The Placebo Effect

The Placebo Effect - The Ghost in the Machine

I have remembered and, in part, misremembered this trial concerning side-effects for over 2 decades now. I was recently inspired to revisit this article by witnessing how cataclysmically wrong Google searches are about the effects/side-effects of medicines and supplements always are. I rarely speak in platitudes, but wow, Googling is dangerous and disempowering.

This study reported in the November 2003 European Heart Journal, PMID: 14585251, “Report of Erectile Dysfunction After Therapy with Beta-Blockers is Related to Patients Knowledge of Side-Effects And is Reversed by Placebo” provides everyone with tremendous insight to the power of words! The beta-blocker used was 50 mg of atenolol, a common medicine used 20 plus years ago.

All it took was 96 men, free of erectile dysfunction (ED), age-range of 45-59 (52 +/- 7 years), being treated for cardiovascular disease, primarily hypertension. In Phase 1 of the trial, 32 men were given the drug but did not know what it was, another 32 men were given the name of the drug but no information on side-effects, and the final group of 32 were told about the medicine and the known side-effect of ED. At 3 months, the rate of ED was 3.1% in Group 1, 15.6% in Group 2, and 31.2% in Group 3! The exact same medicine was given, at the same dosage, to each group. The only difference was “knowledge”.

Phase 2 of the study, I think, is even better! All patients who developed ED were randomized to 50mg sildenafil (Viagra) or placebo for treatment of their ED. Sildenafil and placebo were equally effective at treating the ED! Yes, you can reverse placebo side-effects with a new treatment placebo!

Remember the Henry Ford quote: “Whether you think you can, or you think you can't– you’re right.” Just think what today’s level of misinformation is actually doing to us. Almost everything I prescribe, drug or supplement, people “look up”, profoundly damaging themselves with misinformation, even somewhat accurate information. But they possess no actual context for evaluation based on reading original studies detailing the rate of side effects in the treatment group vs placebo group.

My perception in the 22 years since this study is that the problem has become far worse than the 10 fold worsening of side-effect rates that come with “knowledge”

My suggestion is to find a trusted provider and try the recommended intervention. If some treatment leads to discomfort, stop and reassess later without finding out if Google tells you it is a plausible side effect. Try it again, and if you have the same side effects, stop and tell your provider. What new intervention might be tried?

Don’t trust the internet to be your best healer, trust your direct experiential knowingness.

Your Journey to Health and Healing,

Gary E. Foresman, MD