Half of Doctors Give Placebos

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Half of Doctors Give Placebos

About half of doctors admit to intentionally deceiving patients by prescribing placebos, but might the ends justify the means?

A controversial paper was published in the American Journal of Bioethics arguing that it’s not only OK for doctors to lie to patients, but that we have a “duty to deceive.” Unlike what you see on television, roughly half the time a patient walks into a doctor’s office, a firm diagnosis cannot be made. Half the time the doctor doesn’t know what’s going on. So why not give the patient a sugar pill, such as a homeopathic remedy—which is often just that, an actual sugar pill—or something like a Bach flower remedy? Just because they don’t work better than placebo, doesn’t mean they don’t work (see my video Is Homeopathy Just Placebo?).

Placebos are certainly safer than prescribing an actual drug. As I document in my Uprooting the Leading Causes of Death video, prescription drugs kill an estimated 106,000 Americans a year, effectively making doctors the 6th leading cause of death.

Even just offering a made-up diagnosis and false reassurance seems to work. In one landmark study, two hundred patients for whom no definite diagnosis could be made were randomized into two groups. The honesty group was told “I don’t know what’s wrong with you,” and the dishonesty group was given some fake but firm diagnosis and told confidently they’d get better in a few days—and guess what, they did! They were 90 percent more likely to be cured. A “Deception Flowchart” has even been devised to help us doctors decide, for example, if we should consider a “lying” versus a “non-lying deception” to meet objectives.

Those on the pro-truth side of the fence argue that first of all, placebos aren’t necessarily always safe. The sugar in the sugar pills is typically lactose (milk sugar), for which most of humanity is intolerant after infancy. There was a famous cancer drug trial in which the chemotherapy caused a surprising reduction in nausea and vomiting compared to placebo, but that may have been because it was compared to a placebo made out of lactose. See my video Infant Nearly Killed by Homeopathy for an extreme example of this.

Pro-truth advocates accuse doctors of disease-mongering. By defining vague symptoms as an entity requiring a treatment, healthy people are converted into patients. “They need explanation and reassurance that promote autonomy,” reads one editorial, “not to be given faith in a non-existent disease and crackpot medicine.” If all one cares about is beneficial medical consequences, “might not doctors also have a duty to prescribe things like chanting, crystals, and séances?”

Deception advocates reply: “Doctors have a duty to do the best they can to relieve a patient’s symptoms. If that means they prescribe a placebo, or even conduct a séance…then there is a duty to do these things. If a doctor can really convince a patient that a chant will cure his headache, then it very likely will, and she should ululate it at the top of her lungs.” In fact, “It is a type of deception that patients ought to be thankful for, just as we are thankful when we receive a mendacious compliment from a friend.” Of course you don’t look fat in that dress!

So how many doctors lie to their patients? About half of surveyed internal medicine doctors and rheumatologists in the United States report prescribing placebo treatments on a regular basis. Similar numbers have been found in Canada, Europe, Israel, and New Zealand. See my video The Lie That Heals: Should Doctors Give Placebos? to see the studies themselves.

Surveys show that prescribing placebo treatments seems to be common and is viewed as ethically permissible by physicians. I personally find it ironic that physicians often condemn alternative medicine quacks for giving useless remedies when they themselves do the same thing. As one physician commented, “The vow we take is the Hippocratic oath—not the hypocritic one.”

What does everyone think about this practice? Would you want to be lied to by your doctor if it would help make you better?

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


50 responses to “Half of Doctors Give Placebos

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  1. Nope, wouldn’t want anything but the truth, even if it means telling me, “I have no idea what is wrong with you.” I believe the body heals itself for the most part, anyway, if we can just get out of the way and let it heal itself.

    1. I believe my current him doctors are prescribing me placebos for my chronic pain.
      I personally am an advocate of mind over matter when it’s necessary to manage adversarial situations wherein one must be victorious in order for everyone involved to succeed. However merely trying to trick patients into being pain free is monstrously unkind especially when there is an abundance of evidence available that the injuries to the patients have caused real damage to their bodies. Being aware that the practice is running rampant, my worry is that the DEA is responsible for the deception. If so it’s clear to me that the DEA is therefore responsible for heroin addiction in people who continuously suffer serious pain but can’t be helped by the prescriptions they recieve. If my understanding of the problem is accurate it’s my strong opinion that DEA should not only leave the doctors and consequently their patients alone; the DEA much like some other government agencies should be disavowed and replaced by the Public Health Service or some other Government agency that has been proven to do more good than harm. Perhaps the the criminal hunting responsibilities of it the DEA should go to the FBI or even ATF.

  2. I think prescribing placebos is despicable. If I look fat, I want my friends to tell me the truth, not tell me a lie and allow me to parade around thinking I look great while my non-friends criticize me behind my back. That analogy just shows how hurtful the practice of prescribing placebos really is. If someone is imagining illness, what they need is psychological support and stress relief, and maybe more exercise, light, hobbies, and fun in their lives, not a pill that makes them dependent on a snake-oil guru.

  3. Ugh, this is disheartening in this day and age. I think that our culture of immediacy puts pressure on medial professionals to come up with a quick fix answer to often vague, non-specific ailments, driving this “duty to deceive”. I am a nurse practitioner and see it all the time. People need to hear the hard truth once in a while. Non-specific stomach pains and drinking 4 or 5 diet sodas a day. frequent colds and smoking a pack a day? Yeah. I’ve been there. The answer however is not to give these patients a Tic Tac and tell them it’s the magic pill. If anything, we should be giving them broccoli and telling them IT’S the magic pill.

  4. so you’re saying pharmacies stock “placebo”? and the doctor, when writing a prescription writes ‘placebo’ on the prescription sheet? I have a hard time believing that.

    1. My observation is that the placebo can take many more costly forms. For my now deceased parents it was MRI’s and antibiotics, etc. Homeopathy might have put less strain on our health care system

    2. Yes, pharmacies do stock “sugar pills.”
      And yes, we do write prescriptions for placebo for patients on occasion.
      In my case as a prescriber it’s very rare, but in our American culture, unfortunately many patients expect and demand a pill for every little thing, and often there is little you can do to educate them, especially in the face of pharmaceutical companies spending billions of dollars to market unnecessary pills directly to the public.

    3. I’ve been a pharmacist for nearly 20 years. I personally have never had a physician write for “placebo” and I have never ever heard of a placebo being stocked in the retail pharmacies that I have worked over the years. However, this type of practice (prescribing meds that aren’t that effective) is done all of the time. This is also done in various capacities. When an ER doc used to think the patient was faking pain we would get a prescription for #8 Darvocet N-100. That was an unspoken rule that the prescriber didn’t really think the pain was legit but since it is a very, very weak narcotic it got the physician off the hook. I am appalled at the number of drugs that I dispense that are essentially worthless. From many antidepressants to fibromyalgia drugs to cholesterol drugs…the list goes on. Truth is, we (western culture) are a bunch of whiners and we want things fixed quickly (note: finger occasionally points back to me). We emotionally want things to be OK. So physicians often feel the need to make us feel ok. Physicians also, unfortunately often fall prey to protocol. “A diabetic should have a statin”. Then I ring up the statin along with the pound cake, saltines, Wonderbread, 5 bags of sugar, the case of Dr. Pepper and 3 Tony’s pizzas. OK. My short ramble is done! haha. Seriously though. Many many people don’t want to be healthy. They have NO IDEA what it is like to feel great. They have NO IDEA that there are better ways to life. And in the same breath, I have no idea what it is like to be in a third world country and smile because I have running water. Somethings are relative. And if this doesn’t make sense it may be because I just woke up from a nap. :)

    1. That depends entirely on what they are using as the “placebo”. I am of the mind that the less things you ingest for imagined illness or vague, nonspecific troubles, the better.

  5. “Half of Doctors Give Placebos”

    None of the cited studies’ abstracts substantiate this claim–and at least one would, as it’s a remarkable claim. Where does this come from?

    “Would you want to be lied to by your doctor if it would help make you better?”

    I realize that the context of this question is the ‘western’ medical system. Such a practice, however, is typical in Japan.

  6. The problem is that patients show up with all sorts of vague complaints. People want a pill to fix every little thing. If I can tell a patient to take a pill for two weeks that I know does nothing, and won’t hurt them, then I can be done with them. If I say nothing is wrong, I might end up debating vague symptoms with what seems like a psych patient. We don’t have time for that.

    1. “…then I can be done with them.”
      Are all your pts an annoyance to you, to be gotten out of your exam room as quickly as possible? What awaits? Golf?

    2. Perhaps rather than avoiding what you fear may be a discussion with someone you perceive to be a psych patient, you should figure out ways to address their issues, including what may be a psych referral. Seems more reasonable than dismissing people outright.

      1. In defense of Will, the primary care provider quickly learns that there are many personalities that are very difficult and often don’t seem to want to be made better. Worse they don’t recognize their condition and wod be offended by a psych referral. I understand Will’s reluctance to enter into fruitless conversations. I only came to realize how difficult it is to address these issues in the day to day grind of primary care.

        1. I agree. There is also the very practical element of time. There is just simply not enough time in your average doctor’s visit to have a conversation like that with a difficult patient who wants a quick fix.

  7. When your 10 yr. old child asks if Santa is real, do you lie to him? In this day and age of search engines… how on earth can a health care provider prescribe a placebo without the patient knowing? If I were so prescribed and found out on my own that it was a placebo… (Maybe I asked the pharmacist and/or searched for the medication or made-up diagnosis on line…) I would then feel very deceived by my provider. How could I then trust her for anything in the future? And part of healing is the trust/relationship btwn pt and provider. How could I not feel condescended to or not feel patronized? I want my doctor to partner with me in the care of my body, tell my why he thinks it is not a problem, or invite me to come back in X number of days if symptoms persist. How much more helpful it is to know that my stomach ache is more than likely nerves… Ruling out a medical issue and knowing that it is likely nerves I can address my problem. If I cannot on my own address the stress that is causing the symptoms and if I return again and again to the doctor, is a psych issue so shameful that it cannot be discussed? No time? No time to gently and compassionately make a psych referral? There was a time… 50 yrs ago… when we routinely lied to the terminally ill about their prognosis. How much more helpful it is today to know the truth about terminal disease… so that one can get affairs in order. Truth may hurt, but it is ever so much better than ruining the trust btwn pt and provider.

  8. Doc, I’ve begun to show your recent video on coronaries or cavities to my patients. I think the effect has been dramatic. They are definitely willing to give a plant-based diet a try. I also recommend the supplements that help to support plant-based nutrition, as per the common recommendations. I just wanted to thank you for making these videos, as they are really making a difference. If I am sharing them in my practice, it is probably fairly common – see Will’s comment below.

  9. I’m okay with it. Perhaps by prescribing placebos what the docs are doing is enlisting the help of the power of the mind. Negativity and stress have detrimental effects on your health and immune function, so we all want and need to hear good news. My doc is Chinese, and if he wants to try something outside the box, I’m game.

    1. So if you have a copay of $20 it is the same for sugar as a real drug? Highway robbery. How is this reported to the insurance company and do they know you only got sugar? Can you list the “code” words that are used so we can be made aware? Guess I need to ask my next door neighbor how she dispenses it. One more reason to not go to the Dr.

        1. You make a good point, Doug. I’m in Ontario, Canada, where we have OHIP “paying” for most of our health costs (and we therefore don’t always pay as much attention as we should).
          For this practice to have any acceptability, one would have to assume doctors always had their patients’ best interests in mind. Also, if the problem is life-threatening, one would hope the doc would lay it on the line.
          There may be some patients who demand medication or proactive treatment for their problem—a doctor’s admonition to “Think Positive” may not be enough. If a placebo helps people get into a healing frame of mind and provides reassurance maybe it’s worth the cost???

    2. It’s only to the benefit of the patient if the doc gets the differential diagnosis of “nothing wrong with this patient” right. What placebo takes away from your average patient is the thought that something may still be untreated. If they think they are receiving treatment, they would be less likely to go for a second opinion. With some very insidious diseases that have vague symptoms, this is potentially harmful.

  10. Perhaps “prescribing” placebos is a bad idea because if the patient discovers they were lied to the trust they had with their doctor would be destroyed. I certainly wouldn’t trust a doctor that lied to me.

  11. Complex question. The fact is that much more than half of all physicians prescribe medicines that are either placebos, or meds where the placebo effect is the most important therapeutic effect. Believing that a pill will help you is a very powerful force and has definite bio-physiologic effects.
    The Rx is almost sacramental . In other words, the intended effect is offered in material form. It also completes the patient physician transaction. You can move on to the next patient. I’m not endorsing it, but it is universal.

  12. The headline above is deceiving. If you follow the link to the paper that is cited, it is clear that the author is advocating for the use of placebos, although they are not currently permitted by ethical rules of medical practice. The abstract states:
    “Among medical researchers and clinicians the dominant view is that it is unethical to deceive patients by prescribing a placebo. This opinion is formalized in a recent policy issued by the American Medical Association (AMA [Chicago, IL]). Although placebos can be shown to be always safe, often effective, and sometimes necessary, doctors are now effectively prohibited from using them in clinical practice. I argue that the deceptive administration of placebos is not subject to the same moral objections that face other forms of deception in clinical practice and medical research. Although deception is normally objectionable on the grounds that it limits autonomy and breaches trust, these grounds do not apply to placebos when they are prescribed within appropriate ethical limits. Patients have reason to prefer that doctors can prescribe placebos in ethically responsible ways. Hence, the AMA has an obligation to endorse and to promote the responsible use of deceptive placebos in clinical practice.”

  13. I’m on the side of truth, as I believe most of us are. I think it’s fine for a doc to say “I don’t know what’s wrong with you but I suspect it will go away on its own”, for example. Or just “I have no idea what is wrong with you. Shall we wait and see what happens?” In any case, if a doctor gave a name to my condition I would look it up on the web and find out soon enough that my symptoms did not match or the name was invented.

  14. This kind of thing makes me crazy. A doctors first responsibility is to “DO NO HARM.” How can anyone imagine that lying to patient who comes to you for help with symptoms doesn’t harm them? Just because you don’t know what’s wrong doesn’t mean that there isn’t something that you’ve missed. i find a lot of doctors aren’t really interested in getting to the root causes of diseases. They want a quick and easy fix and then on to the next patient. Both doctors and patients need to move away from this mentality that they (doctors) know everything and that it can be fixed with a pill.

    Thankfully we have wonderful websites like this one, where people can take control of their own health, and hopefully bypass the doctors visits all together!

  15. I am a practicing physician and my approach to nonspecific complaints is to do a reasonable initial evaluation with history taking, examination and appropriate testing. If eveything appears normal – I simply say “your exam and tests are all normal. I don’t think your symptoms are a sign of anything serious, but if they don’t go away or get worse, let me know.” And then, with a slightly kidding tone to my voice, I say “As you know, there is no end to the number of tests I can order”. This is my ‘placebo’. The patient is reassured, and usually the symptom goes away if there is no serious underlying disease – because people don’t want a bunch of expensive tests unless they are really necessary. But, people also want to be taken seriously, and knowing that further tests are available to them, if needed, is also very reassuring. I personally don’t like the idea of being deceitful and prescribing ‘placebos’. It seems disrespectful to me.

  16. Ughh, No lying, no placebos! To me this is a paternalistic attitude of someone who thinks they have rights over their patients, that they know better, and can do anything they want.

  17. There are two types of placebos. The bulk of doctors only use the second type. See this article for reference. http://www.ncbi.nlm.nih.gov/pubmed/23526969

    1) The sugar pill, termed ‘pure placebo’ which are used in clinical trials as controls.

    2) ‘Impure placebos’ are treatments which provide benefit for one indication but are being prescribed for a different indication for which there is, at most, biological plausibility and usually no evidence that they are better than ‘pure placebo’. An example of an impure placebo is an antibiotic like azithromycin when given for what is most likely a common viral illness. Because the illness is likely viral it will provide no benefit other than placebo effect.

    As referenced above, there is evidence that prescribing the ‘impure placebo’ is more effective than telling the patient they will have to wait and get better on there own. I understand why providers do this but it can lead to problems.

    1) Impure placebos have significant side effects, cost money, and in the case of antibiotics contribute to resistance in the individual patient and in the society as a whole.

    2) When the patient does get better, they may be convinced the placebo worked. They may request the same drug the next time they have similar symptoms. Doctors also see that patient’s get better and that prescribing the ‘impure’ placebo satisfies them. These doctors are more likely to prescribe the same drug to other patients in the future. You see the vicious cycle. Pretty soon the doctor is deceived and he is no longer lying to his patients.

    If any placebos are given they should be harmless and cheap and doctors should not be deceived that they are actually working. If you want your doctor to be honest, my suggestion is to always voice that you want the truth and only evidence-based treatments, especially if offered a potentially harmful or expensive drug. It doesn’t hurt to say what’s a reasonable alternative.

    As doctors we have a lot of room for improvement. According to last week’s Journal of the AMA we still prescribe antibiotics for 75% of patients presenting with acute bronchitis for which almost none will benefit more than if they were given a sugar pill. See: Kuehn BM. Excessive Antibiotic Prescribing for Sore Throat and Acute Bronchitis Remains Common. JAMA. 2013;310(20):2135-2136.

    1. What am I as a physician in an urgent care center to do then, when I explain to my patient that they most likely have a viral bronchitis that takes 2-3 weeks to go away and they then complain on their Press-Gainey survey that I am a horrible doctor because I “didn’t treat them” by not giving them an antibiotic? These surveys determine whether or not I stay hired. This is illustrated by the fact that in a study done last year, patients think the average cough illness should be gone by 7 days when in fact, it takes an average of 18 days to resolve. I usually tell people if I think it’s viral and encourage them to “wait it out.” Sometimes when the patient gets irate, I end up giving a written prescription for antibiotic that I tell them to hold on to and only fil if they aren’t improving in another couple of days, only to have them immediately fill it at my checkout desk because they couldn’t care less what I tell them – They just want their “cure-all.” If I don’t give it, I get bad survey scores and I get disciplined. We’ve had doctors be fired for refusing to budge on this and only giving antibiotics where it’s really necessary. This problem is about more than just doctors. It is also about our current business model in American medicine (“the customer is always right”) and people wanting something to make every little thing go away in a day. While I do have patients who respect it when I tell them that i think something is viral (and I always offer symptomatic treatment to all patients, like cough syrup), the majority get angry and roll their eyes at me. So it boils down to this, do I provide “good customer service” (according to my employer) by giving people what they want and stay hired or do I do the right thing and refuse to give it? I agree we prescribe too many antibiotics, but most patients, even with education and honesty from their doctors, still want them. It’s not always as simple as saying no. (I’d like to keep my job!) I try to walk this fine line by using the “written prescription method” above but it doesn’t always work.

      1. Megan: You are in a really tough place. I for one, as a patient, would love to have you as a doctor! The last thing I want is to ever take an unnecessary medication.

        Thank you for trying to do the right thing even if the practicality of your situation doesn’t always allow it.

        —-

        And actually, in thinking about your story, that is the perfect place for a placebo. I wish doctors could prescribe “antibeeotics” (sugar pill with fancy name) for just such situations. It would the patients and the world the least amount of harm and may actually help the patient.

        Thanks for sharing your story.

    2. Tim MD: I thought this explanation of the two types of placebos was a helpful contribution to the discussion. Personally, if a doctor prescribes a placebo, I would think the most ethical one would be the “pure placebo” that you discuss above.

      Thanks for your thoughts.

  18. Going back to the video on homeopathy where you seem to agree that homeopathy is ” witchcraft”, but achieves as good a clinical result as a placebo, one would think the medical profession would be very willing to promote homeopathy. How many deaths has homeopathy been linked to?

  19. Interesting article. Thoughts:

    * Placebo has been demonstrated to work (i.e., facilitate the human body’s healing itself of true, not “pretend” or otherwise unreal, ailments).

    * Psychosomatic illness is not “pretend” or otherwise unreal illness, but rather an actual, measurable state of disease caused or aggravated by stress or other mental state.

    * Sugar pills are not identical to homeopathic remedies. Homeopathic remedies are created by a well-documented and consistent (albeit highly controversial) method of successive dilution in water followed by succussion (vigorous mixing), whereas sugar pills are presumably just pressed together and dehydrated chunks of sugar.

    * Placebo is not identical to homeopathy. Homeopathic remedies have been demonstrated to work several times more effectively than placebo. Homeopathic remedies have been demonstrated to work in farm animals (cows, pigs, etc.) and in plants. These results cannot be rigorously explained away as “psychosomatic” or insignificant.

    We do not well-understand placebo or homeopathy, but that doesn’t mean we can, with complete scientific honesty, ignore their observed efficacy combined with relatively low levels of negative side effects. Both deserve further research.

  20. What seems to be neglected in this discussion is the fact that human beings are not just bodies. We have minds and emotions. Sometimes we need solace or sympathy or reassurance. There may be ways to fill these needs without prescribing a pill, but our society is generally not set up that way. Many people are lonely or do not have sympathetic friends. The physician may be the only one who can offer some kind of hope. This is not a question of to lie or not to lie – it is a question of how do we live without a supportive community? It is not about doctors; it is about our society.

  21. It is unethical, period. This is being done for the convenience of the doctor, not the well being of the patient. And it’s just more evidence of the arrogance and paternalism of the medical profession. I now regard most doctors (not all) as worse than ambulance-chasing lawyers.

  22. you are by far the most uninformed ass i have ever come across you speak of things you really know nothing about , and that makes you look laughable . seriously for starters there is zero chemicals in sugar pellets there are different kinds most are made from milk sugar . I can go on and on but your type is a waste of my time and a detriment to the masses you are way too pedantic for yourself mon cher ,” un vrai petit con” i study both sides of the spectrum and drugs sometimes will save someones life not without risk of course considering the side effects . but no one dies from homeopathy and the most famous scientist in the WORLD (you are i can see not one of them) are looking into homeopathy for answers because it’s works like quantum physics ( going right over your little pedantic head i’m sure) i was raise to learn to shut up if i’m ignorant of a subject and listen to the ones who know , i suggest you do the same.

    1. Paddy: This is a civilized site, not a place for playground name-calling. It is one thing to disagree. It is another to personally attack. Thus, I am taking it upon myself to try to delete your comment.

      If you would like to have a civil, adult discussion, feel free to try again.

  23. This shows that there is something wrong with the patients. Maybe lots of people have hypochondria and placebos are a cure for hypochondria. I do not have health problems and do not go to doctors. Also a placebo is nicknamed a sugar pill but is supposed to be something inert.
    I know a guy that was having problems and he went to doctors and they did not know what was wrong with him, but they put him on lots of drugs. A year later he died and an autopsy showed that he had heart failure a year ago. I told him that he was in bad health since he had a horrible diet with almost no fruits or vegetables. He owned a pizza place that opened early in morning and closed late at night and that is where he got his food.

  24. wow. this is fascinating. i think we may be touching on shamanism. i’ve done some research on this and a shaman reflects back the patient’s belief in the shaman. the doctor him or herself can be a placebo. belief is powerful and something not to be belittled. it can work just as easily to their detriment as to their mental and physical health. the placebo can be a tool in the physican’s tool kit. each person is different. personally, i don’t care what gets me healed as long as i get healed and i would prefer as little side effects as possible so maybe a placebo is not so bad.

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