10: Placebo Should Be An Option Used By PT Flashcards
(26 cards)
Opposition opening statement
(Real case)
Tuskegee Syphilis Study (1932–1972): African American men were unknowingly given placebos instead of treatment.
• Penicillin was withheld even after it became available.
• This case caused suffering, death, and led to legal changes regarding patient consent.
According to the opposition team, placebo is used in what areas?
• Medications (fake pills)
• Clinical trials
• Psychological treatments
(Not only electrotherapy)
Opposition arguments
• No therapeutic effect of placebo in PT
• Wastes time, effort, and resources
• Ethical concerns
What supported the opposition argument “No therapeutic effect of placebo in PT” ?
- PT = active interventions (exercise, manual therapy, modalities). PT’s goal is lasting change, not short-term comfort
- Placebo effects fade, no long-term improvement
- Studies show placebo ≈ no treatment
What supported the opposition argument “Wastes time, effort, and resources” ?
• Delays real treatment for those who need it
• Financial waste
• Resources are better used for evidence-based effective rehab
According to the opposition team’s argument “Wastes time, effort, and resources”, using placebo causes delays for necessary real treatment because … ?
- clinics have limited appointment slots and resources
- placebo takes time away from patients who need real interventions
- Delay can lead to worse outcomes
What examples were provided by the opposition team for their argument “Wastes time, effort, and resources”
Example of lack of true physiological benefit:
- Chronic LBP : Placebo gives short relief, but problem returns without rehab
Example of financial waste:
- Hospitals waste money on placebo treatments like electrotherapy that don’t offer real improvement, instead of funding effective rehab that helps more patients.
What supported the opposition argument “Ethical concerns” ?
- No real physical effect
Leads to:
- trust issues
- misleading and unethical
- research concerns
- lack of honesty - Article 10
- PT Shaikha Sultan’s opinion
- Dr. Talal Alshatti
Which article did the opposition team use for their argument “Ethical concerns” ?
Article 10
Whose opinions did the opposition team use to support their argument “Ethical concerns” and what was their opinion?
PT. Shaikha Sultan:
• Ethical concerns
• Risk of unnecessary suffering
• Impact on patient trust
Dr. Talal Alshatti:
• Placebo may mask real conditions (e.g., nerve root compression)
• In pay-per-service countries, adds financial burden
• Delays diagnosis, wastes time, affects care efficiency
Affirmative opening statement
• PTs are trained to support patient function and reduce unnecessary medical care.
• Even patients in denial deserve respectful, empathetic treatment.
• A physiotherapist’s responsibility goes beyond just physical impairments.
How did the affirmative team define the following :
- Placebo
- Ethical approach
- Code of ethics
Placebo: treatments that achieve physiological effect INDIRECTLY
Ethical approach: prioritizing pt’s benefit over harms, achieving mutual goals with mutual Autonomy
Code of ethics: “Do no harm”
Affirmative arguments
• Physiological influence
• Differential diagnosis
• Managing patient behavior
What supported the affirmative argument “Physiological influence: Neuroscience backs placebo” ?
1) Psychobiological Mechanisms:
- Placebo activates brain areas and chemicals (endorphins, dopamine) that help reduce pain.
2) Chronic Pain:
- It lessens pain in chronic cases through expectation and conditioning.
3) Rehabilitation:
- Its effects are enhanced by patient expectations, therapist relationships, and environmental factors in rehab settings.
Note: Placebo is underrepresented and stigmatized despite proven results
What supported the affirmative argument “Differential Diagnosis Use of Placebo” ?
- Placebo helps tell if symptoms (like pain or fatigue) are psychological or physical.
- It can reveal if movement issues are caused by psychological sources, such as fear, not injury.
What supported the affirmative argument “Managing patient behavior: placebo for behavioral and safety issues” ?
Placebo can help manage patients who:
• Demand unnecessary treatments
• Exaggerate symptoms
• Deny progress
• Fake injuries for attention
It supports trust and cooperation in patients with psychological factors (e.g., hysteria, elderly fear), and is a SAFE alternative when paired with education.
What case example was used by the opposition team to support their argument “Managing patient behavior: placebo for behavioral and safety issues” ?
Opposition rebuttal against “Physiological influence”
• Placebo changes brain activity short-term but doesn’t last
• Benefits fade if belief fades
• Doesn’t treat actual condition
• Affects symptoms, not disease
Project Syndicate - Placebo treatments mainly affect self-reported symptoms (like pain, fatigue, anxiety).
Opposition rebuttal against “Differential Diagnosis Use of Placebo”
• A study found that long-term fibromyalgia pain lowers placebo response, making it less effective in chronic cases.
• It shows the need to consider pain duration in placebo trials.
• The study confirms fibromyalgia is a neurophysiological disorder, not “in the mind” (Clauw, 2014).
• Using placebo this way may cause misdiagnosis and delay proper treatment, as it doesn’t prove symptoms are fake—just that brain and body are connected.
Opposition rebuttal against “Managing patient behavior: placebo for behavioral and safety issues”
• Using placebo as a “safe alternative” in contraindicated cases (e.g., pacemakers) equals no real treatment.
• Not telling patients causes emotional harm and loss of trust.
• Good care means honesty and respect.
• Studies (BMC Medical Ethics 2018; Benedetti 2014) show patients feel betrayed if misled, and placebo effect weakens if suspected.
Opposition closing statement
• Placebo may give short-term relief but isn’t a true therapeutic solution.
• PTs should focus on scientifically proven treatments that target the root cause.
• Therefore, placebo should not be used in physical therapy clinics.
Affirmative Rebuttal to “No therapeutic effect of placebo in PT”
• A meta-analysis found placebo gave major pain relief compared to no treatment.
• Effects were seen across multiple physical therapy settings, showing strong clinical impact.
• Highlights that patient expectations play a key role in treatment outcomes.
Affirmative Rebuttal to “Wastes time, effort, and resources”
• Time: Time spent building therapist–patient connection isn’t lost; it activates neurobiological mechanisms that reduce pain and enhance recovery.
• Effort: Placebo is effortless, as it happens in every session when we are acknowledging and guiding patients throughout treatment.
• Resources: Placebo uses the patient’s brain—activated through communication, environment, and trust. Electrotherapy and similar interventions are only effective if the patient believes they work.
Affirmative Rebuttal to “Ethical concerns”
- Placebo isn’t unethical—it’s about shaping expectations, not lying, and is supported by research.
- It causes no harm or side effects and can be used as part of treatment to improve outcomes.
- Placebo is not the whole plan, but a part of the treatment plan based on patient beliefs and motives.
- It’s based on expectations and beliefs, so there’s no harm to the patient.
- Article 10 supports informed consent and ethical care, which placebo use can align with when applied transparently.
