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About Follies and Fallacies, but mostly about placebo


               Uffe Ravnskov
               Dag Viljen Poleszynski
               Uffe Ravnskov
               Dag Viljen Poleszynski
               Uffe Ravnskov
               Beatrice Golomb
               Dag Viljen Poleszynski

Uffe Ravnskov
Dag Viljen Poleszynski
Malcolm Kendrick
Morley Sutter
Malcolm Kendrick
Dag Viljen Poleszynski
Uffe Ravnskov
Herbert Nehrlich



Uffe Ravnskov
I assume that all of you know Petr Skrabanek, a brilliant mind and one of the first cholesterol sceptics. Unfortunately he died all too early in the midst of his career as an outspoken medical philosopher and scientist.

James McCormick, the president of The Skrabanek Foundation and a member of THINCS has informed me that Petr's books, "Follies and Fallacies", "The Death of Humane Medicine" and "False Premises, False Promises" are now available from Dr. Maurice Gueret . Each priced at £25, £23 and £23, respectively. Cheques to be made payable to The Skrabanek Foundation.

I can recommend all Petr's books warmly. The first one, which he wrote together with James, should become standard reading for all medical students. I am confident that if it had been, much of the lousy science that we so disrespectfully have compared with various forms of animal spillings would never have come into print.


Dag Viljen Poleszynski
I have read Skrabanek's and McCormick's "Follies and fallacies in medicine" and am not that impressed. The chapter on placebo effects completely ignores the very methodical and careful criticism raised against this concept by Gunver Sophia Kienle in "Der sogenannte Placeboeffekt" (Schattauer NY 1995), which she demonstrates does not exist anywhere in the literature surveyed. Furthermore, his chapter on "Alternative medicine" picks some of the least interesting alternatives and concludes that the whole field is full of humbug: "The claims of systems of alternative medicine all have two things in common. They have no detectable or coherent raison d'être other than the enthusiasm of their advocates and, almost withouth exception, they claim to cure or alleviate a very large number of ill-defined and quite disparate ills."

Another statement is: "Many people are convinced of the benefit which they derive from the daily addition of vitamins or other substances to their already adequate diets" (p. 10). No data are offered to show what this means, nor to refute the proven benefits of many nutritional supplements (like folic acid, B6 and B12). Such statements should speak for themselves as an indication of their objectivity and approach to science.

Aside from his sarcastic tone and non-scientific jargon, the book contains many good points concerning conventional medicine.


Uffe Ravnskov
Your criticism of Follies and Fallacies is unfair. On page 113 you can read: Regrettably, not all doctors practice rational medicine (certainly not; my comment), and conversely, not all healers are quacks."

What Petr and James wrote about was the myriad of unscientific alternative healing principles such as homeopathy, Bach´s flower therapy, Christian Science, iridology and much more, all of which "does not derive from any coherent or established body of evidence, not subjected to rigorous assessment to establish its value"(Quotations from FAF).

The non-existence of the placebo effect was unknown to me and is in conflict with my 40 years experience of clinical medicine. Please explain.

Besides, the paper you cite was published 1995 whereas Follies And Fallacies was published 1989. By the same reason the authors could not know any possible effects of folic acid, B6 and B12 besides those that are seen in vitamin-deficient patients


Dag Viljen Poleszynski
I disagree that criticism of Skrabanek & McCormick is unfair. Nobody is beyond criticism. That doesn't mean that they don't have some good points. However, I'm not very impressed with Skrabanek's evaluation of alternatives nor with his sarcasms. If he and his partner were a bit more openminded, they would have known a lot about vitamin therapy in 1989 - 20 years after McCully suggested that the three B vitamins could cure homocysteinurina, more than 30 years after Hoffer's first niacin studies with schizophrenics and about 40 years after the first successfull treatments with megavitamins. The effects of many vitamins were well known by then, although not recognized by orthodox doctors. There are hundreds of alternative therapies, several of which actually work, but S & McC apparently could not find any that had any merit! The effectiveness of vitamin C has nothing to do with the "faith of the therapist", as the authors perhaps would imply - most very effective therapies work by themselves without the necessity of believing in them. One prime example is cutting out wheat and other gluten-containing products by a celiac patient - faith doesn't matter in the improvements which invariably will follow. 

It is in this spirit that Kienle and collaborators have looked critically at all papers published on the placebo effect. They have used the same meticulous and patient procedure that you, Uffe, have used to pick apart any and all studies linking fat and cholesterol to heart disease. Their decimation of Beecher's "landmark" 1955 study is admirable - they show that his data are either constructed, missing of misinterpretated. Beecher's much quoted "35% placebo effect" proves to be a fiction of his imagination. Please read the book by Kienle or her article in Erfahrungsheilkunde 5/1997: 298-307 or (with Helmut Kiene) in Alternative therapies 1996; 6(2): 39-54. Two other critics of the placebo effect are Asbjørn Hrobjartsson and Peter Gøtzsche; cf for instance their article "Is the placebo powerless?" in NEJM 2001; 344: 1594-1602 ("We found little evidence in general that placebos had powerful clinical effects"...).


Uffe Ravnskov
Dag - The aim with Skrabanek's and McCormick´s book was not to discuss good science but to expose follies and fallacies.

I am not familiar with the placebo literature. However, Hrobjartsson and Gøtzsches  NEJM paper was met with many objections that in my opinion were not answered convincingly. Below I have quoted some of them. In any case, you can´t blame the authors for not having read a paper that was published 12 years after the publication of their book!!!  

To the Editor: The main reason we are skeptical about Hróbjartsson and Gøtzsche's condemnation of placebos in nontrial settings concerns expectations. A patient enrolled in a clinical trial with, say, one-to-one randomization knows that there is only a 50 percent chance of getting the putative active ingredient and, furthermore, that there is considerable doubt about the effectiveness of the active ingredient. This is very different from the use of placebos in nontrial settings, in which many patients may believe, 100 percent, that they are receiving a useful active substance. We hypothesize that the relation between doubt about the effectiveness of a treatment and its placebo effect (which we would define as the psychologically mediated effect of treatment) is nonlinear, with a huge reduction in the placebo effect once any substantial doubt is present. Richard J. Lilford, Ph.D., F.R.C.P.
David A. Braunholtz, B.Sc. 

….In most of the randomized, controlled trials, the no-treatment group still involved some form of treatment. Examples were contact with a psychiatrist, maintenance of interpersonal psychotherapy, weekly 60-minute small-group meetings, and additional pharmacotherapy. In some trials, patients were selected after a response to a specific treatment (e.g., only those who had a response to amitriptyline were enrolled in the trial by Klerman et al.,4 and those with a response after placebo in the trial by Rabkin et al.).5 Therefore, the hypothesis that there is no difference between placebo and no treatment was not actually tested, and no definitive conclusions can be drawn.
Thomas E. Einarson, Ph.D., Michiel Hemels, M.Sc.

 ….Hróbjartsson and Gøtzsche conclude that there is no justification for the use of placebos outside the setting of clinical trials. Their findings are impressive, but is their conclusion too sweeping? First, they did find some evidence of an effect in the important subgroup of trials in which the main outcome was pain. Second, despite the large sample, the statistical power to examine many subgroups of interest was low. Their data may have failed to demonstrate a small but clinically useful benefit of placebo for some patients and for some outcomes other than pain. Third, they found statistical evidence of heterogeneity of results in studies with binary outcomes. The results could not be heterogeneous unless at least one trial differed from the others, which would require a real (though unidentified) effect. Fourth, they studied patients in randomized clinical trials, many of which focused on serious conditions whose clinical consequences may have overshadowed small but useful effects of placebo. Fifth, they noted that the low methodologic quality of some trials might explain a lack of effect, though they found no association between dimensions of trial quality and significant effects of placebo…..
John C. Bailar III, M.D., Ph.D.


Beatrice Golomb
You might be interested in another perspective on the placebo issue. I wish I had these in PDF, but I don't. Probably the best single citation is the original Nature letter (and possibly its follow-up). The point is made that there are no regulations about what goes into placebos, any guidelines are at best informal, companies that manufacture the drug under study often determine the components, the composition of placebos are rarely named in journal articles and there is no requirement to do so, and there are no placebos that are known to be truly physiologically inert (including sugar pills, which for instance led to significant GI effects in persons who are lactose intolerant in several studies; or substances that are not absorbed, like methylcellulose which is sufficiently effective at lowering cholesterol that trials were conducted on this effect). Indeed, in some cases the outcome of a study can be traced to active effects of the placebo. A positive, negative or same direction effect of a placebo can lead to the spurious appearance of a negative, positive, or null effect of a drug. 

1.      Golomb BA. Paradox of placebo effect. Nature 1995; 375:530
2.      Golomb BA. Using placebos. Nature 1996; 379:765..
3.      Golomb BA. Are placebos bearing false witness? Chemistry and Industry 1995;   21:900.
4.      Golomb B. When are medication side effects due to the nocebo phenomenon? JAMA 2002; 287:2502-3; discussion 2503-4.


Dag Viljen Poleszynski
Dear Uffe, I agree with you - S & M could not have read the criticism of placebo by Gøtzsche et al., but they could have read Beecher's much quoted paper from 1955, since they did write rather uncritically about the placebo effect (p. 14: ....placebo response from 25 to 75%). This only goes to show that nobody is perfect, we all have something to learn. 

In general, criticism is very important (and you are a master at that), but perhaps equally important is to offer som viable alternatives (at least som alternative hypotheses) to whatever one is criticizing. Otherwise, people may be left with nothing to believe in.... 


Uffe Ravnskov
Why it is so unpleasant/uncomfortable/scary to be without an idea about this or that, not to be able to explain everything? Isn't it a good starting point for discovery? I am rather ignorant than being misled by follies and fallacies.


Dag Viljen Poleszynski
I am not scared/unconfortable not being able to explain everything, on the contrary! However, when patients ask, they need some advice as to what seems to be rational to do, based on the best knowledge at hand. I met the same objection in 1994 when Norwegian elites tried to make Norway join the EU. The "no" movement only said "no" and had no alternatives. I wrote a book outlining a number of alternatives to Norway joining the EU, but the message drowned in the heated media debate. Since the EU was rejected, Norway instead got the EEA agreement, which is a much worse solution (in my mind) than the Swiss alternative (not joining, but having an alternative affiliation). 

Since I edit a health journal and give a lot of lectures, I get a number of questions about nutritional supplements, n-3 oils, how much fat one could eat, etc. If I don't know the answer to a question, I say so, but being able to give some guidelines is met with many positive reactions. Hence, we don't need to explain everything, but we should at least be able to explain why we recommend what we do or live the way we do. 


Malcolm Kendrick
If I may throw my hat into the ring on this one. The placebo effect is something that I have been thinking about a great deal recently - I am not sure why, I just started to question the unquestioned assumption that the placebo effect actually exists. 

Almost all placebo studies have been done in pain - possibly the most subjective of all medical 'experiences.' So far as I am aware no-one has measured placebo effect on objective outcomes e.g. speed of wound healing, or progression of CHF.

As with so many things in medicine the 'placebo' effect fits with our rigidly constructed prejudices i.e. the idea sounds right, so we believe it. No-one has ever (at least not that I could find) done a study with a treatment arm, a placebo arm and a 'do nothing at all' arm. Until such studies are done, we will not know if the placebo effect is real, means anything, or should continue to be included as part of the so-called 'gold-standard' clinical trial. 

I sometimes wonder how many billions of dollars (may) have been wasted on placebo-controlled trials - when the whole concept of the impact of placebo has never been subjected to any trial?


Morley Sutter
Malcolm: Your comments concerning the role of placebos are appropriate.  As illustrated by the attached abstracts I have garnered over the past few years, however, placebos can be ignored only under certain circumstances and after due deliberation.   

Moyad MA. Institution M.A. Moyad, Department of Urology, Univ. of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330; United States.  E-Mail:
The placebo effect and randomized trials: Analysis of alternative medicine. Urologic Clinics of North America. Vol 29(1) (pp 135-155), 2002.
Randomized controlled trials are generally regarded as the gold standard of study designs to determine causality. The inclusion of a placebo group in these trials, when appropriate, is critical to access the efficacy of a drug or supplement. The placebo response  itself has received some attention in the medical literature over the past fifty years. The recent increasing utilization of dietary supplements and herbal medications by patients makes it imperative to reevaluate the placebo response in conventional and alternative medicine. This article will review some of the negative and positive results from randomized trials utilizing dietary supplements androstenedione, beta-carotene, CoQ10, garlic, soy, vitamin C and E...) for a number of non-urologic and urologic conditions, including cancer. 

 Moerman, Daniel E. PhD;  Jonas, Wayne B. MD Deconstructing the Placebo Effect and Finding the Meaning Response. Annals of Internal Medicine.   136(6):471-476, March 19, 2002We provide a new perspective with which to understand what for a half century has been known as the "placebo effect." We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of "meaning," to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the "meaning response." We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being. 

Kaptchuk, Ted J. OMD Institution From Harvard Medical School, Boston, Massachusetts. The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?[Miscellaneous] Annals of Internal Medicine.   136(11):817-825, June 4, 2002.
In alternative medicine, the main question regarding placebo has been whether a given therapy has more than a placebo effect. Just as mainstream medicine ignores the clinical significance of its own placebo effect, the placebo effect of unconventional medicine is disregarded except for polemics. This essay looks at the placebo effect of alternative medicine as a distinct entity. This is done by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. The term placebo effect is taken to mean not only the narrow effect of a dummy intervention but also the broad array of nonspecific effects in the patient-physician relationship, including attention; compassionate care; and the modulation of expectations, anxiety, and self-awareness. Five components of the placebo effect-patient, practitioner, patient-practitioner interaction, nature of the illness, and treatment and setting-are examined.  Therapeutic patterns that heighten placebo effects are especially prominent in unconventional healing, and it seems possible that the unique drama of this realm may have "enhanced" placebo effects in particular conditions. Ultimately, only prospective trials directly comparing the placebo effects of unconventional and mainstream medicine can provide reliable evidence to support such claims. Nonetheless, the possibility of enhanced placebo effects raises complex conundrums. Can an alternative ritual with only nonspecific psychosocial effects have more positive health outcomes than a proven, specific conventional treatment? What makes therapy legitimate, positive clinical outcomes or culturally acceptable methods of attainment? Who decides?

Grandjean P.  Guldager B.  Larsen IB.  Jorgensen PJ.  Holmstrup P.PLACEBO RESPONSE IN ENVIRONMENTAL DISEASE - CHELATION THERAPY OF PATIENTS WITH SYMPTOMS ATTRIBUTED TO AMALGAM FILLINGS. Journal of Occupational & Environmental Medicine.  39(8):707-714, 1997 Treatment of patients who attribute their environmental illness to mercury from amalgam fillings is largely experimental. On the Symptom Check List, overall distress, and somatization, obsessive-compulsive, depression, and anxiety symptom dimensions, were increased in 50 consecutive patients examined and Eysenck  Personality Questionnaire scores suggested less extroversion and increased degree of emotional lability. Succimer (meso-2, 3-dimercaptosuccinic acid) was given at a daily dose of 30 mg/kg for five days in a double-blind, randomized placebo-controlled trial, Urinary excretion of mercury and lead was considerably increased in the patients who received the chelator: Immediately after the treatment and 5 to 6 weeks later, most distress dimensions had improved considerably, but there was no difference  between the succimer and placebo groups. These findings suggest that some patients with environmental illness may substantially benefit from placebo.

 Weihrauch TR.  Gauler TC.Placebo - Efficacy and adverse effects in controlled clinical trials [Review] Arzneimittel-Forschung. 49(5):385-393, 1999 May.
The therapeutic efficacy of placebo in a series of diseases has long been known. It is less well known, however, that treatment with placebo can also produce significant adverse drug reactions. Therefore, the placebo drug reactions from controlled trials were studied for the first time systematically   Method: The efficacy and the safety of placebos were investigated using patient and drug data pooled from randomized, placebo-controlled, multicentre studies in five different groups of indications covering the therapeutic areas of cardiology (nisoldipine), neurology/psychiatry (nimodipine/ ipsapirone), metabolism (acarbose) and gastroenterology (hydrotalcite).   Results: The efficacy of placebo was clear, and varied not only between the five indication groups but also within them. Whereas placebo, unlike active treatment, produced hardly any improvement in symptoms in patients with severe stroke, it was as effective as active treatment in patients with mild neurological deficits, producing an improvement of about 50 %. In patients with angina pectoris, placebo produced an increase in exercise tolerance (treadmill walking time to onset of ST-segment depression and angina attacks) of about 10 % on average, compared with about 22 % under active treatment (nisoldipine). In diabetes therapy, placebo produced no improvement in fasting and postprandial blood glucose levels compared with active treatment (acarbose), and also had no effect on HbA(1C) values.   Adverse effects of placebo: Adverse drug reactions were observed under treatment with placebo. The frequency and type of placebo-induced adverse reactions also varied between indication groups. For example, typical cardiovascular effects such as tachycardia were observed in the control group. The placebo side effect profile was largely similar to the side effect profile of the active treatment. Some adverse  drug reactions (such as "dry mouth" in patients with generalized anxiety syndromes) were observed more frequently under placebo than under active treatment.   Conclusions:   Treatment with placebo is frequently effective and cannot therefore be considered as "non-treatment".   Placebo effects can only be quantified by direct comparison with "non-treatment".   Like active treatment, treatment with placebo is frequently accompanied by adverse drug reactions.   Placebo adverse effects are often disease- and active treatment-specific.   The effects and adverse effects of a placebo need to be known before the effects of active treatment in controlled clinical trials can be assessed.   The mechanisms of placebo effects are many and varied (e.g. endorphin release, conditioning).   Since the use of drugs without regard to evidence-based medicine (prescription of drugs without proven efficacy = pseudoplacebos) may clearly also result in serious adverse effects, such practice may not only be non-beneficial but may even be harmful.

 Hrobjartsson A.  Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing  placebo with no treatment. [Review] New England Journal of Medicine. 344(21):1594-1602, 2001 May 24.  
Background: Placebo treatments have been reported to help patients  with many diseases, but the quality of the evidence supporting  this finding has not been rigorously evaluated. Methods: We conducted a systematic review of clinical trials in which patients were randomly assigned to either placebo or no treatment. A placebo could be  pharmacologic (e.g., a tablet), physical (e.g., a manipulation), or psychological (e.g., a conversation). Results: We identified 130 trials that met our inclusion criteria. After the exclusion of 16 trials without relevant data on outcomes, there were 32 with binary outcomes (involving 3795 patients, with a median of 51 patients per trial) and 82 with continuous outcomes (involving 4730 patients, with a median of 27 patients per trial). As compared with no treatment, placebo had no significant effect on binary outcomes, regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect, but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials. The pooled standardized mean difference was significant for the trials with subjective outcomes but not for those with objective outcomes. In 27 trials involving the treatment of pain, placebo had a beneficial effect, as indicated by a reduction in the intensity of pain of 6.5 mm on a 100-mm visual-analogue scale. Conclusions: We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos 


Malcolm Kendrick
Thanks for that. As usual, someone on this group has information. It appears from the abstracts that my natural prejudices in this area are re-inforced. Placebos have no effect on non-subjective outcomes e.g. patients with severe stroke. With significant impact on subjective outcomes - primarily pain. 

You say that placebos can only be ignored under certain circumstances and after due deliberation. My problem with this statement is that one can only deliberate when you have data upon which to deliberate. If I said that there was no need to have a placebo arm in a hypertension trial, then how could this point be discussed. There is no data on the effect of a placebo on blood pressure reduction. 

The current 'answer' to the lack of data is always to have a placebo arm - just to be safe? But in real clinical practice you do not treat some patients with an active compound and others with a placebo. You either treat or you do not. So a trial with no placebo arm would give you a more accurate representation of what would happen to outcomes in real clinical practice - would it not? 

Frankly, I think the whole idea that trials should be done (wherever possible) with a placebo arm is completely non-scientific, as there is little or no evidence to support the hypothesis. Just because a few people report reduced pain, or increased endurance on a tread-mill test when given placebo, does not mean that all, or any, clinical outcomes are affected by placebo (other than subjective reporting). Nor does it mean that this effect translates in any way into clinical trial results. 

Currently, the need for a placebo control arm in a clinical trial is an unsupported hypothesis. Or to use Uffe's term - a myth.


Dag Viljen Poleszynski
Malcolm hit the nail on it's head! If we are looking for real cures, there is no need for placebo-controls. I just had phone call from a lady who reduced her weight from 161 kg til 51 kg on a low-carb diet (98 kg down in 8 months). Was it a "placebo effect", and should there have been a control person??? Placebo-controlled studies were made for drug trials with small effects. Let them continue using this method for things that hardly work, as shown by Uffe... 
Again: read the German studies previously referred to and be convinced.


Uffe Ravnskov
…but don´t forget to read Follies and Fallacies as well.

Finally, a humorous look at the matter, sent by Herbert

FDA Approves Sale of Prescription Placebo
  WASHINGTON, DC- 9/17/03 - After more than four decades of
  testing in tandem with other drugs, placebo gained approval
  for prescription use from the Food and Drug Administration
  "For years, scientists have been aware of the effectiveness
  of placebo in treating a surprisingly wide range of
  conditions," said Dr. Jonathan Bergen of the FDA's Center for
  Drug Evaluation and Research. "It was time to provide doctors
  with this often highly effective option."
  In its most common form, placebo is a white, crystalline
  substance of a sandy consistency, obtained from the
  evaporated juice of the Saccharum officinarum plant. The FDA
  has approved placebo in doses ranging from 1 to 40,000
  The long-awaited approval will allow pharmaceutical companies
  to market placebo in pill and liquid form. Eleven major drug
  companies have developed placebo tablets, the first of which,
  AstraZeneca's Sucrosa, hits shelves Sept. 24.
  "We couldn't be more thrilled to finally get this wonder drug
  out of the labs and into consumers' medicine cabinets," said
  Tami Erickson, a spokeswoman for AstraZeneca. "Studies show
  placebo to be effective in the treatment of many ailments and
  disorders, ranging from lower-back pain to erectile
  dysfunction to nausea."
  Pain-sufferers like Margerite Kohler, who participated in a
  Sucrosa study in March, welcomed the FDA's approval.
  "For years, I battled with strange headaches that surfaced
  during times of stress," Kohler said. "Doctors repeatedly
  turned me away empty-handed, or suggested that I try an over-
  the-counter pain reliever-as if that would be strong enough.
  Finally, I heard about Sucrosa. They said, 'This will work,'
  and it worked. The headaches are gone." Researchers diagnosed
  Kohler with Random Occasional Nonspecific Pain and Discomfort
  Disorder (RONPDD), a minor but surprisingly pervasive medical
  condition that strikes otherwise healthy adults.
  RONPDD is only one of many disorders for which placebo has
  proven effective, Bergen said.
  "Placebo has been successful in the treatment of everything
  from lower-back pain to erectile dysfunction to nausea,"
  Bergen said. "That's the beauty, and the mystery, of placebo.
  It's all-purpose. Think of it like aspirin, but without any
  of the analgesic properties."
  The FDA is expected to approve the drug for a wide range of
  mood disorders later this year. According to Bergen, initial
  research has shown placebo to be effective in the treatment
  of bipolar disorder, depression, dysthymia, panic disorder,
  post traumatic stress disorder, seasonal affective disorder,
  and stress.
  As industry analysts predict the drug's sales will top $25
  billion in the first year, the approval of placebo is
  expected to unleash one of the pharmaceutical industry's
  biggest marketing battles to date.
  GlaxoSmithKline expects to have two versions of placebo on
  the shelves in late December. One, a 40-milligram pill called
  Appeasor, will be marketed to patients 55 and over, while the
  other, Inertra, designed for middle-aged women, is a liquid
  that comes in a 355-milliliter can, and is cola-flavored. Eli
  Lilly plans a $3 million marketing campaign for its 400-
  milligram tablet, Pacifex.
  "All placebos are not the same," Eli Lilly spokesman Giles
  French said. "Pacifex is the only placebo that's green and
  shaped like a triangle. Pacifex: A doctor gave it to you."
  Despite such ringing endorsements, some members of the
  medical community have spoken out against placebo's approval,
  saying that the drug's wide range of side effects is a cause
  for concern.
  "Yes, placebo has benefits, but studies link it to a hundred
  different side effects, from lower-back pain to erectile
  dysfunction to nausea," drug researcher Patrick Wheeler
  said. "Placebo wreaked havoc all over the body, with no rhyme
  or reason. Basically, whichever side effects were included on
  the questionnaire, we found in research subjects."
  Added Wheeler: "We must not introduce placebo to the public
  until we pinpoint exactly how and why it works. The drug
  never should have advanced beyond the stage of animal
  testing, which, for some reason, was totally ineffective in
  determining its effectiveness." In spite of the confusing
  data, drug makers say placebo is safe.
  "The only side effect consistent in all test subjects was a
  negligible one-an almost imperceptible elevation in blood-
  glucose levels," French said. "It's unfair to the American
  people to withhold a drug so many of them desperately think
  they need."