Will a placebo work only if the patient believes it's real? Does a placebo have to be innocuous, like a sugar pill? Do placebos have a place not just in research but in modern medical treatment? For some answers, we turn to a provocative new study by Harvard researchers, and to psychologist James D. Herbert, director of Drexel University's anxiety treatment and research program.
The Harvard study, published last month in PLOS One, a journal of the Public Library of Science, found that 37 patients with irritable bowel syndrome who were given pills described as "placebo pills, like sugar pills" reported more symptom relief than 43 patients who simply met with doctors.
The results defy the conventional wisdom that harnessing the "placebo effect" for treatment requires the doctor to do something unethical: Deceive the patient.
"Placebo research has really been stuck because of ethical concerns," Herbert said.
The ethics and effects of placebos are complex. For example, study after study has shown that placebos work almost as well as anti-
depressants known as SSRIs.
And Herbert suspects the fakes would be every bit as effective if pharmaceutical companies used "active" placebos - pills with the same side effects as SSRIs, including nausea and low libido.
In the 1960s, when active placebos were permitted in studies, they lifted mood just as well as most older antidepressants. But today, a placebo that makes patients "feel crappy" is considered unethical, Herbert said.
As for the Harvard study, that placebo was not truly inactive, as patients were told "placebo pills . . . have been shown in clinical studies to produce significant improve-
ment in IBS symptoms through mind-body self-healing. . . ."
"I doubt that if they said, 'Here's a sugar pill, just take it,' that you'd see the same results," Herbert said. "Placebo effect is all about expectations."
That's why he believes prescribing placebos would be appropriate for certain patients with conditions shown to benefit from psychological as well as medical therapy - illnesses such as depression and fibromyalgia. Cancer would be a different story.
"You have to be careful not to overgeneralize," he said.
http://www.philly.com/inquirer/health_science/weekly/20110103_Study_suggests_placebos_may_have_place_in_treatment.html#ixzz1AYH6qgQt
The Harvard study, published last month in PLOS One, a journal of the Public Library of Science, found that 37 patients with irritable bowel syndrome who were given pills described as "placebo pills, like sugar pills" reported more symptom relief than 43 patients who simply met with doctors.
The results defy the conventional wisdom that harnessing the "placebo effect" for treatment requires the doctor to do something unethical: Deceive the patient.
"Placebo research has really been stuck because of ethical concerns," Herbert said.
The ethics and effects of placebos are complex. For example, study after study has shown that placebos work almost as well as anti-
depressants known as SSRIs.
And Herbert suspects the fakes would be every bit as effective if pharmaceutical companies used "active" placebos - pills with the same side effects as SSRIs, including nausea and low libido.
In the 1960s, when active placebos were permitted in studies, they lifted mood just as well as most older antidepressants. But today, a placebo that makes patients "feel crappy" is considered unethical, Herbert said.
As for the Harvard study, that placebo was not truly inactive, as patients were told "placebo pills . . . have been shown in clinical studies to produce significant improve-
ment in IBS symptoms through mind-body self-healing. . . ."
"I doubt that if they said, 'Here's a sugar pill, just take it,' that you'd see the same results," Herbert said. "Placebo effect is all about expectations."
That's why he believes prescribing placebos would be appropriate for certain patients with conditions shown to benefit from psychological as well as medical therapy - illnesses such as depression and fibromyalgia. Cancer would be a different story.
"You have to be careful not to overgeneralize," he said.
http://www.philly.com/inquirer/health_science/weekly/20110103_Study_suggests_placebos_may_have_place_in_treatment.html#ixzz1AYH6qgQt
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