A great new drug called “placebo”

A great new drug called “placebo” December 27, 2010

This reminds me of an old Steve Martin routine, when he played a “wild and crazy guy” in a white suit with a fake arrow through his head.  He was going on about how he found this new drug that gave a mind-blowing high.  It’s called “placebo.”

Imagine your doctor gives you fake medication and tells you it’s nothing more than a sugar pill. Would it still work?

Incredibly, according to a new study of patients with irritable bowel syndrome, the placebo effect, even when patients were in on the secret, worked almost as well as the leading medication on the market.

It’s also a lot cheaper. And the best part about placebo – no side effects.

“I didn’t think it would work,” said senior author and Harvard Medical School associate professor of medicine at Anthony Lembo in a statement. “I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them.”

Researchers at the Harvard Medical School’s Osher Research Center and Beth Israel Deaconess Medical Center split 80 patients into two groups. One group was given placebos and informed of it. The other group was given nothing.

“Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had ‘placebo’ printed on the bottle,” said Harvard Medical School associate professor of medicine Ted Kaptchuk. “We told the patients that they didn’t have to even believe in the placebo effect. Just take the pills.”

After three weeks. the placebo group reported adequate symptom relief at double the rate of the group told to do nothing (59 percent vs. 35 percent). And those results are about as good as the leading irritable bowel syndrome drugs on the market.

Researchers sounded the usual cautionary notes. The study was small. It’s not clear what it would mean for other conditions and more research is needed.

via Irritable Bowel Syndrome: Placebo Works Even if Patients Know – Health Blog – CBS News.

Somebody should–quick–manufacture sugar pills under the brand name “Placebo” and market them as treatments for all diseases.

Anybody have any theories that would explain these results?  I’d be curious about a theory that explains the placebo effect in any event–how is it that a mental belief can affect a physical ailment?  Second, how can a mental belief affect a physical ailment when it isn’t a mental belief?

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  • Matthew Surburg

    How does the placebo effect work? No idea, aside from vague generalizations and hand-waving. However, this does remind me of another article I saw a few years back:

    http://www.theonion.com/articles/fda-approves-sale-of-prescription-placebo,1606/

    (Warning: the article text is clean, but the side links on the page may be a bit, ahem, “salty.”)

  • Matthew Surburg

    How does the placebo effect work? No idea, aside from vague generalizations and hand-waving. However, this does remind me of another article I saw a few years back:

    http://www.theonion.com/articles/fda-approves-sale-of-prescription-placebo,1606/

    (Warning: the article text is clean, but the side links on the page may be a bit, ahem, “salty.”)

  • Tom Hering

    The Tetzel effect.

  • Tom Hering

    The Tetzel effect.

  • Booklover

    Sugar moves the bowels. It would be helped along if the pills were also gel-coated. :-/ Also, taking these pills on a regular basis would help the patient to be more mindful of what he is putting into his gut regularly, which would make him more, er, regular. There is also the beneficial effect to the bowels of water, taken with the pill. (Believe it or not, some people do not think of drinking water regularly.)

    I doubt there would be the same outcome with, say, asthma or cancer. But who knows. We are strange creatures.

  • Booklover

    Sugar moves the bowels. It would be helped along if the pills were also gel-coated. :-/ Also, taking these pills on a regular basis would help the patient to be more mindful of what he is putting into his gut regularly, which would make him more, er, regular. There is also the beneficial effect to the bowels of water, taken with the pill. (Believe it or not, some people do not think of drinking water regularly.)

    I doubt there would be the same outcome with, say, asthma or cancer. But who knows. We are strange creatures.

  • Did you hear about the man who overdosed on Placebos?

    He thought he was dead.

  • Did you hear about the man who overdosed on Placebos?

    He thought he was dead.

  • Pete

    With regard to a mental belief affecting a physical ailment, this has to do with the complex ways in which pain or symptom perception is managed within the central nervous system.
    In my younger days I ran the high hurdles. I was slightly less than the ideal height for this and would routinely hit 4 to 7 of the ten hurdles with my trail ankle. This is not terribly painful, but would sometimes be enough to cause minor soreness and bleeding. But, at the finish of a race you’re focused on a number of things: what was my time, where did I place, and simply recovering your breath. I typically wouldn’t notice that my ankle was painful or even bleeding until I’d walked back to the starting line to put my sweat pants back on. Once I saw the bruised or bleeding ankle, it gained more prominence in the “perception hierarchy” of my central nervous system and it began to hurt. The sensation of pain being sent to my CNS from my ankle had been the same quantitatively since the end of the race, but what had changed was the way the CNS processed or prioritized this sensory data.
    That’s but one example of how sensations such as the pain from irritable bowel can be modified by the central nervous system.
    One element of the placebo effect is believed to be the “investment” if you will, of the recipient: I have a symptom. I go to my doctor. He gives me a pill that he says will help. I am “invested” in him – he’s got he right diplomas on his wall. I’m trusting that he knows a good bit about my particular problem, knows what will help and that he wants to help. And I’m also invested in the treatment – I’ve probably paid some money for it. I want it to work. On some level, it is my expectation that it will work.
    That’s what makes the study cited here so interesting – the understanding (by the placebo recipients) that they were being given a sugar pill that wouldn’t ordinarily be expected to impart any specific therapeutic benefit.

  • Pete

    With regard to a mental belief affecting a physical ailment, this has to do with the complex ways in which pain or symptom perception is managed within the central nervous system.
    In my younger days I ran the high hurdles. I was slightly less than the ideal height for this and would routinely hit 4 to 7 of the ten hurdles with my trail ankle. This is not terribly painful, but would sometimes be enough to cause minor soreness and bleeding. But, at the finish of a race you’re focused on a number of things: what was my time, where did I place, and simply recovering your breath. I typically wouldn’t notice that my ankle was painful or even bleeding until I’d walked back to the starting line to put my sweat pants back on. Once I saw the bruised or bleeding ankle, it gained more prominence in the “perception hierarchy” of my central nervous system and it began to hurt. The sensation of pain being sent to my CNS from my ankle had been the same quantitatively since the end of the race, but what had changed was the way the CNS processed or prioritized this sensory data.
    That’s but one example of how sensations such as the pain from irritable bowel can be modified by the central nervous system.
    One element of the placebo effect is believed to be the “investment” if you will, of the recipient: I have a symptom. I go to my doctor. He gives me a pill that he says will help. I am “invested” in him – he’s got he right diplomas on his wall. I’m trusting that he knows a good bit about my particular problem, knows what will help and that he wants to help. And I’m also invested in the treatment – I’ve probably paid some money for it. I want it to work. On some level, it is my expectation that it will work.
    That’s what makes the study cited here so interesting – the understanding (by the placebo recipients) that they were being given a sugar pill that wouldn’t ordinarily be expected to impart any specific therapeutic benefit.

  • I smell a large government grant to study this in the making, and I wouldn’t be surprised if it turns out the data were fudged to that end.

  • I smell a large government grant to study this in the making, and I wouldn’t be surprised if it turns out the data were fudged to that end.

  • Placebo effects have been well documented in several studies, both in the cause of symptoms and the alleviation of symptoms. I am mindful of a study done to see if aspartame actually caused allergic reactions. They had four groups two where told if they were getting sugar or Equal and two who were not told. The people who were told they had Equal did have a higher report rate while those told they were given sugar had the lowest report rate. The other control groups (not told)had fairly even low report rates. Now the part I love, they all were given Equal.

    I have heard more and more doctors talking about using placebos for the patients who absolutely insist on taking a pill (usually antibiotic) when a pill won’t actually help. Generally, the reason they don’t is they don’t like lying to their patients.

    In regards to Irritable Bowel Syndrome, frequently is stress related (caused by unusually high fight or flight hormones, which naturally cause the bowel to shut down and evacuate if reasonable full so as too lighten the load) so the very act of taking a pill for it could be relaxing to the patient and alleviate major symptoms.

  • Placebo effects have been well documented in several studies, both in the cause of symptoms and the alleviation of symptoms. I am mindful of a study done to see if aspartame actually caused allergic reactions. They had four groups two where told if they were getting sugar or Equal and two who were not told. The people who were told they had Equal did have a higher report rate while those told they were given sugar had the lowest report rate. The other control groups (not told)had fairly even low report rates. Now the part I love, they all were given Equal.

    I have heard more and more doctors talking about using placebos for the patients who absolutely insist on taking a pill (usually antibiotic) when a pill won’t actually help. Generally, the reason they don’t is they don’t like lying to their patients.

    In regards to Irritable Bowel Syndrome, frequently is stress related (caused by unusually high fight or flight hormones, which naturally cause the bowel to shut down and evacuate if reasonable full so as too lighten the load) so the very act of taking a pill for it could be relaxing to the patient and alleviate major symptoms.

  • Melissa

    It would appear that this just goes to show how, on a very basic level, suffering of the mind and body desires something “extra nos” to restore us, and at the very least, make us feel well. We can certainly take that and run with it on a theological scale.

    After working for 4 years in a psychiatric facility, psycho-somaticism was, and is, rampant. It’s amazing to watch a unit of patients digress when one person is having a bad day, making the psychological symptoms seemingly ‘contagious’. Even for the staff. Transference and countertransference are coined terms that refer to how staff respond to patients subconsciously based on their own feelings-which can impact professionalism. It would be fair to say, that “no one is left unaffected,” to one degree or another, in this particular community…and I would posit, is similar as we look at various communities or groupings on a sociological scale as well.

    But to revisit the “placebo effect,” it seems that the very essence of our human nature desires restoration, as I’d mentioned. So, to have something outside of ourselves that promises to help or soothe, has a tremendous (and at least temporal) impact.

  • Melissa

    It would appear that this just goes to show how, on a very basic level, suffering of the mind and body desires something “extra nos” to restore us, and at the very least, make us feel well. We can certainly take that and run with it on a theological scale.

    After working for 4 years in a psychiatric facility, psycho-somaticism was, and is, rampant. It’s amazing to watch a unit of patients digress when one person is having a bad day, making the psychological symptoms seemingly ‘contagious’. Even for the staff. Transference and countertransference are coined terms that refer to how staff respond to patients subconsciously based on their own feelings-which can impact professionalism. It would be fair to say, that “no one is left unaffected,” to one degree or another, in this particular community…and I would posit, is similar as we look at various communities or groupings on a sociological scale as well.

    But to revisit the “placebo effect,” it seems that the very essence of our human nature desires restoration, as I’d mentioned. So, to have something outside of ourselves that promises to help or soothe, has a tremendous (and at least temporal) impact.

  • WebMonk

    There are dozens of different ways in which the placebo effect could work even without vague statements about belief directly affecting physical substances. Like has been mentioned above – a heightened awareness of what is being done/eaten. Or, lowered stress for a variety of possible reasons.

    There are also a lot of very well documented ways in which a person can control physiological states through concentration and practice. Placebo effects could be a less dramatic effect of that. Lots of different possibilities, and they’re pretty much impossible to separate from each other to know which one is having the largest effect on a particular patient.

  • WebMonk

    There are dozens of different ways in which the placebo effect could work even without vague statements about belief directly affecting physical substances. Like has been mentioned above – a heightened awareness of what is being done/eaten. Or, lowered stress for a variety of possible reasons.

    There are also a lot of very well documented ways in which a person can control physiological states through concentration and practice. Placebo effects could be a less dramatic effect of that. Lots of different possibilities, and they’re pretty much impossible to separate from each other to know which one is having the largest effect on a particular patient.

  • Matthew Surburg

    What Pete @ 5 says about investment is quite apt, but it is worth remembering that the reverse also applies: while a person who is invested in finding relief is more likely to find relief, a person who is invested in his symptoms will find relief elusive. Being in the “sick role” can sometimes bring benefits (psychologists call them “secondary gain”). A person may receive extra attention which heightens his feelings of self-worth, or he may use his symptoms as leverage within his family or social circle. He may receive prescriptions for medications which are designed to alleviate his symptoms, but which also produce other pleasurable side effects. He may feel absolved of the necessity of working, and the Social Security Disability system may cause him to lose income if his symptoms become less, well, disabling. None of this happens at a conscious level (if it does it’s simple malingering), but the disincentive to get well can be strong.

  • Matthew Surburg

    What Pete @ 5 says about investment is quite apt, but it is worth remembering that the reverse also applies: while a person who is invested in finding relief is more likely to find relief, a person who is invested in his symptoms will find relief elusive. Being in the “sick role” can sometimes bring benefits (psychologists call them “secondary gain”). A person may receive extra attention which heightens his feelings of self-worth, or he may use his symptoms as leverage within his family or social circle. He may receive prescriptions for medications which are designed to alleviate his symptoms, but which also produce other pleasurable side effects. He may feel absolved of the necessity of working, and the Social Security Disability system may cause him to lose income if his symptoms become less, well, disabling. None of this happens at a conscious level (if it does it’s simple malingering), but the disincentive to get well can be strong.

  • Another placebo effect: A study published in JAMA reported that the commonly used SSRI antidepressants are no better than placebo for most cases of depression. The authors reviewed 30 years of data and concluded that “the benefit of antidepressant medication compared with placebo may be minimal or nonexistent in patients with mild or moderate symptoms”.

    ref JAMA 2010;303(1):47-53) for more:

    http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants-are-placebos-by-jeffrey-dach-md.aspx

    jeffrey dach md

  • Another placebo effect: A study published in JAMA reported that the commonly used SSRI antidepressants are no better than placebo for most cases of depression. The authors reviewed 30 years of data and concluded that “the benefit of antidepressant medication compared with placebo may be minimal or nonexistent in patients with mild or moderate symptoms”.

    ref JAMA 2010;303(1):47-53) for more:

    http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants-are-placebos-by-jeffrey-dach-md.aspx

    jeffrey dach md

  • I wonder what would happen if they did another study where one group was given pills marked “Effective Placebos” and the other given pills marked “Ineffective Placebos.” (And yes, a control group given nothing. Or should one group be told they were getting an “effective nothing” and the other an “ineffective nothing.”? I guess the control group would just be left alone and not told they were being given nothing.)

  • I wonder what would happen if they did another study where one group was given pills marked “Effective Placebos” and the other given pills marked “Ineffective Placebos.” (And yes, a control group given nothing. Or should one group be told they were getting an “effective nothing” and the other an “ineffective nothing.”? I guess the control group would just be left alone and not told they were being given nothing.)

  • And looking back at the text, it appears that what was measured was “reported relief,” which might be very different from objective relief. Maybe those who took the placebos suffered just as much but felt better about it.

  • And looking back at the text, it appears that what was measured was “reported relief,” which might be very different from objective relief. Maybe those who took the placebos suffered just as much but felt better about it.