- A study published in the Annals of Internal Medicine show that the manner in which a placebo is administered can determine how it works.
- Researchers reviewed more than 100 clinical trials for knee osteoarthritis in which some patients received placebos or sham treatments.
- The big surprise was that a sham injection with saline solution was better than a placebo pill, and also 1.6 times better than the drug Tylenol (acetominophen).
For the most part, the placebo debate has been focused on whether or not it's ethical to give some patients placebos or sham treatments, while others receive actual medications or therapies. However, this is a new twist. Now that it is understood that there are differences in efficacy among various types of placebos and sham treatments, the decision-making process will become even more complex for treating practitioners.
This new reality has been dubbed the "efficacy paradox" in an editorial in the same issue of the journal in which this study were published. The efficacy paradox suggests that a treatment which seems only marginally better than placebo might actually be much better than another treatment if the placebo effect itself varies.
This effect has been documented in a range of disorders and conditions, and merits recognition by the medical world.