The Placebo Effect

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.

In fact, earlier this year a protest was held outside of Boots Chemists in the UK to highlight the farce that is homeopathy. As most homeopathic medicines are diluted to a point where no active ingredients remain, 1 x 10^23, the group of protesters 'overdosed' on these medicines. All survived just fine, suffering no ill effects at all.

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.

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4 Comments

Filed under James' Corner

4 responses to “The Placebo Effect

  1. murfomurf

    The Placebo Effect is intriguing and I wonder if it is part of the human condition- there will ALWAYS be some people who respond strongly to placebo?? Anyway, I had a go at this challenge from a psychology testing point of view (I’ve developed successful tests before), but couldn’t really dream up anything wonderful; not really enough time for a well-researched response to many of these things I find:
    https://gw.innocentive.com/ar/workspace/challengeDetail/9188673?challenge=9188486

    The challenge is now under evaluation, so it’s too late to enter (bugga, eh?!)

  2. I got this in my RSS reader today. Wish Id got it a few days ago…
    http://www.badscience.net/2010/04/placebo-nocebo/
    This guys is fantastic. You should be following his blog/site (www.badscience.net) and reading his book.

  3. The placebo effect is fascinating. You know sugar pills even cause side-effects including constipation, diarrhea and nausea. Weird.

    • I love the Placebo effect so much! Its just so creepy. Another study which I didn’t know about when I originally wrote the article linked ceremony to effect by showing that when patients are told the placebo pill is expensive the pills work better than if they are told they are cheap or generic brands. But expensive pills are only as good as cheap pills when they suddenly have their prices slashed.

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