The Power of the Placebo by Jeffrey Dach MD

When I was a medical student, at the University of Illinois about 30 years ago, my medical school instructor advised me to always give medication along with the suggestion that it will be very effective. This is called the Placebo Effect or the power of suggestion on the mind. By merely suggesting that something will work, it does, even if it's the inert sugar pill called a Placebo. Doctors use the placebo effect in many ways, some intentional, and some unintentional. 


SSRI Drugs No Better Than Placebo

An interesting example can be found with the antidepressant drugs.  Dr. Khan reviewed clinical trial data submitted to the FDA for nine SSRI antidepressant drugs approved by the FDA between 1985 and 2000. This included 10,030 depressed patients in 52 clinical trials.  The Placebo (inert dummy pill) worked better than the SSRI antidepressant pill in more than half the studies.  This is astounding information showing the power of the Placebo, or the lack of effectiveness of the SSRI antidepressant drugs.(1)(2) 


Knee Arthroscopy No Better than Placebo for Osteoarthritis

Another placebo effect in an article from the July 11, 2002, New England Journal showed that arthroscopic knee surgery for osteoarthritis is no better than a placebo (in this case a sham operation).  Actually, this isn't surprising, since it is obvious to anyone with rudimentary medical knowledge that arthroscopic surgery simply cannot replace the worn out cartilage of osteoarthritis.(3)  However, in spite of this, a half million procedures a year were being done with no more effectiveness than placebo, until this study brought the practice to a halt.

Reverse Placebo Effect

The Reverse Placebo effect is also at work. In this case, the mental suggestion of an adverse outcome actually increases the chances that this will occur. For example, 25 years ago when I trained in radiology, we routinely used I.V. contrast material that sometimes caused allergic reactions and rarely resulted in death. My colleagues were obligated to inform the patient in advance of the possible adverse outcome, but in actual practice they avoided doing so, because from experience they knew that the mere suggestion would become a self-fulfilling prophecy.  Fortunately, the older contrast materials were replaced with safer agents years ago. (4) My conclusion is that efficacy of a pill or procedure is influenced by belief and the power of suggestion.  But then again, this is true only if you believe it.  

Articles with Related Interest:

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. By Steve Silberman 08.24.09  

THE POWERFUL PLACEBO by Henry K. Beecher, M.D. J Am Med Assoc. 1955;159 (17):1602-1606.

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References:

(1) http://query.nytimes.com/gst/fullpage.html?sec=health&
res=9B0CE2DF1F3FF936A15755C0A9649C8B63
Can the Placebo Treat Depression? That Depends By RICHARD A. FRIEDMAN New York Times June 25, 2002

(2) http://www.ncbi.nlm.nih.gov/pubmed/11799341
Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. Khan A, Leventhal RM, Khan SR, Brown WA., Journal of Clinical Psychopharmacology, 22, 40-45. Northwest Clinical Research Center, Bellevue,

(3) http://content.nejm.org/cgi/content/abstract/347/2/81
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee J. Bruce Moseley, M.D., Kimberly O'Malley, Ph.D., Nancy J. Petersen, Ph.D., Terri J. Menke, Ph.D., Baruch A. Brody, Ph.D., David H. Kuykendall, Ph.D., John C. Hollingsworth, Dr.P.H., Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H. NEJM V347:81-88 July 11, 2002 No.2

(4) http://www.ncbi.nlm.nih.gov/pubmed/16454540
Current understanding of contrast media reactions and implications for clinical management. Drug Saf 2006;29(2):133-41.

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