A Placebo Straw Man

I acknowledge this setup is a bit of a straw man, but it’s still a justification I hear from time to time so it’s worth examining.

The argument goes that we should be performing certain interventions, such as providing oxygen for pain control, despite them having no evidence basis or even a plausible mechanism because they harness the placebo effect.

“Here’s some oxygen; it will make you feel better.”
Click image for source.

The placebo effect is a real phenomenon and it can (and, some argue, sometimes should) be harnessed to improve a patient’s perception of their outcome. In select cases it can even affect objective physiological measurements. The merits of if and when we should be providing placebos have been debated for years.

There is one common circumstance when we certainly should NOT be administering placebos, however, and that is when there is an intervention or treatment available that has been proven superior. That is the case in my “oxygen for pain control” straw man.

Sure, it would be nice if prehospital care could be simplified by managing the patient with an isolated humerus fracture at the BLS level—especially on days when the paramedic is seeing three ALS calls for every BLS the Basic takes—but this is not the time to try and even the case load.

There are plenty of pharmacological agents available that have been proven superior to placebo for pain control, so when the former options are available, it is decidedly wrong to try and scrape by on latter. Maybe one could make a case for giving oxygen as a stop-gap in a truly rural setting where BLS is the only level of transport available, but the point of this discussion isn’t to delve into these specifics and what-ifs.

It is to drive home the point that administering oxygen for pain control is not just ridiculous, it is unethical when alternatives that have been proven superior to placebo are available.

Can you think of any other interventions we provide in prehospital and emergency medicine that also fit this bill?