The Placebo: A Reader ed. by Franklin G. Miler et al. (review)

The Placebo: A Reader is an edited collection of discussions, panels, conference presentations, literature reviews, position pieces, and primary research articles. My favorite part of the book was Part 1, a walk through the history, ethics, philosophy, meaning, and power of the placebo. The placebo effect ripples into the physiology of the body, changing cells, biology, and processes.

This book is meant to be graduate level and post-graduate reading for those who are studying or just fascinated by the placebo effect. For those of us who teach holistic concepts, we often discuss placebo effect. The uninformed misunderstands the placebo effect as effective for those "weak of mind." Bogus treatments and snake oil were an unethical use of the placebo effect, but how do we use the placebo effect ethically? If it works 33% of the time, then why not employ its power, while using western approaches to addressing the disease? Psychosomatic effects exist. The healing effects of the placebo are very likely through the immune connections between the mind and the body.

The placebo effect may behaviorally condition the immune response, much like Pavlov's dogs, and can be seen in rats. The placebo and classical conditioning are discussed in the book through connections to endorphin release, reduced anxiety, and the patient's own expectations.

Application of placebo analgesia in a time when opioid addiction crisis is relevant to current practice. We need to find ways to reduce pain without making addicts out of surgical orthopedic patients. Prescription opioids should not be the first line treatment for pain.

Placebos have a remarkable therapeutic effect especially in treating subjective experiences. Placebos are even more effective as the stress of the situation increases. This complementary approach enables all healing aspects of the body.

Part 2 presents the historical landmark studies on the placebo effect. This section reviewed the theoretical studies around expectancy and hope and their influence on biological response. Experimental application to asthma, pain, allergic response, addiction, Parkinson's, immunosuppression, and anxiety are presented. Most are significant to the field even to this day.

Part 3 discusses the ethical issues that are raised when the placebo effect is used in research and clinical practice. This is a good read for those in practice and research. Institutional review boards don't approve of researchers lying to their participants, and we must provide full disclosure. That in itself can derail a study examining the placebo effect. For patients with chronic rheumatoid arthritis pain, how ethical is it to offer them a placebo and deprive them of their anti-inflammatory analgesics that has potential to increase pain and worsen their quality of life? Not all placebo-controlled studies leave patients untreated, and this is an ideal approach to ethical research.

The placebo effect, for me, shows the power of the mind over the body. Deceptive or not, placebos are being used in traditional western medicine and complementary healing modalities because they are a therapeutic tool that has the potential to heal. They are just too valuable of a tool in our tool box to give up. Our intention is to find the most ethical and honest ways to practice and research with the placebo effect. The etymological meaning of the word placebo is "to please." Believing in the potential for healing and embracing hope has positive effects on immune function and the body's own ability to fight disease. We do have a conscious choice in wellness, illness, healing, and transcendence. There are subtle changes happening at levels we do not yet understand.