The biggest headache for any drug-company executive is the placebo, or ‘sugar pill’, used in controlled trials to show that a drug in question works. Patients are divided into two groups, one of which is given the active drug, while the other takes the placebo, but no one knows who got what, not even those giving the pills. The idea is that far more patients will improve with the drug than with the placebo. Upon this assumption is built the entire edifice of modern medicine.
In practice, so many patients receive the same relief and even the same side-effects with a placebo as with the drug itself that a placebo is not a true control. Indeed, placebo power was best illustrated in patients with Parkinson’s disease, where the body’s system for releasing the brain chemical dopamine is faulty. The standard treatment for Parkinson’s is a synthetic form of dopamine. Yet, in one study, doctors at the University of British Columbia in Vancouver showed on PET scans that, when patients given inert placebos were told they had received dopamine, their brains substantially increased the release of their own stores of the chemical (Science, 2001: 293: 1164–6).
The placebo problem—the subject of this month’s News Focus—was raised to another degree of complexity when Harvard’s professor of medicine Ted Kaptchuk ran a double-blind trial in which patients with irritable bowel syndrome were given a placebo, but told that they were taking a sugar pill, while the other patients were given nothing at all (PLoS ONE, 2010; 5: e15591). The placebo group were also told that placebos have been shown to create powerful mind–body self-healing.
Kaptchuk found that nearly two-thirds of his placebo group reported symptom improvement—even more than had improved with the powerful IBS drug alosetron in a recent trial (Clin Ther, 2008; 30: 884–901).
This raises the very basic question I’ve been wrestling with for some time: do pharmaceutical drugs ever work? Is it ever the drug itself that heals, or is the mental expectation of healing enough to marshal the body’s healing mechanisms?
Other research bolsters the idea that the ‘healer’ may be more powerful than any agent. A recent study of 83 rheumatoid arthritis patients attended by a homeopath concluded that the consultation with a sympathetic practitioner—rather than the remedy itself—was the cause of the physical improvements reported by the patients (Rheumatology, 2010; doi: 10.1093/rheumatology/keq234).
There’s also the power of healing rituals—the idea of ‘taking some-thing’, even when that something is known to be fake. Of 46,000 heart patients, those taking a placebo fared as well as those using the heart drug. The only survival factor appeared to be the belief that the therapy would work and a willingness to follow it religiously. Those who tended not to survive were those who had been lax with the regimen—whether active drug or placebo (BMJ, 2003; 326: 841–4).
Such studies suggest that what we take doesn’t matter; the connection with the healer, the healing words and practices, the expectation of healing—in other words, our thoughts about healing—are always what turns out to be the true healer.