effect can be
used to reinforce the effects of a drug
or a treatment, perhaps by stressing the
good results it has produced on other
patients.

There are many methodologically sound
projects which have shown that placebos
can be very effective with patients -
affecting about 35% of ill people.

According to Gliedman and Thorn, it is
not possible to show the direct
relationship between a positive placebo
reaction relationship and the increased
suggestibility of the person taking it,
and this bears out the theory of the
conditioned reflex effect of the
placebo. There are some drugs which can
be replaced by placebos with a large
percentage of patients, e.g. in 30% of
cases for analgesics, rising to 60% in
the treatment of headaches, while in 40%
of cases of asthma they can lessen the
severity of an attack. A popular or
dominant person in a group can influence
the placebo effect on other individuals.
The situation among groups of teenage
drug addicts is somewhat analogous.
New drugs are tested through a double
blind clinical trial. This aims to
create objective conditions for testing
a drug in which the importance of the
doctor's attitude (positive or negative)
to the drug and its psychotherapeutic
action is reduced as far as possible.
Thus one group is given the drug being
tested, which is labelled A, and a
second group suffering from the same
illness is prescribed a placebo B. The
doctor who prescribes the drug and
assesses its effects does not know which
drug, A or B, is in fact the placebo,
i.e. he is as blind as the patient. If
both groups have the same results it can
be concluded that the drug has little or
no effect. If the drug is effective it
will produce a much greater success than
the placebo. If the placebo produces
better results then it shows that the
drug is in some way harmful.

It is not allowed to give a patient a
placebo if it could in some way damage
their health. Negative side effects
(nausea, vomiting, diarrhoea, allergic
reactions, dryness of the mucous
membrane, increased pulse rate, edema, a
rash, etc.) tend to be more common among
neurotics. Such reactions are similar to
the attitude some people have to
pharmaceutical drugs, which can be
termed pharmacophobia. This leads to a
rejection of drugs on the part of the
patient, who often insists they are
poison (that they are chemicals) and
that poison should be avoided. Some
people do not tell their doctors of
their feelings about medicines,
especially in cases when there has been
opposition to their opinions in the past
but they have not changed their minds.

The opposite situation is termed
pharmacophilia or pharmacophagy, i.e. an
exaggerated love of taking medicines, as
if the person was fascinated by them.
Such people take such quantities of
drugs that they sometimes replace their
normal diet. They often manage to
convince their doctors to prescribe the
drugs they want, and maintain that some
drugs are universal medicines, for
example hormones and vitamins. 
The most popular drugs with these people
are however analgesics, hypnotics,
psycho-stimulants and anti-asthmatics.
Some people's pharmacophagy amounts to
drug addiction which it is very hard to 
cure, particularly when the patient
tries to hide it.

It is even possible to become dependent
on a placebo. Belolouckv (1973) gives
the example of a thirty-year-old patient
who was prescribed Mezoridazin for
psychosomatic digestive problems. When
the prescription ran out it was replaced
by a placebo and this had the same
effect, even when the patient was told
that the medicine was pointless, which
indicated a degree of dependency.
The placebo effect can be found in
everyday life in relation to food and
other aspects of eating habits, and even
in habits relating to other needs, e.g.
sexual, security, recognition,
self-realisation. The concept of the
placebo effect is not however used in
this context.

PhDr. M. Mikul‡ät’k, sen.

G. C. Davidson, John, M. Neall, Abnormal
Psychology, Wiley and Sons, NY 1996
R. Kone‹nù, M. Bouchal, Psychologie pro
lŽkaÞe, Avicenum, Praha 1971