This morning, NPR (www.npr.org) reported a new wrinkle in our understanding of the “placebo effect”.
It has been well-established in drug studies that many of the people who take sugar pills as “controls” will have a significant improvement in their symptoms. This effect tends to run at around 30% of controls, though it can be higher. Since most studies are placebo-controlled and “blinded” (the subjects don’t know if they are on the real pill or not), it has been assumed that the subjects are hoping or believing that they were given the actual study pill. As a result, it is postulated that this belief triggers some sort of mind-body connection that facilitates self-healing mechanisms, in the immune system or elsewhere.
But those pesky researchers at Harvard couldn’t be satisfied with this explanation. Lead researcher Ted Kaptchuk reasoned that the intentional use of placebos in practice would have to rely on deception, which is potentially unethical. So is it possible that even patients who knowingly take a placebo will also improve?
Needless to say, grant funding for such a study was almost impossible, and the “usual suspects” all declined to help. Finally, the National Center for Complementary and Alternative Medicine stepped up with support.
Here’s the scenario: subjects with the chronic, frustrating condition of IBS (irritable bowel syndrome) were told that they would either get a placebo pill or no treatment. That was all they could choose from. And those who received the placebo pills were told what they were getting. What do you think happened?
Turns out that a whopping 59% of those taking the placebo pills reported “adequate relief” on the placebo (compared with 35% in the “no treatment’ group)!
So where did the placebo effect come from? Apparently not from some misguided expectation of being on a powerful drug. Kaptchuk believes it is the ritual of going to the doctor, receiving a pill with a confident explanation of its potential and most important, taking the pill as directed each day. This would explain certain phenomena, like people demanding antibiotics from their doctors for their common cold symptoms, and then swearing by their effectiveness.
Fascinating stuff. But it raises another question in my mind: Decades ago, doctors were held in highest esteem by society–patients traditionally would hang on their every word and follow their instructions to the letter, for better or worse. In recent times, patients have become more educated about their conditions and more proactive and collaborative in their care. Most of us have encouraged this “empowered partnership” trend as a good thing. But I can’t help but wonder if, by decreasing the paternalistic and ritualistic aspects of the doctor visit, we may be decreasing the effectiveness of our pills??