I’ve
always been fascinated with the placebo effect. For those that may not be familiar,
this effect occurs when a fake treatment or inactive substance is given to a
patient and there is an improvement in the patient’s condition. In fact, the
most rigorous clinical trials are called “double-blind, placebo controlled.” These
studies have some people getting an inactive treatment, or placebo, and others
getting an active treatment where neither the patients nor the practitioners
know who is getting which treatment. After the data is collected it can be
determined how good the active treatment is compared with the inactive
treatment. It is interesting that while really good pharmaceutical drugs will
be successful in a much greater proportion of patients than the placebo, in
virtually every clinical trial there will be patients who notably improve after
receiving just a sugar pill, a salt water injection or even a fake surgery.
I
remember as a kid that simply driving to the doctor’s office made me feel
better. While logically being in a car when sick should have only made me feel
worse, the knowledge that I was going to see a doctor made me feel better- even
before I stepped into the doctor’s office.
The
placebo effect is the topic of last week’s episode, Real
Doctors, Fake Medicine of the Only Human podcast. Host Mary
Harris interviews Dr. David Kallmes who studied the effectiveness of
vertebroplasty, a surgery to repair spinal fractures. His findings, published in the New
England Journal of Medicine, found that about 40 percent of both those
patients that received the real surgery and those that received a sham surgery
experienced immediate pain relief from the procedure.
So
while it kind of makes sense that people may experience relief from a sham
surgery simply because patients trust their surgeons and whole heartedly
believe them, there is also evidence that patients experience an improvement in
their symptoms even when a physician tells them that what they are being given
is a fake treatment. Mary Harris interviewed Ted Kaptchuk, director of the
Center for Placebo Studies at Harvard Medical School, to discuss this
phenomenon.
Ted
Kaptchuk’s research shows that patients experience relief from their symptoms
even when they are told that the treatment is fake. In one study, 27 percent of
patients had adequate relief with fake treatment that they were informed by physicians
was fake. That’s almost a third of patients!
The
research by the Center for Placebo Studies suggests there is a neurobiological
effect, a physical effect within the body, which causes patients to experience
relief from their symptoms. As Ted Kaptchuk described in more depth in a Science
Friday podcast, he hypothesizes simply going to a doctor’s office and
having a positive interaction with the physician or the act of taking a pill
and then chasing it with water may activate some sort of subconscious response
from our bodies that alleviates symptoms. He believes the placebo effect
resides in endorphins, the body’s own painkillers and possibly has a genetic connection.
Ted
Kaptchuk closes with “what I think I’m
doing is quantifying and making the art of medicine a science.” No matter what
your position is on the placebo effect, everyone can agree that a supportive,
trusting relationship with a medical provider is going to have a positive
effect on health outcomes.
