Placebo (a term used here for the sake of clarity): “An inert substance usually prepared to look as similar [as possible] to the active product investigated in a study.”
A number of directly-involved parties have defended their care of Elvis over the years, as have many, many disinterested parties, by citing the efforts of Elvis’s medical support personnel (Dr. Nichopoulos, unlicensed nurse Tish Henley, plus the handful of aides) to use placebos when giving Elvis medications. That is, they would have 3 pills to give him, for example, but instead of giving him the 3 pills they’d give him only 2, and replace the contents (in this case capsuled medications) with sugar or water/saline. So, they claim, they were helping Elvis, by giving him 2 pills and 1 placebo, instead of the 3 prescribed pills, thus reducing his intake of the drug.
There are two huge problems with this.
First, there is the confusion that is caused in the brain when a dose of 3 pills given over time creates a certain effect, and then the same 3 pills taken again creates a different effect. Simply, if the “placebo” is given as part of one dose, and then not included in the next dose, the brain can process the effects differently, and in some situations this leads the patient to compensate for the altered (reduced) effect, by taking more of the drug the next time. For example, if Elvis were given 3 pills of the same medication every day for 30 days, his brain would create a “memory” of that effect, and that effect would be associated with 3 pills. But if someone then replaces one of these pills in an inconsistent way, by replacing the 3rd pills randomly, then the brain does not process the effect the same way. This can lead to over-medicating, in this case Elvis theorizing that if 3 pills is no longer giving him the effect he has associated with the 3-pill dosage, then he should try 4 pills. In his mind, this 4th pill would be compensating for the reduced effect of the 3 pills. But what happens if the 3rd pill is reintroduced, without his knowledge, and Elvis is standing there about to take the 3 pills, but he says, “Hey, 3 pills isn’t helping, I think I’ll take 4 instead”? He would then be taking 4 full-strength/active pills, no placebos, instead of the prescribed 3 pills. Over time, the dosages he would be taking would increase and decrease based on who was giving him the medications and whether that person (randomly) decided to use the “placebo.” Who was in charge of making this decision? David Stanley? Rick Stanley? Al Strada? Joe Esposito? Tish Henley? Dr. Nichopoulos? Were records kept documenting the use of these so-called placebos? (Hint: No.)
Elvis was also at risk of withdrawal in this situation, and his tolerance would have shifted based on these increases and decreases of medication.
Second, and most important, is the word “placebo.” When these family members and friends and medical folks tell us that placebos were used for Elvis, what they are trying to do is convince us that efforts were made to curtail Elvis’s intake, and on the surface, sure, this does appear to be what they were trying to do, and this appears to be a noble attempt to help (this effort will ultimately fail, though, if Elvis himself did not have the desire to decrease his intake; that’s how addiction works). But, while the inert pills or solutions they gave Elvis were technically considered placebos, the fact remains that these people were simply replacing medications without Elvis’s knowledge in an effort to reduce the amount of medication, and thus not providing the placebos in a responsible, safe, and ethical way. As outlined above, randomly replacing a medication is dangerous and can lead to over-medication, which can lead to overdose, and can also result in withdrawal. So technically, yes, these were placebos, but they were not provided to the patient in the proper manner. The word “placebo,” then, can be misleading.
Quick question: If the prescriptions were legitimate and the doses appropriate, as Dr. Nichopoulos and others have said they were, then why were any efforts to reduce the drug intake even necessary? Think about this: the Nichopoulos apologists have told us how great Elvis was cared for and treated, and they say all the medications and dosage levels were appropriate and necessary. But wait: how can anyone say that 3 pills, for example, is appropriate and necessary while using “placebo theory” to reduce the patient’s intake of that medication? Either 3 pills is appropriate and necessary, or it’s not. If a doctor has to use a placebo to reduce a dose from 3 pills to 2 pills, then the fact is that TWO pills is the appropriate and necessary dosage, not three. So, we must conclude that the very use of a placebo, in any form, was a clear indication that the patient (Elvis) should have been taking a lower dose. Looking at it another way, if Elvis actually needed 3 pain pills but was given only 2 pain pills, then he was not being treated with the proper dose. If, on the other hand, Elvis was given 2 pain pills instead of 3 pain pills because the person dispensing the pills knew the pain pills were not being used for their intended effect, then that person should have taken steps to correct the situation. Either Elvis was being short-changed his medications, or he was given medications he didn’t need. Which was it?
A placebo, in its proper use, is a pill that does not have any therapeutic effect on the patient, and is given to the patient with or without his knowledge as part of a clinical trial. A placebo, then, is used for testing in a controlled environment. What these people were doing, though, as stated above, was manipulating the medication protocol without the patient’s knowledge. When a pill is given this way, the person replacing the medication is really just screwing around with the dosage and trying to fool the patient. There is nothing ethical or honest or helpful about it at all, and as stated above, it was actually very dangerous.
Could this effort have been successful if they had approached it a different way? The key here is that Elvis had access to other medications, and he could take whatever he wanted, whenever he wanted. So unless Elvis had absolutely no access to other medication, this type of intervention could not have worked.
As an example of how amateurish this effort really was, consider the following: Dr. Nichopoulos would provide prepared syringes to various people on Elvis’s staff (primarily Henley and Strada). This meant that the medications were already in the barrel sections of the syringes, and no further preparation was required. At random times, these people would quickly (and furtively) squirt some of the medication on the floor so that Elvis wouldn’t notice, and thus would not realize that he was not getting the full dosage. But here’s the twist: Nichopoulos would sometimes prepare these syringes with saline solution already in the barrel, but then fail to tell anyone, so what Strada or Henley were actually doing was squirting out water, thinking it was a liquid narcotic. No planning, no advance knowledge, no preparation; just hand over some syringes with some sort of liquid in them…drugs or water…whatever…fail to mention what’s in them…and then hope for the best.
And here’s another example: Al Strada testified in 1981 that he would intercept medications from Henley, not knowing that the medications were already placebos, meaning he’d replace the placebos…with placebos.