When are placebos no longer placebos?

20161121080000, Rachel Seah
The act of taking a pill itself may have given rise to a placebo effect
The act of taking a pill itself may have given rise to a placebo effect
In the medical field, the placebo effect – a person’s response to a “dummy pill” – may either be positive, with the patient reporting improvement in symptoms, or result in the contrary, where a person may suffer from what appears to be side effects.

While placebos cannot cure diseases, studies on placebos focus on the relationship between mind and body, with one theory suggesting that a person's expectations drive the placebo effect, causing the body’s chemistry to mimic effects in accordance with one’s expectations of the medication.

This is illustrated by the results of one such study, where participants were given a placebo “stimulant”, resulting in an increase in their pulse rates and blood pressures. When given the same pill and were told that it would cause drowsiness, they experienced the opposite effects.

Placebos work – even when labelled as placebos

In an attempt to harness the placebo effect, Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Centre conducted a study to find out whether people might benefit from a placebo even if they knew it was a dud.

The study involved 83 people in Portugal, all of whom had chronic lower-back pain not caused by any serious conditions, and were informed that the placebo, to be taken twice a day for three weeks, was an inactive substance containing no pharmaceutical drug. All participants continued their usual regimens for pain relief, with half the group assigned to take the placebo in addition to their regular treatment.

In other words, the placebo in this study did not serve as a control, but as the experimental treatment – and the researchers were explicit about it.

Interestingly, the scores rated by participants for usual and maximum pain levels declined by 30% for those receiving the placebo by the end of the three-week study, compared to 9% and 16% for the control group.

According to Kaptchuk, the findings translate to a substantial reduction in pain – even with a placebo.

"Patients would feel the difference and physicians would notice it," he says.

“It's not (just) the pill, it’s what surrounds the pill.”

The researchers have surmised that the act of taking a pill itself — unscrewing the bottle top and swallowing something that looks like a medicine — may have given rise to a placebo effect, even when patients do not consciously expect the pill to have an effect.

This includes the interaction with and trusting relation between patients and their doctors.

“It’s absolutely not the pill,” says Kaptchuk.

“It’s what surrounds the pill.”

If patients trust that their doctors’ words are true – that the treatment might possibly work, even with the knowledge that a placebo was given, the brain can fill in the picture and improve symptoms.

“Unconscious placebo” versus being “gullible”

People say, "I'm not gullible, I don't fall for these things, but echinacea really works,” says Erik Vance, author of a recent book on placebos.

“The first thing is not true; we're all gullible. And the second thing is, that person probably experienced an unconscious placebo,” he said.

“They think they're way too smart to be fooled. We should just all accept that this is what we do and embrace it.”

"These kinds of studies show that a package of care that includes an ethical placebo can have a benefit," says Jeremy Howick, a senior researcher in the University of Oxford's Nuffield Department of Primary Health Care Sciences who was not involved in this the study.

"You might not need to deceive patients to get an effect."

According to Kaptchuk, the study is a proof of principle, and that it should be repeated in larger groups of people over longer periods of time. If proven true, he adds, open-label placebos may be a helpful “watch and wait” strategy for patients who are considering treatment with medication for common, but non-urgent conditions.

However, in order for placebos to come into widespread use in healthcare, “it will take patients demanding it,” said Kaptchuk. MIMS

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Sources:
http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo
http://www.npr.org/sections/health-shots/2016/11/08/501035923/how-the-brain-powers-placebos-false-memories-and-healing
http://www.livescience.com/56531-placebo-treatment-back-pain.html
http://www.livescience.com/32941-is-the-placebo-effect-real.html
http://www.webmd.com/pain-management/what-is-the-placebo-effect?page=1