Search results matching tag 'placebo'

Healing thoughts

jowddty — Tue, 01 Feb 2011 10:40:00 GMT

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.

Mind medicine

jowddty — Mon, 27 Sep 2010 15:58:00 GMT

Dr Bruce Moseley, an orthopaedic specialist at Methodist Hospital in Houston, TX, was convinced of the powerful effect of the human mind on healing. He recruited 180 patients with severe knee osteoarthritis and divided them into three groups, two of which underwent true surgery to clear out degenerative tissue and debris. The third group underwent a sham operation: they were surgically prepared, put under anaesthesia and wheeled into the operating room, where incisions were made in their knees, but no procedure was carried out.

Over the next two years, none of the patients knew who had received the real operations and who had received the placebo treatment, yet all three groups reported moderate improvements in pain and joint function. In fact, the placebo group reported better results than some of those who had received the genuine operation.

The mental expectation of healing was enough to marshal the body’s healing mechanisms. The intention, brought about by the expectation of successful surgery, led to physical change (N Engl J Med, 2002; 347: 81–8).

The role of the mind in healing—the subject of Bryan Hubbard’s cover story this month—completely baffles the medical community. Yet, it is well documented that belief in a placebo will bring about the same physiological effects as an active agent—so much so that it causes the drug industry enormous difficulty when designing trials; as so many patients report the same relief and even the same side-effects with a placebo as with the tested drug itself, a placebo is not a true control.

How can belief—and, in this case, a wrongheaded belief—affect the outcome of healing? Some clues come from intriguing brain studies showing that the electrical activity within the brain, and between the brain and other parts of the body, is identical whether we are merely thinking about doing something or actually doing it.

In weightlifters, for instance, the EEG patterns in the brain that are activated to produce specific motor skills become activated while the skill is only being simulated mentally. Indeed, just the thought is enough to produce the neural instructions to carry out the physical act.

In the case of placebos, our bodies don’t distinguish between a chemical process and the thought of a chemical process.

According to a major review, the only factor for survival appears to be a belief that the therapy will work and a willingness to follow it religiously. Patients who stick to their doctor’s orders fared equally well whether taking a drug or a sugar pill. In contrast, those who tended not to survive were those who were lax with their regimens, regardless of whether it was a placebo or an actual drug (BMJ, 2006; 333: 15–9).

Such studies suggest that our beliefs—about our medicine, about the outcome of a health crisis, about our connections to our place in the world—are a more powerful healer than any diet or exercise programme; they protect us against the worst toxins and the greatest adversity.

Knowing this, every doctor now has a duty to never give a negative diagnosis, and every patient has a duty to follow only the regime that he truly believes in. The thought it generates in us—whether positive or negative—is our most potent medicine. May we always use it wisely.

Let us prognose

bshubbard — Fri, 02 Nov 2007 11:50:00 GMT

It's been said that medicine is the new religion. Drugs and surgery have replaced God in our drive for certainty and control in a world that appears random. For his part, the doctor often dons a white coat as a player in the brave new priesthood, while dispensing prescription sheets to the laity, or patient.

As a priest-like figure, the doctor has enormous power. I'm sure there is a placebo effect even in prescription drugs, especially if the patient is convinced they will work.

But perhaps his greatest power is the prognosis, his considered view of the patient's chances of survival and recovery. The prognosis is so influential in the outcome that it becomes self-fulfilling, especially for the patient who is open to suggestion.

I have direct experience of the prognosis. My own mother was given three months to live after she had hidden her breast cancer from everyone for several years. We didn't tell mum what the doctor had said, but instead took charge of her therapy ourselves. She made a full recovery within a year, and went on to live for quite a few years afterwards.

I'm reminded of the power of the prognosis, and how uncannily inaccurate it is, by a report in today's British Medical Journal. A study found that doctors at 92 intensive care units consistently got their prognosis wrong, even though they were so sure of its accuracy that they saw little point in treating the patients they had already consigned to the mortuary.

More than 60 per cent of patients were alive 180 days after treatment, when doctors had said less than half would survive that long. Even the patients who were at death's door survived far longer than the doctors predicted. Doctors reckoned just 10 per cent would survive the next 180 days, but 40 per cent did so.

Perhaps they survived so long because they were too ill to hear the prognosis.