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December 2014

Using the Placebo Effect to Treat Cold Symptoms in Children

Author Affiliations
  • 1Department of Pediatrics, University of Washington, Seattle
  • 2Treuman Katz Center for Bioethics, Seattle Children’s Research Institute, Seattle, Washington
JAMA Pediatr. 2014;168(12):1091-1092. doi:10.1001/jamapediatrics.2014.2355

Although it has been recognized for centuries,1 the concept of the placebo effect was brought to professional consciousness with the 1955 publication of “The Powerful Placebo.”2 In this seminal work, Beecher used a quasi–meta-analysis approach to estimate that 35.2% of patients had a satisfactory response to placebo for relief of pain. Despite limitations in design and more recent analyses calling these results into question, the study by Beecher is largely responsible for the commonly held perception that approximately one-third of patients respond to placebos.3 In this issue of JAMA Pediatrics, Paul et al4 report the results of a randomized clinical trial comparing the efficacy of agave nectar (the study intervention), placebo, or no treatment for acute nighttime cough in children 2 to 47 months old. Although the study intervention provided no more relief from cough symptoms than placebo, both treatments were statistically superior to no treatment. The investigators contend that these findings are indicative of a placebo effect. Perhaps more provocatively, they suggest that knowingly using a placebo to treat cold symptoms in young children may constitute good medicine.

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1 Comment for this article
Is water really a placebo in cough?
Mike Vanzieleghem, MSc (Lon) | MV Pharma Consulting
While the placebo effect is a difficult devil to deal with in running clinical trials for many diseases/conditions, some badly chosen, presumed-negative comparators in certain cases do exert beneficial effects for simple physiological reasons. As a parent, I had always found a drink of water for a nighttime cough often helped a great deal, whether through rehydration or other actions. What you suggest in terms of use of placebos as a therapeutic opens up ethical territory in the region called \"deceit\" which has been a valuable tool in sociological areas of investigation but of generally doubtful acceptability in medicine. Your idea is appealing but I think using placebos deliberately for effect, beyond the extent to which it is presently used in research/diagnoses may be a slippery slope.