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January 18, 2011

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Sham pills may help us—even without the sham

Dec. 22, 2010
Courtesy of Public Library of Science
and World Science staff

Sham pills, known as place­bos, have been used in count­less med­i­cal stud­ies for dec­ades. By com­par­ing their ef­fects to those of real med­i­cines, re­search­ers can dis­count the pos­si­bil­ity that the true drugs work mere­ly be­cause the idea of hav­ing been treated makes us feel bet­ter.

But re­search­ers say they now seem to have made a sur­prise dis­covery. Not only do the fake pills tru­ly make some pa­tients feel im­proved—that much was al­ready known—but they can even work when the doc­tors drop any pre­tense that this is real med­i­cine.

By com­par­ing the ef­fects of pla­ce­bos to those of real drugs, re­search­ers can dis­count the pos­si­bil­ity that the true drugs work only be­cause the mere idea of hav­ing been treated makes us feel bet­ter, through psy­cho­log­i­cal ef­fects. (Im­age cour­tesy Nat'l Lib­rary of Med­i­cine)
The fake pills—con­tain­ing a bit of sug­ar or some oth­er harm­less con­tents—are tech­nic­ally known as pla­ce­bos (pluh-SEE-bose) and are draw­ing re­search in­ter­est in their own right. One rea­son is that re­search has found as many of half of U.S. doc­tors se­cretly give place­bos to un­sus­pect­ing pa­tients—perhaps even with good in­ten­tions, giv­en that the bo­gus nos­trums do some­times work.

The new study took an un­usu­al tack. Har­vard Med­i­cal School re­search­er Ted Kap­tchuk teamed up with col­leagues to ex­plore wheth­er the pow­er of place­bos can be har­nessed hon­estly.

To do this, 80 pa­tients suf­fer­ing from ir­ri­ta­ble bow­el syn­drome, a chron­ic in­tes­ti­nal prob­lem with a range of an­noy­ing or pain­ful symp­toms, were di­vid­ed in­to two groups. One re­ceived no treat­ment, while the oth­er re­ceived place­bos—hon­estly de­scribed as “like sug­ar pill­s”—which they were told to take twice dai­ly.

“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 Kaptchuk. “We told the pa­tients that they did­n’t have to even be­lieve in the pla­ce­bo ef­fect. Just take the pills.”

For three weeks, the pa­tients were mon­i­tored. By the end, re­search­ers re­ported, 59 per­cent of the pla­ce­bo-takers re­ported ad­e­quate symp­tom re­lief, but only 35 per­cent of the oth­ers re­ported such re­lief. Al­so, on oth­er out­come meas­ures, pla­ce­bo-takers were found to dou­ble their im­prove­ment rates to a de­gree roughly equiv­a­lent to the ef­fects of the most pow­erful med­ica­t­ions for the con­di­tion.

The study is pub­lished Dec. 22 in the re­search jour­nal PLoS One.

“I did­n’t think it would work,” said Har­vard Med­i­cal School’s An­tho­ny Lembo, an ex­pert on the the syn­drome and sen­ior au­thor of the pa­per. “I felt awk­ward ask­ing pa­tients to lit­er­ally take a pla­ce­bo. But to my sur­prise, it seemed to work for many of them.”

“Place­bo” means, in Lat­in, “I shall please”; the mon­i­ker comes from the idea that the dum­my pills pro­vide a psy­cho­log­i­cal sat­is­fac­tion.

The au­thors of the new re­search cau­tion that the study is small and lim­it­ed and simply opens the door to the no­tion that place­bos are ef­fective even for the fully in­formed pa­tient—a hy­poth­e­sis that will need to be con­firmed in larg­er tri­als. “N­ev­er­the­less,” said Kap­tchuk, “these find­ings sug­gest that rath­er than mere pos­i­tive think­ing, there may be sig­nif­i­cant ben­e­fit to the very per­for­mance of med­i­cal rit­u­al. I’m ex­cit­ed about stu­dying this fur­ther.”

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Sham pills, known as placebos, are used in countless medical studies. By comparing their effects to those of real medicines, researchers can discount the possibility that the true drugs work only because the mere feeling of having been treated makes us buck up a little, through psychological effects. But researchers say they’ve now found, to their surprise, that the dummy pills make many patients feel better even when doctors strip away any pretense that this is real medicine. The fake pills—containing a bit of sugar or some other rather useless, harmless contents—are technically known as placebos (pluh-SEE-bose) and are drawing research interest in their own right. One reason is that research has found as many of half of U.S. doctors secretly give placebos to unsuspecting patients—perhaps even with good intentions, given that the bogus nostrums do sometimes work. The new study took an unusual tack. Harvard Medical School researcher Ted Kaptchuk teamed up with colleagues to explore whether the power of placebos can be harnessed honestly and respectfully. To do this, 80 patients suffering from irritable bowel syndrome, a chronic intestinal problem with a range of annoying or painful symptoms, were divided into two groups. One received no treatment, while the other received placebos—honestly described as “like sugar pills”—which they were told to take twice daily. “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 Kaptchuk. “We told the patients that they didn’t have to even believe in the placebo effect. Just take the pills.” For three weeks, the patients were monitored. By the end, researchers reported, 59 percent of the placebo-takers reported adequate symptom relief, but only 35 percent of the others reported such relief. Also, on other outcome measures, placebo-takers were found to double their improvement rates to a degree roughly equivalent to the effects of the most powerful medications for the condition. The study is published Dec. 22 in the research journal PLoS One. “I didn’t think it would work,” said Harvard Medical School’s Anthony Lembo, an expert on the the syndrome and senior author of the paper. “I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them.” “Placebo” means, in Latin, “I shall please”; the moniker comes from the idea that the dummy pills provide a psychological satisfaction. The authors of the new research caution that the study is small and limited and simply opens the door to the notion that placebos are effective even for the fully informed patient—a hypothesis that will need to be confirmed in larger trials. “Nevertheless,” said Kaptchuk, “these findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual. I’m excited about studying this further.”