The Placebo Effect

Each month at the Harris Health Orthopedic Residency, one of the clinicians holds a journal club. Last month, one of my fellow residents and I chose to lead the journal club. We chose the recent JOSPT editorial written by Dr. Benz and Dr. Flynn entitled, "Placebo, Nocebo, and Expectations: Leveraging Positive Outcomes." This article was a great introduction to the topic of the Placebo Effect.

To begin, you must first ask yourself: "How much do I currently use the placebo effect in my practice?" or better yet, "Am I using placebo effects without knowing it?" A placebo is defined as a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. To answer the first question, we ALL use placebos with each patient interaction, whether intentionally or not. Our clinical mannerisms, our tone of voice, how we dress, and the clinic environment are all placebo effects. BUT, in order for a placebo to be effective, the patient must be able to assign a positive meaning to these things. An interesting study looked at two groups of people given a certain medication. One group was given an Aspirin, the second group was given the generic form of Aspirin. The chemical composition was the exact same; however, the group who received Aspirin had much better results. How is this possible? The group who received Aspirin were able to assign a meaning or positive correlation with that intervention. They could both physiologically and psychologically agree with the treatment, and therefore the treatment was more effective. The placebo effect is all about expectations! 

Dr. Benz and Flynn conclude the editorial by saying we should use the placebo as another "tool in the proverbial tool kit." They say that the power of the mind to react positively to a genuinely weak (think sham) but perceptually agreeable intervention is far more compelling than forcing a highly evidenced based intervention on a patient who cannot assign meaning to that intervention. 

Next time you are trying to "sell" a patient on an intervention, think about the words you use, how you approach the subject, and the patient's expectation. Above all, act confident. If you display confidence in the treatment, the patient will have more confidence as well. 

-Jim 

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