Sham therapy

A placebo (/pləˈsiːboʊ/ plə-SEE-boh) is an inert substance or treatment which is not designed to have a therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures.In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice—which the Government claims is very important—as it means patients do not have all the information needed to make choice meaningful. A further issue is that the placebo effect is unreliable and unpredictable. A placebo (/pləˈsiːboʊ/ plə-SEE-boh) is an inert substance or treatment which is not designed to have a therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures. In drug testing and medical research, a placebo can be made to resemble an active medication or therapy so that it functions as a control; this is to prevent the recipient(s) or others from knowing (with their consent) whether a treatment is active or inactive, as expectations about efficacy can influence results. In a clinical trial any change in the placebo arm is known as the placebo response, and the difference between this and the result of no treatment is the placebo effect. A placebo may be given to a person in a clinical context in order to deceive the recipient into thinking that it is an active treatment. The use of placebos as treatment in clinical medicine is ethically problematic as it introduces deception and dishonesty into the doctor–patient relationship. Even though placebo effects were already discussed in 18th century psychology, the role of placebo effects in clinical settings has only been recognized fully in the 20th century. An influential 1955 study entitled The Powerful Placebo finally established the idea that placebo effects were clinically important, and were a result of the brain's role in physical health, but it did not account for regression to the mean or other factors, and reassessments of the data have found no evidence of any placebo effect. Subsequent research has found that placebos have no impact on diseases; they can only affect the person's perception of their own condition. Improvements that patients experience after being treated with a placebo can also be due to unrelated factors, such as a natural recovery from the illness. The word 'placebo', Latin for 'I will please', dates back to a Latin translation of the Bible by St Jerome. The American Society of Pain Management Nursing define a placebo as 'any sham medication or procedure designed to be void of any known therapeutic value'. In a clinical trial, a placebo response is the measured response of subjects to a placebo; the placebo effect is the difference between that response, and no treatment. It is also part of the recorded response to any active medical intervention. Any measurable placebo effect is termed either objective (e.g. lowered blood pressure) or subjective (e.g. a lowered perception of pain). Placebos can improve patient-reported outcomes such as pain and nausea. This effect is unpredictable and hard to measure, even in the best conducted trials. For example, if used to treat insomnia, placebos can cause patients to perceive that they are sleeping better, but do not improve objective measurements of sleep onset latency. A 2001 Cochrane Collaboration meta-analysis of the placebo effect looked at trials in 40 different medical conditions, and concluded the only one where it had been shown to have a significant effect was for pain.