Placebos work -- even without deception

December 22, 2010 by David Cameron

(PhysOrg.com) -- For most of us, the "placebo effect" is synonymous with the power of positive thinking; it works because you believe you're taking a real drug. But a new study rattles this assumption.

Researchers at Harvard Medical School's Osher Research Center and Beth Israel Deaconess Medical Center (BIDMC) have found that placebos work even when administered without the seemingly requisite deception.

The study is published December 22 in .

Placebos—or dummy pills—are typically used in clinical trials as controls for potential new medications. Even though they contain no active ingredients, patients often respond to them. In fact, data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

Because such "deception" is ethically questionable, HMS associate professor of medicine Ted Kaptchuk teamed up with colleagues at BIDMC to explore whether or not the power of placebos can be harnessed honestly and respectfully.

To do this, 80 patients suffering from irritable bowel syndrome (IBS) were divided into two groups: one group, the controls, received no treatment, while the other group received a regimen of placebos—honestly described as "like sugar pills"—which they were instructed 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," says Kaptchuk. "We told the patients that they didn't have to even believe in the . Just take the pills."

For a three-week period, the patients were monitored. By the end of the trial, nearly twice as many patients treated with the placebo reported adequate symptom relief as compared to the control group (59 percent vs. 35 percent). Also, on other outcome measures, patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications.

"I didn't think it would work," says senior author Anthony Lembo, HMS associate professor of medicine at BIDMC and an expert on IBS. "I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them."

The authors caution that this study is small and limited in scope 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," says 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. Placebo may work even if patients knows it is a ."

More information: Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, et al. (2010) Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE 5(12): e15591. doi:10.1371/journal.pone.0015591

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Going
5 / 5 (5) Dec 22, 2010
How can the big pharmaceutical companies make a profit from this?
Quantum_Conundrum
4.1 / 5 (14) Dec 22, 2010
Has anyone considered the possibility that something in the placebo may in fact have been medically helping the patients?

Why didn't they do a "negative control"?

It should have been split into more groups.

1) Real Placebo - actually is a placebo
2) Fake Placebo - secret leading drug for the illness.
3) control - nothing
4) "Not Placebo" - But it is a placebo
5) "Not Placebo" - and it's a medication.

Groups 1 and 2 are told they are on placebo.

Groups 4 and 5 are told they are on medication.

1) Tell them they are on placebo
2) Tell them they are on placebo, but give a drug
3) nothing
4) Tell them they are on a drug, but give placebo
5) Tell them they are on a drug.

This would allow positive and negative controls across the entire range of the phenomenon simultaneously.
Mira_Musiclab
1 / 5 (4) Dec 22, 2010
Hard to dispute that placebos seem to work in some cases, but I find the whole thing to be completely unethical..

Profit from bogus medication, yet tout efficacy through 'the power of the mind'...

Scary.
Quantum_Conundrum
5 / 5 (6) Dec 22, 2010
So anyway, it looks like their conclusion is that the placebo effect is self-fulfilling.

Because they've heard of the placebo effect, they expect a placebo effect to actually cure them.

Then because they expect to be cured, they believe they are cured.
Raveon
2.3 / 5 (7) Dec 22, 2010
I've always felt that using controls like placebo's is unethical. Every patient in a drug study should get the drug, period. Especially when patients are terminal.

It should be easy to tell if it works and if it's the placebo effect, so what? If people get better with the drug and there are no bad side effects, distribute it. If the drug really doesn't work it will be found out sooner or later.
NickFun
not rated yet Dec 22, 2010
Leading drug manufacturers are now working on more potent placebos: http://www.spooft...81a16119
CaptBarbados
5 / 5 (2) Dec 22, 2010
Careful now... that's close to prayer. The placebo effect may very well represent the same physical benefit as asking for healing from a higher power. Whether you believe the result or not, what did it?
Jotaf
5 / 5 (5) Dec 22, 2010
This is easy to explain: the patients knew they were participating in a study, and they probably entertained the thought that the pill might be a real medicine disguised as a placebo ("it even says placebo on the bottle!").

So they were like, "yes, a placebo indeed... right! *wink wink*" ;)
komone
5 / 5 (2) Dec 22, 2010
Is this the same as the reported effects of homeopathy? Some studies years ago showed an "effect" as a result of homeopathic pills. Perhaps it was just being a pill-taker that caused that effect? If for nothing else, this is an interesting study.
Sackbut
not rated yet Dec 22, 2010
Maybe the control group should have been given the placebo but told not to take it. It would be interesting to see how this would play out with a more rigorously defined disease than IBS.
gjbloom
not rated yet Dec 22, 2010
It shows that a fair bit of healing can be induced through the expectations of the patient. Med schools might want to consider adding a course to teach charismatic suggestion.

I bet repeating this study would reveal that placebos vary in effect from doctor to doctor, correlated with the ability of the doctor to "sell" the medicine to the patient.
RobertKarlStonjek
5 / 5 (1) Dec 22, 2010
I can't wait for the immortality placebos to hit the market...
Physmet
not rated yet Dec 23, 2010
What happens if they are given the placebo and specifically told that it won't have any effect, but that they should take it anyway. Does the power of negative thinking come into play?

Also, perhaps we are so trained that taking pills will make us better that just the mere act boosts our morale. Or, maybe our body does have a slight trained response over time to the action of taking pills. There are quite a few possibilities.

I remember my son would say he had this terrible headache. We'd eventually give in and give him some ibuprofen. Within 5 minutes his headache was practically cured! No matter that it takes about 30 minutes to fully hit the system... We're all crazy medicine addicts haha
aorora
not rated yet Dec 23, 2010
I do believe that the medical attention given to those patients being monitered with full attention has reliefed many of the symptoms
it's the irritable bowl syndrom after all
the good mode can really relief the symptoms
frajo
5 / 5 (2) Dec 23, 2010
With 80 participants the sample size is too low for conclusions.
- They didn't factorize for (the lack of) knowledge of the meaning of the word "placebo":
- they didn't factorize for the Milgram effect (believing authorities);
- they didn't factorize for the patient's individual optimism/pessimism;
- they didn't factorize for the patient's individual stance wrt. effectiveness of western type treatment.

Anyway, it's an interesting topic.
Sauvignon
5 / 5 (1) Dec 23, 2010
I suspect that a good number of the patients in this study did not know the meaning of the word placebo. I also suspect they would not admit that. So when given pills with "placebo" on the bottle, and told they are "like sugar pills" they would simply transfer the perceived authority of the doctor to the medicine and believe that the medicine they were given was not "aspirin" or "paracetamol" but a different drug called "placebo". Perhaps its made from placentas they probably thought. This study proves very little because ignorance is boundless.
thales
not rated yet Dec 23, 2010
This is great. So I could start marketing a placebo pill, label it "Placebo", claim scientific support for its efficacy, and the FDA couldn't touch me. I'm seriously going to be rich. I can claim it's been scientifically shown to help with pain, irritable bowel syndrome, headaches, etc.
aroc91
3 / 5 (2) Dec 23, 2010
Has anyone considered the possibility that something in the placebo may in fact have been medically helping the patients?

Why didn't they do a "negative control"?

It should have been split into more groups.

1) Real Placebo - actually is a placebo
2) Fake Placebo - secret leading drug for the illness.
3) control - nothing
4) "Not Placebo" - But it is a placebo
5) "Not Placebo" - and it's a medication.

Groups 1 and 2 are told they are on placebo.

Groups 4 and 5 are told they are on medication.

1) Tell them they are on placebo
2) Tell them they are on placebo, but give a drug
3) nothing
4) Tell them they are on a drug, but give placebo
5) Tell them they are on a drug.

This would allow positive and negative controls across the entire range of the phenomenon simultaneously.


Your point is invalid because placebo pills are sugar pills. Sugar is in everything we eat, so there's nothing in the pill that the subjects weren't already getting from their diet.
MikeMike
not rated yet Dec 23, 2010
This investigation should have objectively measured a change, eg skin rash or similar. People can report improvement without actually improving.
CHollman82
not rated yet Dec 23, 2010
The majority of the public is so ignorant I doubt that more than half of them even know what the word placebo means and I also doubt that they understood the implications of the pill have no active ingredient...

This is still the placebo effect, coupled with stupidity.

I mean, maybe if the doctors explicitly told everyone "This pill will do nothing to help you but I want you to take it anyways because you are part of an experiment"... then I might agree with their conclusion.
CHollman82
3 / 5 (2) Dec 23, 2010
Has anyone considered the possibility that something in the placebo may in fact have been medically helping the patients?

Why didn't they do a "negative control"?

It should have been split into more groups.

1) Real Placebo - actually is a placebo
2) Fake Placebo - secret leading drug for the illness.
3) control - nothing
4) "Not Placebo" - But it is a placebo
5) "Not Placebo" - and it's a medication.

Groups 1 and 2 are told they are on placebo.

Groups 4 and 5 are told they are on medication.

1) Tell them they are on placebo
2) Tell them they are on placebo, but give a drug
3) nothing
4) Tell them they are on a drug, but give placebo
5) Tell them they are on a drug.

This would allow positive and negative controls across the entire range of the phenomenon simultaneously.


QC is so dumb he doesn't understand what a sugar pill is... Unless you think all of these people were on a 100% sugar free diet before hand, which is almost impossible.
aroc91
not rated yet Dec 23, 2010

QC is so dumb he doesn't understand what a sugar pill is... Unless you think all of these people were on a 100% sugar free diet before hand, which is almost impossible.


It's not almost impossible. It is impossible. Learn2biology.
trekgeek1
5 / 5 (1) Dec 23, 2010
Messy study. As people have said, they may have thought that "placebo" printed on the bottle was just to throw them off and thought it was real medication. Many may not have understood what the effect was, but just know that placebos work and thus thought sugar pills actually had medicinal value while completely misunderstanding the psychological premise behind it. They should even see if stepping into a hospital and talking to someone in a lab coat starts some healing process. Just walking into a medical facility may give people a placebo effect by being around a known environment of healing. Next time pass them out at a star bucks while wearing sweat pants and a graphic tee.
mjrtom
not rated yet Dec 23, 2010
haha some of these comments are hilarious. as many have stated, the sugar pill can not contain anything that would medically contribute to the betterment of the IBS patients' health.

as for the patients possibly not knowing what a "placebo" is, the article states that they made it clear to the patients what they were given.

this is a small study, but it's a very good start. i think the best reason for the observed reactions would be that the patients know of the "placebo effect", and somehow had higher hope for some sort of placebo effect. optimism is a cure.
frajo
not rated yet Dec 24, 2010
as for the patients possibly not knowing what a "placebo" is, the article states that they made it clear to the patients what they were given.
But they didn't verify whether it really was clear for the patients.

this is a small study, but it's a very good start. i think the best reason for the observed reactions would be that the patients know of the "placebo effect",
The placebo effect is one of the things nobody really understands, some know the meaning of, and everybody has heard of.
and somehow had higher hope for some sort of placebo effect. optimism is a cure.
Optimism can be helpful.
Dually
not rated yet Dec 25, 2010
What this new finding shows is how unnatural it is for the human mind to think logically.
knikiy
not rated yet Dec 26, 2010
I wonder if IV placebos work faster?
jmhoward
not rated yet Dec 28, 2010
I have thought that the "placebo effect" is due to stimulation of DHEA for years. It is my hypothesis that evolution selected DHEA because it optimizes replication and transcription of DNA. Therefore DHEA levels affect all tissues. I think behavioral interaction of all sorts that are positive stimulate DHEA, including the interaction with a physician, individuals perceived as positive, ...even including the effects of close contact "prayer" including touching or simply being nearby a patient, etc.

Therefore, if something is perceived as a positive, it will stimulate DHEA.
This includes a prescription from a physician or even the interaction with a positive physician who even says that a pill is a placebo.

I first submitted this idea to the Journal of Neuroscience and received an email from the journal quoting my idea in 2005.
Lynorg
not rated yet Dec 29, 2010
@aroc91

QC is so dumb he doesn't understand what a sugar pill is... Unless you think all of these people were on a 100% sugar free diet before hand, which is almost impossible.

It's not almost impossible. It is impossible. Learn2biology.

Becareful, QC could be right. Very few placebo pills or "suger pills" are actually made of suger. In fact, many have a complex composition.

Check out this link for example: w w w w dot healthiertalk.com/placebo-pills-more-just-sugar-027

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