Placebo Studies: Do Pharmacies Dispense Placebos?
Do modern pharmacies dispense placebos to patients?
Is it possible that you have actually been given a prescription placebo?
I have been a pharmacist for nearly 20 years. During that time I have never had a patient ask me "Is this just a placebo?" Maybe it is because the question has simply never occurred to anyone. Maybe it is because people are sure the answer is "no." But maybe, just maybe, people are wondering but are simply too embarrassed to ask.
Well, I am going to try to answer that question for you. In this article I will explain:
- What a placebo is
- When and how placebos are used
- Whether you have likely been dispensed a placebo
WHAT IS A PLACEBO?
According to the dictionary a placebo is: "A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well."
A medical dictionary gives a similarly definition: "a usually pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder."
So a placebo is a pill, a capsule, a topical cream/ointment or even an injection that has no pharmacologically active ingredient.
QUESTION: But if a placebo has no "medication" and is only "inert" then what exactly is IN a placebo?
ANSWER: A placebo tablet or capsule would typically contain lactose, a white powdery substance (a type of sugar often found in dairy products). Lactose is a filler found in many prescription tablets or capsules. It has no particular pharmacological qualities and thus serves well as a placebo. An injectable placebo would simply contain saline (salt water). A topically applied placebo cream or ointment would likely just contain petrolatum (aka Vaseline).
WHEN & HOW ARE PLACEBOS USED?
Are placebos merely an outdated gimmick reserved for movies or fictional novels? Do placebos actually get used today? Do doctors prescribe placebos for patients? Have you ever taken, unknowingly, a placebo?
It may surprise you to know that placebos, unlike dinosaurs, are actually not extinct. Placebo therapy still has a place in modern medicine. Below I will explain when and how they are used.
Placebos today are used in primarily 4 situations:
1) In clinical studies. Placebos are used to determine the true effectiveness of a prescription medication. A standard drug trial process involves what is called a "double blind placebo controlled trial." What this means is that neither patient nor doctor knows who is getting the "real" medication and who is simply getting the placebo. Patients are interviewed and monitored by an independent group (ideally) and the results are carefully recorded. When the trial is over, then the true recipients of the medicine and/or placebos are revealed. Placebo studies help determine if a drug's effects are more than just subjective or imagined.
So, if you have ever participated in a clinical study of a new medication...it is possible you have received a placebo. You might not ever know for sure. Many patients in such studies will report remarkable cures or unbearable side effects...all while receiving a placebo. Some will have to even discontinue the study due to side effects "produced" by the placebo alone. Our mind can cause us to respond physically to an imagined ingredient. This is known as the "placebo effect" and it is powerful.
2) Homeopathy: A type of over-the-counter "alternative" medications are known "homeopathic." Homeopathy, in this context, simply means "like cures like." It was a system of treatments developed in the late 18th century. The theory is that to treat a particular symptom or disease you must administer very small amounts of a natural ingredient KNOWN TO CAUSE that symptom. Like cures like.
However, in homeopathy, the "very small amount" is, in reality, none at all. This is accomplished by a series of dilutions in which the active ingredient is repeatedly diluted and reduced so that literally none of the original product remains. If you look on the back of almost any homeopathic remedy package you will see the ingredients listed as "24X" or something similar. Want to know what that means? It is a sort of "secret" nomenclature. What it means is that, after dilution, the original ingredient is present in 1 part to 1 x 1024 parts. Mathematically, with that dilution, it is unlikely that a single molecule of the original ingredient is present in any homeopathic product ever made.
This, however, does not mean that homeopathy is useless. For many people homeopathy, just like a placebo, really works.
3) Impure Placebos (or "active" placebos): What are these? Several studies have been done to determine how often a doctor prescribes a remedy which he/she KNOWS will have no "true" effect upon the patient's condition. An example is when a patient is prescribed an antibiotic for what is clearly a viral infection. It does nothing. But sometimes a patient insists it is necessary and thus the doctor complies. These are known as "impure" placebos. They have an actual ingredient...but it simply is not effective for what is being treated. This is placebo therapy, even if the dispensed medication actually contains real medicine. For more information on the frequency of this practice, check out this article.
4) Pure placebos: This is when a doctor knowingly and deliberately dispenses a true placebo. It has no medicine, though it is being represented as a medical product. For an interesting article on the ethics of placebo dispensing by physicians, CLICK HERE. This practice is probably more common in hospital settings than in retail.
PLACEBO: Backwards!! :)
Maybe now you are wondering....
Have I ever received a placebo from my doctor?
Is it possible that the pills I have been taking for years are just fake?
The answer...probably...is "no."
Well, maybe you have received what I describe above as an "impure" placebo (a medication, though real, but is really ineffective for your condition). For example, maybe you complained about being tired...and you were told to take a Multi-vitamin. You bought it, took it, and felt better. The effect, almost entirely, is imagined. Vitamins don't give energy. They have no calories. And true vitamin-deficiency was unlikely.
However...I suppose it is also fair to say that we have all, at one time or another, benefited from the "placebo effect." So strong is the power to "imagine" the curative properties of any treatment, that I suspect even legitimate medications (and other treatments for that matter) are often "helped along" by the power of the placebo effect.
But as for dispensing "true" placebos....
In all my years of retail pharmacy I can only recall 2 instances of dispensing what we call a "true" placebo.
The first case was for a prescription then known as "Cebo Caps." They were a legitimately manufactured placebo. I dispensed it to the caretaker of a severely mentally ill patient. I did not believe it to be unethical, but rather compassionate (though I am still surprised the insurance company actually accepted the claim).
The second situation was when I was asked by a local physician to prepare some lactose capsules for him. I did so as a courtesy. He said he was conducting a private study, and I knew him. In reality, he was probably testing out the placebo effect on someone.
So...by all means...please continue to take your prescribed medication. And if you have any questions about your medication....feel free to ask below!
FOR FURTHER READING:
Check out THIS ARTICLE on Placebos and the types of personalities that are most benefited by them.