Frequently Asked Questions

Placebos & the Therapeutic Encounter

What is a placebo?
What is the therapeutic encounter?
Why is it important to study placebos and the therapeutic encounter?
What does a placebo look like?
Are placebos effective?
Are placebos safe?
When are placebos used?
Can placebos cure any illnesses?
Do physicians prescribe placebos?
Do patients ever find out that they have been given a placebo?
How long have placebos been around?

Placebo Effect

What is the placebo effect?
What are the biggest factors contributing to the placebo effect?
How common is the placebo effect?

Program in Placebo Studies & the Therapeutic Encounter (PiPS)

What is placebo studies?
Why is the program called the Program in Placebo Studies and the Therapeutic Encounter?
What is the objective of PiPS?
Who is involved?  With whom is PiPS affiliated?
How is PiPS funded?
Does PiPS offer opportunities for student or post-doctoral researchers?
Does PiPS host any events that are open to the general public?
Where can I read more about placebo studies research?
How can I support PiPS?
How can I contact PiPS?

What is a placebo?
A placebo is something that imitates a medical treatment but is not actually a real treatment, for example a pill that looks like medicine but is actually made of sugar. For this reason, a placebo treatment is often called a “dummy treatment” or a “sham treatment.” Even though placebos don’t have active ingredients, research suggests that they can relieve the symptoms of medical conditions. PiPS researchers examine this phenomenon from a variety of scientific, clinical, and academic disciplines.

What is the therapeutic encounter?
The therapeutic encounter encompasses all aspects of the healthcare experience, including the provision of care, the patient-provider relationship, the medical ritual, the clinical context, and trust, compassion and hope.  The therapeutic encounter surrounds all treatments, whether active or placebo. The emerging field of placebo studies is producing scientific evidence that these intangible elements of medicine contribute fundamentally to improving patient outcomes.

Why is it important to study placebos and the therapeutic encounter?
The placebo effect can increase the effectiveness of active treatments. Understanding more about placebos and the therapeutic encounter has the potential to improve the way we develop new medical therapies and the way we deliver care.  By investigating questions such as what makes patients’ awareness of their symptoms increase or decrease, our research provides insights into how to maximize the efficacy of active medical treatments, how to harness the mind-body connection to induce self-healing, and how to more efficiently develop new pharmaceuticals.

What does a placebo look like?
Placebos take many forms but they always look, feel, taste, and sound like real medical treatments. Examples include sugar pills, injections that contain only saline solution (salt water), and sham (fake) surgery.

Are placebos effective?
Research evidence suggests that placebo treatments affect pain, fatigue, insomnia, anxiety, depression, Parkinson’s disease, irritable bowel syndrome, asthma, migraine, dementia, and nausea.  Furthermore, placebo responses are not only in the mind: they can also be observed in the body and the brain. PiPS has made important contributions to this research and is developing new studies to further explore the therapeutic effectiveness of placebos.

Are placebos safe?
Placebos are generally safe, but even treatments without active ingredients can cause negative side effects, depending on the context in which they are given. Studies have shown that if people are given sugar pills and told they might experience negative symptoms such as nausea or pain, then they sometimes experience those symptoms. This phenomenon is called the nocebo effect.

When are placebos used?
Placebos are most commonly used in randomized controlled trials designed to test the efficacy of medical treatments (mostly pharmaceutical drugs). In this context, placebos are given to participants who do not know whether they are receiving the active drug or a placebo.  Prior to participation in such a trial, all patients must provide informed consent.

In the clinical setting, the code of medical ethics discourages physicians from giving placebos without informing patients. Studies suggest, however, that physicians frequently prescribe placebos. After PiPS researchers published a study in 2010 suggesting that placebos were still effective even when given with patients’ knowledge that they were receiving placebos, physicians have begun to consider openly prescribing placebos as part of standard medical practice. When prescribing an “open-label placebo,” it is critical that patients receive full disclosure that they have been prescribed a placebo.

Can placebos cure any illnesses?
Placebos have been shown to be effective in alleviating symptoms of illnesses defined by pain, fatigue, nausea, and anxiety and functional disorders in the digestive, pulmonary and urinary systems, among others. For this reason, our team has focused its research on illnesses such as irritable bowel syndrome, depression, chronic pain, asthma, and migraine headaches.   We plan to expand our work to such areas as cancer symptom management, Parkinson’s disease, and the cardiovascular system.

Do physicians prescribe placebos?
National surveys indicate that many physicians prescribe placebos, sometimes without telling their patients. Often these placebo treatments are active medications such as vitamins or antibiotics that the physician does not believe will be effective for the medical issue presented by the patient. To address this issue, PiPS researchers are exploring the most effective and ethical way for physicians to honestly prescribe placebos in clinical settings. In addition, PiPS researchers have published ethical analyses that advocate for full disclosure of any medical treatment, including placebo treatments.

Do patients ever find out they have been given a placebo?
Federal law requires that all patients participating in clinical trials should be aware that they will either receive a placebo or an active treatment.  Once the trial has been completed, however, there is no legal requirement to inform patients whether they received active medication or placebo. PiPS researchers have published ethical analyses arguing that this policy should be changed. In addition, when placebos are given in a clinical context, we believe that patients should know they are receiving placebos at the time of treatment.

How long have placebos been around?
The earliest written documentation of a physician knowingly giving a patient a treatment without active ingredients is found in William Cullen’s lectures given in 1772.

Below are passages excerpted from PiPS Director Ted Kaptchuk’s article, “William Cullen and a missing mind-body link in the early history of placebos”:

“Cullen employed the term ‘placebo’ at least twice in his series of lectures given in 1772…Because Cullen had no hope that treatment could cure Mr Gilchrist, he decided to employ a placebo treatment to comfort or please his patient… Cullen described his prescribing principle as follows:

‘I prescribed therefore in pure placebo, but I make it a rule even in employing placebos to give what would have a tendency to be of use to the patient.’”

What is the placebo effect?
It is commonly said that the placebo effect is the effect of a treatment such as a sugar pill, but in fact it is the effect of the therapeutic encounter: everything that surrounds the sugar pill, including the provision of care, clinical context, medical ritual, trust, compassion and hope.  It is the effect that is due to the meaning that the treatment has for the patient.

What are the biggest factors contributing to the placebo effect?
Researchers are still teasing apart the components of the placebo effect, but important ingredients seem to be the quality of the patient-provider relationship, the medical context (white coats, stethoscopes, diplomas on the wall), and medical rituals such as taking blood pressure, disrobing, and giving a medical history. In addition, characteristics of the placebo treatment itself also seem to be important (e.g., color, shape, number and cost of the placebo pill). In other medical traditions such as Chinese medicine, the contexts and rituals involved in producing placebo effects are probably different from those in a biomedical context.

How common is the placebo effect?
The placebo effect contributes to many medical treatments. Even when we take pills with active ingredients, part of their effect is likely due to the placebo effect.

What is The Program in Placebo Studies and the Therapeutic Encounter (PiPS)?
Hosted at Beth Israel Deaconess Medical Center, the Program in Placebo Studies and the Therapeutic Encounter is the first multidisciplinary research center to examine the biological basis of the placebo response with the goal of optimizing its value and impact in medicine.  It draws its members from across Harvard Medical School’s teaching hospitals, as well as Harvard’s Faculty of Arts and Sciences.

What is placebo studies?
Placebo studies is a multidisciplinary field that investigates the background encompassing and enfolding any medical treatment. Placebo studies moves the “backdrop” of medicine to front and center by highlighting aspects of healing that are common across medical specialties and modalities, including different healing traditions.  Placebo studies are inherently historical, anthropological, psychological, and sociological, as well as scientific and clinical. PiPS is the first multidisciplinary center in the world to be created for the pursuit of placebo studies.  Its efforts are translational and cross-cultural.

Why is the program called the Program in Placebo Studies and the Therapeutic Encounter?
The placebo effect cannot be isolated from the context within which it occurs. Indeed, our research indicates that the context of the therapeutic encounter is at least as important as the placebo treatment itself. For this reason, PiPS researchers investigate not only the biological effects of placebos, but also the therapeutic encounter, i.e., the context in which medical treatments are given and received.

What is the objective of PiPS?
The ultimate goal of PiPS is to improve patient care. Our research agenda spans clinical care, neuroscience and molecular biology, as well as psychology, bioethics, anthropology and the history of science. PiPS aspires to apply its growing understanding of the placebo effect to improve the effectiveness of clinical protocols, the efficiency of pharmaceutical development, and our ability to understand the patient experience.

PiPS pursues research in the following areas: Initiatives in the Humanities and Bioethics, Patient-Oriented Clinical Research, Research in Neuroscience & Molecular Biology, Research in the Social Sciences, and Research Methodology.

Who is involved?  With whom is PiPS affiliated?
PiPS is a network of more than 20 researchers from Harvard Medical School’s teaching hospitals and the Faculty of Arts and Sciences at Harvard University. PiPS is hosted at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. PiPS welcomes new collaborators. For more information about our current team, please visit this page.

How is PiPS funded?
PiPS research is primarily funded through NIH grants, the majority of which come from NCCAM, the National Center for Complementary and Alternative Medicine.  As a relatively new program with limited funds, PiPS is currently seeking funding partners to support fellowships for young researchers, pilot studies, educational outreach and program infrastructure.

Does PiPS offer opportunities for student or post-doctoral researchers?
PiPS welcomes post-doctoral researchers with an interest in pursuing research in the field of placebo studies. We also encourage medical students who would like to join ongoing research projects to contact us. Please direct all inquires to placebostudies@bidmc.harvard.edu and include information about your interests, qualifications, and research experience.

Does PiPS host any events that are open to the general public?
The monthly Harvard-wide seminar series in placebo studies hosts leading researchers in the field of placebo studies and is open to the general public.  Past seminars have included: Factors Influencing the Placebo Response in Depression; Pain & Pleasure: Neuroscience of Subjective Experience; and Neuroscience-based Empathy Training for Clinicians: Research Results.

Where can I read more about placebo studies research?
PiPS researchers are continuously presenting and publishing their findings.  All of their articles can be found here. Examples of media covering PiPS are available here.

How can I support PiPS?
PiPS is actively seeking partnerships with individuals and foundations that share its vision of elucidating the placebo response, promoting patient-centered medicine, and improving the value of health care by increasing the quality and decreasing the costs of care. Donations are processed and acknowledged by Beth Israel Deaconess Medical Center, a registered 501(c)3 in the Commonwealth of Massachusetts. To make a donation, please follow the link below or contact us.
www.gratefulnation.org/programinplacebostudies

How can I contact PiPS?
To keep up-to-date with PiPS related news and events, please subscribe to our mailing list.  We would also love to hear your comments, inquiries regarding research or the program, interests in partnerships, and ideas via our contact form, email, or phone.

Email: placebostudies@bidmc.harvard.edu
Telephone:
617-945-7827

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