Placebo effects are very powerful and are important not just in research, but also in demonstrating to us how our demeanour may be just as important as the drugs we give. It is often said that if two obstetric units (for instance) do things quite differently (eg for or against artificial rupture of the membranes) then if one unit is vindicated by research, the other unit must be wrong. This need
not follownot just because the population served by the errant unit may be different. The errant unit may believe it is a centre of excellence, and its staff may rupture membranes with joy in their hearts, knowing they are fulfilling their destiny as the best obstetric unit bar none. This feeling may communicate itself to labouring mothers, who, due to an interaction between communication, beliefs, cognition, and contractility, have their babies with few complicationsso much so, that if the unit went over to the correct method, their results might come to mirror their plummeting self-confidence. (This is an important reason for the failure of imposed protocols which look good on paper) Research in this area is very difficult to do, because you cannot easily control for joy in the heartbut with care it can be systematically analysed: in a placebo-controlled study of antihypertensives the partners of the enthusiastic doctor broke the code, and told him that his experimental treatment appeared similar to existing treatments without telling him who was having the active drug, and who was having the placebo. From this point, there was an immediate, marked increase in BP in both groups, although the difference between the drug and the placebo was maintained.
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