Imagine that you went to the doctor and got a prescription. Eventually, you found out that it was for sugar pills and nothing magic or active in them. Just nothing that treated your illness. This sounds immoral, doesn’t it?

Now, consider if the pill nevertheless made you feel better.

Welcome to the fascinating world of placebos and the placebo effect where belief can change biology! In this blog, I will discuss whether or not physicians can prescribe placebos, how they work, and when they really do help.

What Is a Placebo?

Placebo is any treatment that looks like it is a real medical commitment, but has no therapeutic value. And while it does not mean a placebo has no effect on the person, it means it does not treat the condition physiologically.

Sometimes placebos can take on many forms:

• Sugar pills that look and feel like real medications
• Saline injections (saltwater)
• Treatments such as creams or ointments without active ingredients
• Fake or sham surgeries (for research trials)

In research, placebos are the treatment that is used to compare the treatments effects of whether a new drug or treatment does work, compared to no treatment at all.

What Is the Placebo Effect?

The placebo effect is the phenomenon that occurs when a person can experience what they believe to be an improvement in their symptoms after a treatment that they believe works — even when the treatment has no actual therapeutic action!

In other words, just believing can elicit a positive response.

This phenomenon is well studied in medical science. This isn’t a placebo that you are “just pretending” to feel better, and the brain and body have actually responded as if you are receiving real treatment.

Why Does This Happen?

Here are some things that can evoke the placebo effect:

• Expectations: If you expect to achieve relief, the body may produce its own natural chemicals like endorphins (pain) or dopamine (motivation and reward).
• Conditioning: If you’ve previously been sick and took medication to feel better, your brain may associate taking pills with receiving a remedy.
• Doctor interaction: Trust in a medical provider, through verbal and nonverbal interaction, can enhance the placebo effect. Studies have demonstrated that simple warmth and confidence in a doctor enhanced the effectiveness of placebos.

This is such an amazing illustration of the mind-body connection, and this cannot be neglected in clinical research and in treatment.

Real-life examples of the placebo effect

The placebo effect is not just a theoretical notion; it has occurred across a vast range of clinical studies and conditions:

Pain control

Patients given placebo pain killers have self-reported significant pain reductions (disproportionate to actual pain reduction), particularly when told they were receiving a powerful drug. In one trial, people who received placebo with “an expensive look” felt more pain relief than those who received the placebo with no particular look or feel.

Depression and Anxiety

For mild to moderate depression, placebos are almost as effective as antidepressants. This is one reason for placebo-controlled studies of psychiatric drugs: belief is a factor in symptoms surrounding mental health.

Parkinson’s Disease

As strange as it sounds, patients with Parkinson’s who received placebos have shown increased dopamine receptor activity in the brain, the very substance they have too little of with the disease. Their motor skills also improved (temporarily) without any active drugs.

Asthma and Allergies

Some research indicates that patients with asthma who received placebo inhalers reported less shortness of breathe and wheezing. Their lung function did not worsen, but the patients’ perception of their symptoms did, which was nature for their quality of life.

Irritable Bowel Syndrome (IBS)

One study provided IBD patients “open-label” placebos, where patients received placebo pills (which were clearly labelled as placebo). Patients showed some improvement in symptoms even though they were well aware that the pills they received were placebo pills. Simply being in a caring medical context with structure seemed to help their symptoms.

Can placebos be prescribed by doctors?

Yes, but only in certain circumstances and typically not without telling the patient.

Most countries prohibit prescribing a placebo without a patient’s consent. This could be ethically wrong. It violates the principle of informed consent and also may destroy the trust a patient has in the doctor-patient relationship.

When Are They Acceptable?

• In Primary studies: Patients agree to either take the actual medication/placebo.
• Open-label Placebos: Providers may prescribe placebo, and tell patients it’s a placebo – some may find it useful.
• Supportive Care: A provider may accrue a treatment for minor ailments that has no evidence for effectiveness (like a vitamin or mild supplement), as long as it could be harmless and potentially helpful in terms of psychological treatment.

In the UK, the General Medical Council (GMC) says a doctor may only provide placebo if:

• they think it could benefit the patient,
• the patient is not deceived, and
• there is no risk to the patient either materially or delay critical/necessary treatment.

Can the Doctor prescribe a placebo without the patient’s knowledge?

Legally it depends on the country but ethically the answer is almost always not.

Some surveys indicate that doctors do sometimes use “impure placebos” – like antibiotics for viral infections – which won’t be helpful for the affliction but may meet the expectations of the patient.

It is a particularly divisive issue. Although helpful and reassuring in the short term it contributes to side effects such as mistrust in the healthcare system or increased resistance to antibiotics.

Are Placebo Pills Available to Purchase?

Yes, there are placebo products for sale online. For example, there are:

• Sugar pills sold as “open-label placebos”
• Pills sold as “Mood Enhancer” or “Mental Reset” pills that contain no other active ingredients.
• Supplements that suggest all good has positive meanings, and otherwise have no known effects.

People use these for:

• Routine building (e.g., a prescribed routine to fall asleep)
• Breaking bad habits (e.g., a placebo to help stop smoking or an addiction to pain medications)
• Anxiety that is bothersome (a placebo to jump start the day, or a placebo for mild stress or mild motivational challenges)

Placebos are not substitutes for real medicine, however, some individuals report beneficial experiences in minor medical problems where mindset and attitude are involved.

Can Placebos Cure Serious Disease?

No. Placebos relieve symptoms. Placebos do not actually cure diseases or conditions. Placebos may:

• Relieve pain
• Reduce nausea
• Provide a boost to energy and sleep
• Reduce anxiety

Placebos do not reduce tumor size, fix broken bones, or eradicate infections.

In serious diseases (e.g., cancer, diabetes, or cardiovascular disease), it is dangerous to replace active medical treatment with placebos. Always follow medically-documented treatment. Never rely on belief or fake pills for treatment.

Are There Risks of the Placebo Effect?

Yes, often in the form of under-use, misuse, or overuse of its capacity. Individuals could:

• Delay or avoid valid treatment for a serious illness
• Get caught up in false “miracle cures” sold as alternatives
• Distrust the healthcare system when participants think placebos are administered without their consent

The placebo effect can be an effective tool in treatment. It should never be considered a substitute for valid treatment of serious disease.

Is It Possible to Think Yourself Better?

In some ways it is. While not completely interchangeable, the placebo effect demonstrates that there is a mind-body connection for example, a patient hopes for a treatment, a patient expects change, a patient’s past experiences influence their present perceptions. These thoughts and experiences can impact a person’s physical health.

This is no trick, and also should not be considered a panacea, but highlights that healing is not always about the medicine prescribed. At times the acceptant of treatment with its meaning are just as large as any medicine taken.

What About the Nocebo Effect?

There is a dark side to the placebo effect, called the nocebo effect. The nocebo effect happens when someone expects the “doctor said so” negative side effects, and then has a series of those side effects, even though the treatment is fake.

Examples:

• Having a headache after a sugar pill because you anticipated side effects
• Feeling drowsy after taking a pill that read “may cause drowsiness,” even though it was just a placebo
• Feeling unwell after receiving a vaccine simply because you read about the side effects on the internet

This illustrates the power of expectations: they can facilitate healing or they can make you feel worse.

What Are Placebo Pills in Birth Control Packs?

Most packs of birth control pills include 21 active pills and 7 placebo pills. These placebos are:

• Made with sugar or other inactive materials
• Taken during your “period week”
• Used to keep you in the habit of taking a daily pill

Can you get pregnant on placebo pills?

Not if you have been taking your active pill consistently. You are still protected during your placebo week since the hormone levels are still high enough to prevent ovulation.

Do placebo pills prevent pregnancy?

No, since there are no hormones. The placebo pills are to maintain the regimen and to signal to the users when it is time for withdrawal bleeding (which is your period-like response to stopping active hormones).

What If You Know You’re Taking a Placebo?
It turns out, placebo effects can still happen even if patients know the treatment is not “real.” This has been demonstrated in studies of this phenomenon (which is called an open-label placebo) in:

• Chronic pain
• IBS
• Depression

As long as patients believe that the act of taking the pill might offer some help, the ritual of taking medication can elicit brain responses.

Conclusion

The placebo effect is real, and quite powerful. It demonstrates just how intrinsically tied our minds are to our bodies, and how expectation alone can affect your pain, mood, and even brain chemistry.

But placebos also raise some tough ethical questions. Doctors can’t (and shouldn’t) lie to patients, even if the results could be positive. And while placebos can support and reinforce healing, they should never be a substitute for a real medical treatment.

So the next time someone says “it’s all in your head”, remember: sometimes that’s exactly where healing starts.

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