Placebo Effect: Realer Than Real Deal Holyfield


Not the newest of news, but anything that reminds us of how tenuous a business/science medicine is has great public policy implications today. From the Boston Globe:

You're not likely to hear about this from your doctor, but fake medical treatment can work amazingly well. For a range of ailments, from pain and nausea to depression and Parkinson's disease, placebos–whether sugar pills, saline injections, or sham surgery–have often produced results that rival those of standard therapies…..

But any attempt to harness the placebo effect immediately runs into thorny ethical and practical dilemmas. To present a dummy pill as real medicine would be, by most standards, to lie. To prescribe one openly, however, would risk undermining the effect. And even if these issues were resolved, the whole idea still might sound a little shady–offering bogus pills or procedures could seem, from the patient's perspective, hard to distinguish from skimping on care….

But according to advocates, there's enough data for doctors to start thinking of the placebo effect not as the opposite of medicine, but as a tool they can use in an evidence-based, conscientious manner. Broadly speaking, it seems sensible to make every effort to enlist the body's own ability to heal itself–which is what, at bottom, placebos seem to do. And as researchers examine it more closely, the placebo is having another effect as well: it is revealing a great deal about the subtle and unexpected influences that medical care, as opposed to the medicine itself, has on patients….

In the last decade-plus, however, the accumulating data have sparked a renewed interest in the placebo as a treatment in its own right. Numerous studies have shown that it can trigger verifiable changes in the body. Brain scans have shown that placebo pain relief is not only subjectively experienced, but that in many cases the brain releases its own internal painkillers, known as endogenous opioids. (This placebo effect can even be reversed by the opioid-blocker naloxone.) Another study, published in Science in 2009, found that patients given a topical cream for arm pain showed much less pain-related activity in the spinal cord when told it was a powerful painkiller. A 2009 study found that patients benefited as much from a fake version of a popular spinal surgery as they did from the real one; asthma patients have shown strong responses to a mock inhaler…..

One audacious tack would be to tell the truth: to notify patients that they are about to be given a fake pill. The idea sounds absurd, and doctors have long assumed that would ruin the effect. But there's almost no research on the question, and it may not be as unthinkable as it seems. One reason it could work involves "classical conditioning"–the notion that we can learn on a subconscious level, like Pavlov's dogs, to biologically respond to certain stimuli. This concept suggests that the brain could automatically react to the placebo in a way that doesn't require conscious faith in the drug. (The placebo effect has been observed in rodents, which bolsters this theory.) 

Whole thing worth reading, though it does drift off in a direction I find a bit off-putting: elevating and aggrandizing the ritual power of medical professionals themselves, which I think our culture (and politics) does too much of already. Read my Suck.com classic on the troubles with conflating health care and health.