Jan 31, 2011

The panacea is the placebo

What exactly is the placebo effect?

It has long been known that there can be a measurable, observable, or felt improvement in health or behaviour not attributable to a medication or invasive treatment that has been administered. Simply speaking, a patient gets better just by the fact that they take a pill containing an inert substance and being told its an actual treatment. Even the exact nature of the fake treatment is known to elicit different placebo effects. 

Anything from giving patients sugar pills to fake saline injections are known to elicit a placebo effect of different strengths. We know that four fake pills a day are better than two fake pills a day, and even the colour of the fake pill have different effects depending on the ailment. More bizarrely, even the fake treatment can cause side effects.

The exact nature of this placebo effect is the subject of a recent study published in PLoS ONE . Up until now the placebo effect has relied on the patient not knowing they have been given a placebo. An ethical dilemma for most doctors. This new study has added confusion to the placebo effect. Researchers tested to see if patients knowing that they were given a placebo had any measurable outcome on the placebo effect. Removing the deception from the treatment would surely destroy any placebo effect?

The simple and elegant study entitled “Placebos without deception” took 80 patients (the majority of which women) diagnosed with irritable bowel syndrome (IBS) and randomized into two groups, one of which was given an open-label placebo, the other was given no treatment. Patients knew they were getting no more than an inert substance that would do nothing for them. The results open up a vast array of questions into the nature of the placebo effect. Researchers concluded that “placebos administered without deception may be an effective treatment for IBS” with open-label placebos producing significantly higher improvement scores across the board. An ethical placebo? This new study obviously has its implications for patient care but the most important question is does the placebo still work even if the patients are sceptical?

But there is a growing school of thought that the placebo effect is getting stronger. A range of supposed medical breakthroughs have already been undone by the placebo effect. The phrase “no more effective than a placebo” seems to have run its course. In an age when the human genome is being touted with the ability for personalised medicines, the placebo seems to offer the “one drug fits all” solution. Perhaps a new definition of placebo is needed?

Written by Dr. Charles Ebikeme for The All Results Journals.

No comments:

Post a Comment