Recently I was reading through some online medical reporting. The following headline caught my eye: Use More placebos, German Doctors Advised.

I can see it now. A clinician says, “Here you go Herr Weber. Take this sugar pill . . . um, I mean expensive medication to prevent migraines. Take 2 a day and call me next week.”

Placebos work because of the psychological expectation of getting better; this is called the placebo effect. Improving because of the expectation to improve is very real. The placebo effect explains why pharmaceutical researchers use placebos in control groups – they need to balance the expectation of improvement in the group that gets the real drug by giving the control group something to take as well. But should clinicians be prescribing placebos to patients?

In America and England, prescribing placebos without patient’s permission is unethical. Sure we could give patients placebos with their permission, but if patients are told that they are taking a placebo then it won’t work because the placebo effect will have been nullified. There is no expectation of getting better when people are told that the pill is really made out of sugar or flour, unless they ascribe medicinal properties to those two baking goods.

The German Medical Association also reported that placebos sometimes work better than real medications. This sounds strange. How can placebos work better than real meds when, in both cases, patients benefit from the placebo effect (the expectation of getting better just because they are taking something)? The only thing I can think of is that the placebos are nicer looking pills, covered with pretty pastel colors and small, technical writing.

I can see it now. A patient says, “Mmm. These pink, heart-shaped pills that taste like sugar are going to really help my headaches, much more so than those plain, awful tasting, expensive white pills I took last month.”