In light of the recent victory of Simon Singh over the British Chiropractic Association I wanted to put up something I wrote a little while ago. People should not tolerate the pedaling of exaggerated claims and flat out lies like those given off by the BCA and homeopaths worldwide. I wrote this piece about the placebo effect which is a measurable background activity of all drug (real or fake) used to treat disease. It seems to be based on patients expectations and is a very interesting phenomenon. It previously appeared in The Adelaide Advertiser on 06.12.2008.
It sounds like something a witch-doctor would say: If you simply think the little green pill will help cure your disease, it will . . . Believe it or not, it’s a scientifically proven truth.
It’s called the placebo effect. And it’s something drug company’s loathe and ‘‘snakeoil’’ salespeople depend upon.
The placebo effect is one of the most intriguing unexplained phenomena in modern medicine. You would think that giving someone a simple sugar pill instead of, for example, a pain-relief drug would have no effect. But medical trials routinely produce reports of improvement from both groups.
It is an effect that has been studied for a very long time and is so prominent that all modern drugs have to be tested in comparison against it to prove their true effectiveness.
But the placebo effect is much more complicated than it seems.
Alarmingly, four placebo sugar pills a day appear to be more effective than two when it comes to eradicating gastric ulcers. An injection of salt-water is a more effective treatment for pain than sugar. And green sugar pills are more effective in treating anxiety than red sugar pills.
Why? It appears to be all in the mind. Not in the placebo itself.
It’s about the expectations produced by the process – or ceremony – of receiving a treatment. We expect an injection to be more effective than a pill. So, mysteriously, it is . . .
It gets more mysterious. A study shows that even when patients know they have taken a placebo, it still has an effect. Patients described as neurotic or anxious were given a placebo – and told it was just a placebo – for a week.
They made sure the message got across: ‘‘Do you know what a sugar pill is? A sugar pill is a pill with no medicine in it at all. I think this pill will help you as it has helped so many others. Are you willing to try this pill?’’
Amazingly, of the 15 patients who took part 14 reported an improvement in their anxiety. Eight patients stated that they believed the pills were placebos, although only three patients claimed to be absolutely certain. Six thought the pills contained drugs despite being told they didn’t, with two patients absolutely certain they were medicated.
How can modern science explain this?
It can’t. Yet. But we’re trying.
The ‘‘ceremony’’ effect also appears to apply without physical placebos. An Italian study gave one group of patients medication normally. The other group received their medication secretly.
Those who knew they were being treated showed much higher levels of improvement than those who didn’t. The problem with the placebo effect is that it is often exploited by pseudo-scientists and alternative medical practitioners.
The classic example of this is homeopathy. Homeopathy is founded on a belief that an ill person can be treated using a substance that can produce, in a healthy person, symptoms similar to those of the illness. This substance is diluted and used to ‘‘prime’’ the immune system so that it can clear the disease of its own accord.
The truth is these treatments never perform better than the placebo effect as the idea that mimicking some symptoms will help cure a disease is false. This is why medicines are tested against placebos and existing medications – to prove they are more effective than the mysterious power of a placebo alone.
The placebo effect is believed to be caused by a mixture of psychological, cultural and personal reasons but is certainly a real and interesting phenomenon in medical science.
How we interpret and measure this phenomenon is also important, as it forms the standard control – the baseline against which true effectiveness is measured – for many clinical trials.