'Honest' placebos help without side-effects, expense
Dr. Eleanor Barbera
Older residents frequently enter long-term care with multiple medications prescribed for their varying health conditions. In fact, it's the polypharmacy itself that can bring them to our doors due to harmful medication interactions and symptoms such as dizziness that lead to falls, hospitalizations and the need for increased care.
In long-term care, geriatricians often work to reduce the number of medications their patients receive. A 2011 review in the journal Gerontology suggests that the use of a placebo may be a worthwhile tool in this effort.
Typical purpose of placebos
A placebo is often thought of as a harmless substance used as a control in research to determine the effect of actual medications. In order to be proven effective, the experimental medication must be significantly more beneficial to subjects than the placebo because simply receiving a pill is found to have beneficial effects.
In other words, medical conditions can improve just by thinking that the pill one is taking is going to help, even if it has no medical properties. (This is why I like to read the copy on, say, a bottle of hair conditioner — to enhance its psychological effects ... I'm only half-kidding.)
Atypical use of placebos
The studies reviewed in the 2011 Gerontology article consider the placebo not as a control condition but as a substance worthy of study in and of itself, investigating factors that influence its level of effectiveness.
They examined the use of placebos as an analgesic, to address anxiety and depression and for Parkinson's disease and consistently found a significant reduction in symptoms — especially when paired with verbal suggestions that the placebo will be successful.
In Jo Marchant's “A Placebo Treatment for Pain” in the New York Times this month, she writes of a 2014 study that found that a placebo was 60% as effective as a pain pill. What's more, when the actual pain medication was labeled “placebo,” it reached 60% of its usual effectiveness.
Even more remarkably, these results held up when the placebo was honestly labeled as such. Despite knowing that the pill they were taking was a placebo it was still half as effective as the pain medication.
(I find this mind power incredible, so much so I almost ended each of the sentences in this section with an exclamation point!)
Application to seniors
I regularly talk with elders who are suffering from distressing symptoms such as constipation, dry mouth and other medication side effects.
The pages of McKnight's frequently include articles on the challenging financial aspects of long-term care.
Perhaps the use of placebos could be a small step in the direction of easing both problems.
It's important to note, however, that placebos aren't effective for people with dementia. As stated in the 2011 Gerontology piece, “the impairment of cognitive functions has been found to disrupt the psychosocial component of a treatment.”
Enhancing the effect of honest placebos
To make the most of honest placebos, research indicates that the recipients need to believe that the pills are going to work. This suggests that a trusted authority should be the one to describe the benefits of the placebo effect, such as a physician wearing a suit or white lab coat.
Honest placebos could be tailored to the desires of the resident. For example, residents could choose their favorite color among a rainbow of pills labeled “placebo.”
They could select how often they'd like to get their “medication,” whether they'd prefer a liquid or a pill, and what time they'd prefer to receive it. (No early morning awakenings needed for this group!)
Presenting the placebo in a warm, pleasant manner can also enhance its effects. As Jo Marchant observes: “Harvard researchers studied patients in pain from irritable bowel syndrome and found that 44 percent of those given sham acupuncture had adequate relief from their symptoms. If the person who performed the acupuncture was extra supportive and empathetic, however, that figure jumped to 62 percent.” (Exclamation point!)
A quick Google search found an Australian company selling sugar pills with an authentic-looking “placebo” label, several businesses hawking “happy pills” and other joke remedies on Amazon, and an app developed to track the effects of the use of a placebo.
The best way to purchase placebo pills, aside from making your own, would be to work with your pharmacy service to create placebos that best fill the needs of your residents.
While placebos are clearly not going to be effective for every resident in every circumstance, for willing residents with certain ailments they can be an effective, inexpensive, side-effect-free aid worth trying before adding another medication to a resident's drug regimen.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.