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Geriatr Gerontol Int. 2010 Apr;10(2):131-7. doi: 10.1111/j.1447-0594.2009.00580.x. Epub 2010 Jan 19.

Would the elderly be better off if they were given more placebos?

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1
The Geriatrics Institute, University of Miami Miller School of Medicine, Division of Geriatrics and Gerontology, and the Geriatrics and Extended Care Service and Geriatric Research Education, and Clinical Center of Miami Veterans Affairs Medical Center, Miami, Florida 33125, USA. evan.cherniack@va.gov

Abstract

Placebos are useful in the medical care of the elderly, although the exact definition of a "placebo" or "placebo effect" is difficult to define precisely. They have an important role as control treatments in research trials, but a non-specific "placebo effect" may also be beneficial part of many physician-patient interactions. Physicians also give them deliberately according to several studies worldwide to satisfy patient demands or because they believe in a "placebo effect" among other reasons. A significant placebo effect has been observed among older patients in clinical trials of antidepressants (12-15%), and in treatments of Parkinson's disease (16%). Placebos activate serotonergic pathways in the brain used by antidepressants. In Parkinson's disease, the administration of a placebo stimulates dopamine release in the dorsal (resulting in motor effects) and ventral striatum (which influences expectation of reward). Much of our understanding of the placebo effect comes from studies of placebo analgesia which is influenced by conditioning, expectation, meaning and context of the treatment for the patient, and patient-physician interaction. It is anatomically medicated by brain opioid pathways. Response to "sham" acupuncture in osteoarthritis may be an example of its use in the elderly. Placebos have often been considered a deception and thus unethical. On the other hand, some physicians and ethicists have suggested conditions for appropriate uses for placebos. A placebo might offer the theoretical advantage of an inexpensive treatment that would not cause adverse drug reactions or interactions with other medications, potentially avoiding complications of polypharmacy.

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