Power of the placebo

New studies are showing that placebos are often prescribed to unknowing patients—and that they work

by Anne Kingston

Power of the placebo

Stephan Elleringmann/laif/Redux

In Western medicine, placebos have long been the bridesmaids, never the bride. That’s not surprising: they’re sham pills or simulated medical interventions, seen as handmaidens for use in clinical trials rather than the real thing. Their influence, known as the “placebo effect,” is understood to be a perceived (and not necessarily real or measurable) improvement in a medical condition. Now a spate of new studies trumpeting placebos’ efficacy and their prevalence in mainstream medical treatment is dramatically shifting that perception.

In March, a study by the German Medical Association, or BÄK, revealed half of German doctors prescribe placebos—including vitamin pills and homeopathic remedies—and that they were effective treating minor maladies such as an upset stomach. (A study from Erasmus University in the Netherlands in May found placebos effectively treated migraines in 36 per cent of participants.)

“Placebos have a stronger impact and are more complex than we realized,” said Christopher Fuchs, the managing director of the BÄK, when the study was released. “They are hugely important in medicine today.” The following month, a McGill University survey triggered shock ripples with its revelation that 20 per cent of Canadian medical school doctors prescribed placebos to unknowing patients and that more than 35 per cent of psychiatrists prescribed medications in “subtherapeutic” doses, or below the minimal recommended therapeutic level. A glimpse into why that is the case can be found in The Emperor’s New Drugs: Exploding the Antidepressant Myth, a new book by British psychologist Irving Kirsch, who embarked on a 15-year scientific quest that examined all 42 FDA reviews of the six most widely used antidepressant drugs; he discovered placebos to be 82 per cent as effective.

Doctors working in pain and general primary care, as well as psychiatrists, are starting to pay close attention to the placebo effect, says Ted Kaptchuk, an associate professor at Harvard Medical School who has studied placebos for 15 years. “For a lot of common complaints that doctors see on a regular basis—the bread and butter of health care—there aren’t a lot of drugs to help. And those that are available are only marginally better than placebos and come with side effects.”

Placebos have limits, Kaptchuk says. “They don’t shrink tumours or help you with memory.” But they can help in areas he defines as “subjective complaints of self-appraisal” such as nausea and pain. That doctors are prescribing placebos doesn’t surprise him: “Physicians are trained to give drugs—they’re a conveyor belt to the pharmaceutical industry. That may sound facetious, but there’s truth to it. So they give sub-optimal doses to please patients, to make people feel they are being taken care of.” This in itself can be therapeutic, says Kaptchuk. He speaks of healing as an art, as well as a science: “A lot of what we’re doing is the context of healing, the ritual of healing, not the drug itself. And sometimes the context is much more powerful than the drug.”

The German study recommended that placebos be used in minor illness where they seem likely to be successful. BÄK is now calling for internationally recognized guidelines. The topic is a thorny one, raising the ethical dilemma of doctors deceiving their patient. The challenge, says Kaptchuk, is to harness placebos’ power without deception. His research suggests it’s possible: one study found 59 per cent of patients with irritable bowel syndrome given placebos described as “sugar pills” reported symptom relief compared to 38 per cent who received no treatment at all.

“Obviously there is a way of being a compassionate, empathetic physician,” Kaptchuk says. “Sometimes that’s enough—our studies show that.” He recently sat in on a clinic with advanced Parkinson’s patients. The doctor was wonderful, he says, “And when patients left, people who could barely walk were walking differently. They were so happy to have her for just half an hour.” Kaptchuk’s newest research looking at placebos and asthma will be published in the July New England Journal of Medicine. It’s embargoed, so he can’t talk about results. But expect them to shed even more needed insight into the science—and art—of healing.




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Power of the placebo

  1. viagra cialis and other such drugs is an expensive placebo but they work…wonder how?  oh the power of suggestion!

  2. Anthropologists have known this for years. It’s kind of a half-kept secret that Western Science, and especially Western Medical Science doesn’t like to admit — magic works.  At least, magic where the subject really believes in it.  This has been shown over and over again in tribal societies.

    Yeah, there are limits, and that’s where the western scientific method comes in, but too often we discard the original idea and end up wasting a lot of resources where they aren’t needed.

    • I think you’re being a bit unfair to “Western Science”, that mighty monolith.

      It’s through science that we know how well placebos work – and have known for a long time.  I don’t see that this has ever been a secret, although certainly some drug shills are happy to obfuscate it, of course.  They’re few in number, but they’re the ones talking directly to consumers.  Well, I take it back – perhaps a century ago, some physicians wouldn’t have wanted to publicly admit to the existence of sham treatments at all, as the spread of knowledge of sham treatments would reduce their effectiveness notwithstanding the one study mentioned in the article.  So it was a “secret” of physicians in the age of paternal medicine, though any scientist would likely have happily confirmed that placebos work even then.  That said, it’s been entirely open for decades now.

      I do think the rush to informed consent, necessary though it certainly has been, has proceeded too far and is actually interfering with medical care.  It’s this, not any reluctance to recognize a placebo effect, that prevents sugar pills and the like from being far more commonly prescribed.  Another stumbling block that has reduced the ability of practitioners to exploit the placebo effect and the “art” of medicine is the modern, worsening standard in terms of doctor-to-patient contact time.  No pill is needed, closer attention, unhurried discussion and reassurance have been well-documented to lead to improvement.

      These two factors have opened the door for alternative practitioners to scoop up the easy victories in health care, bringing unnecessary heaps of woo and nonsense with them.

      Now, if you can find an acupuncturist who’ll admit that sham acupuncture works just as well, that would be news indeed.  Fortunately Almighty Science holds itself to a higher standard.

  3. A good example of high-tech placebo or faith-healing is the effect of Paolo Zamboni’s “liberation” treatment for multiple sclerosis. This treatment is based on the scientifically absurd idea that MS is caused by blocked neck veins and that opening the obstructions will instantly improve blood flow the brain and relieve subjective symptoms associated with MS. Dozens of YouTube anecdotes show instantaneous improvement in MS symptoms with no objective evidence of any real effect on brain pathology. Of course, there a just as many YouTube videos showing instantaneous improvement in MS symptoms with renewed faith in God or Jesus. 

    What is special about “liberation” is that thousands of MS patients have each spent tens of thousands of dollars to avail themselves of this placebo and many firmly believe they have been at least partially cured. And when their symptoms worsen they ascribe the deterioration to “restenosis” of the veins requiring more “liberation”, not to commonly observed progression of the disease itself. 

    See blog for details of the junk science behind Zamboni’s faith healing.

    http://medicalmyths.wordpress.com/2011/02/04/the-perfect-crime-ccsvi-not-leaving-a-trace-in-ms-liberation-is-a-hoax/

  4. Placebos do not work. They cause an effect known as the placebo effect, which is really the body working to control the condition. And they do it by deceiving the person into thinking they are getting the real deal when they are in fact not.
    One of the reasons a placebo effect inducing medicine can be effective is that he patient trusts that their doctor is giving them the real medication. Once that trust is lost, boom no more placebo effect. If the patient knows that they are not receiving the real drug, then they will not expect any improvement. The mind is a wonderful thing and can be fooled into doing things, but not if it knows from the get go that you are fooling it.
    All those physicians who publicly advocate the use of more placebo inducing substances, lieing in effect, are in reality undermining their own remedy. And physicians who say they are prescribing a drug and do not are guilty of fraud and possibly worse if the drug is paid for via insurance.
    Ethically and legally speaking the whole area of placebo prescription is riven with difficulties.

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