Should I be concerned about the Placebo Effect
I have watched for years as the debate rages on about various so called “alternative” treatments and the placebo effect. First of all, before we get into the particulars of any debate, we must define the goal of medicine. The goal of medicine is to provide a pathway to healing and a reduction in symptoms that caused by disease. With that definition in mind, anything, even a totally fake treatment, that results in a positive affect on the patient, is a good thing.
So what exactly is a Placebo? According to WebMD “A placebo is anything that seems to be a “real” medical treatment — but isn’t. It could be a pill, a shot, or some other type of “fake” treatment. What all placebos have in common is that they do not contain an active substance meant to affect health.” In an effort to distort this whole placebo thing a little further, doctors have come up with two classifications. Pure Placebo (a sugar pill) and Impure Placebo (anything else that is not a proven drug). By these definitions, anything that is used to treat an ailment, that is not an FDA certified treatment, is an Impure Placebo. This is why you see that nifty little FDA warning on so many things that says, “These claims have not been evaluated by the FDA.”
So a Placebo Effect must be when someone responds to a Placebo in any manner, good or ill. By this definition we can see that each and every non-sanctioned treatment in America is in fact a Placebo Effect. Now I am getting ahead of myself so lets look at what the experts say a Placebo Effect is. Back to WebMD, “Sometimes a person can have a response to a placebo. The response can be positive or negative. For instance, the person’s symptoms may improve. Or the person may have what appears to be side effects from the treatment. These responses are known as the “placebo effect.””
One of the big problems with Placebo Effect is the fact that doctors have no idea what it is or how it works. They have learned to predict when it may be a factor but it is a factor in so many things that several studies suggest that as much as 90% of side effects from prescription drugs can be attributed to Placebo Effect. That’s right, if you have an odd reaction to a drug it is most likely a placebo effect. Some doctors are even suggesting allergies are nothing more than placebo effect. In the UK Doctors regularly prescribe Placebos to their patients to very good effect with as many as 80% of doctors making use of this practice.
In many studies it has been shown that the Placebo did better than the prescription drug. Furthermore as much as 75% of the effective in anti-depressants is due to the placebo effect. In several studies with was shown that patients receiving Placebo Surgery (IE fake surgery) did as well as patients receiving the real thing. Medical literature includes a great deal of testimony that the placebo effect routinely works 30 percent of the time, with Dr. Herbert Benson of Harvard stating that it may work up to 90 percent of the time.
Ernest Lawrence Rossi writes, “In other words, the effectiveness of placebo compared to standard doses of different analgesic drugs under double-blind circumstances seems to be relatively constant…it is worth noting that this 56% effectiveness ration is not limited to placebo versus analgesic drugs. It is also found in double-blind studies of non-pharmacolgical insomnia treatment techniques (58% from 14 studies) and psychotropic drugs for the treatment of depression such as tricyclics (59% from 93 studies reviewed by Morris & Beck, 1974) and lithium (62% from 13 studies reviewed in Marini, Sheard, Bridges and Wagner, 1976). Thus, it appears that placebo is about 55-60% as effective as active medications irrespective of the potency of these active medications.”
“Psychologist Bruno Klopfer was treating a man named Wright who had advanced cancer of the lymph nodes. All standard treatments had been exhausted and Wright appeared to have little time left. His neck, armpits, chest, abdomen, and groin were filled with tumors the size of oranges, and his spleen and liver were so enlarged that two quarts of milky fluid had to be drained out of his chest every day. Wright heard about an exciting new drug called Krebiozen, and he begged his doctor to let him try it. At first the doctor refused because the drug was being tried on people with a life expectancy of at least three months. Finally the doctor gave in and gave Wright an injection of Krebiozen on Friday, but in his heart of hearts he did not expect Wright to last the weekend. To his surprise, on the following Monday he found Wright out of bed and walking around. Klopfer reported that his tumors had ‘melted like snowballs on a hot stove’ and were half their original size. Ten days after Wright’s first treatment, he left the hospital and was, as far as his doctors could tell, cancer free. When he entered the hospital he had needed an oxygen mask to breathe, but when he left, he was well enough to fly his own plane at 12,000 feet with no discomfort. Wright remained well for about two months, but then articles began to appear asserting that Krebiozen actually had no effect on cancer of the lymph nodes. Wright, who was rigidly logical and scientific in his thinking, became very depressed, suffered a relapse, and was readmitted to the hospital. This time his physician decided to try an experiment. He told Wright that Krebiozen was every bit as effective as it had seemed, but that some of the initial supplies of the drug had deteriorated during shipping. He explained, however, that he had a new highly concentrated version of the drug and could treat Wright with this. The physician used only plain water and went through an elaborate procedure before injecting Wright with the placebo. Again the results were dramatic. Tumor masses melted, chest fluid vanished, and Wright was quickly back on his feet and feeling great. He remained symptom-free for another two months, but then the AMA announced that a nationwide study of Krebiozen had found the drug worthless for the treatment of cancer. This time Wright’s faith was completely shattered. His cancer blossomed anew and he died two days later.” (Brono Klopfer, Psychological Variables in Human Cancer, Journal of Prospective Techniques 31, 1957, pp. 331-40.)
We have so little understanding of the placebo effect that it is amazing that doctors continue to argue over it. What’s funny is that we understand less than 10% of what is happening with the bacteria in our gut and that is significantly more than we understand of the placebo effect and how it works. As a matter of fact, if you take a serious look at the tens of thousands of published medical studies that had double blind placebo trials, you will see that Placebos cure about 30% of everything, including sickness, cancer, allergies, metal ailments, etc. Some drugs do better, some do worse and still doctors continue to prescribe them. Prozac for example, did worse than the placebo in seven out of the past ten studies. Even when people know they are on a placebo, the effect does not seem to fade. Even when people scream at them that it is a fake drug, it still works for people experiencing the placebo effect. Crazy, right? On top of all of this, according to Dr. Ted Kaptchuk, as much of 50% of prescription drug effectiveness can be attribituted to the Placebo effect.
So what does this mean to you and your health? Well it does mean that if you go to a doctor or an alternative medical provider, regardless of their competency, you have a one in three chance of seeing improvement. If they are competent your chance may get better but remember that in the United States, that one in seven deaths are cause by prescription drugs. Starfield, B. (2000). The Journal of the American Medical Association (JAMA) Vol 284, No 4. Johns Hopkins School of Hygiene and Public Health. That’s right, 1 in 7 or about 15% of all deaths in America are caused by prescription drugs.
I often laugh when my friends scream and rage against the world because someone is using homeopathy but if homeopathy is in fact a placebo, those people using it have a 30% chance right off the top of getting better, and that is with a zero chance of dying due to a bad prescription or a misunderstood prescription. So what the big deal with trying it to see if it works for you? As has been pointed out many times, it is only a sugar pill, right? Until we can understand the placebo effect, I find that attacking any form of treatment that does not cause harm, even if it is a known placebo, is nothing short of a demonstration of our ignorance of the world around us. If something works for you then it is medicine. Not alternative medicine but medicine.
One last note, if you are using any treatment and not seeing results, try something new. Don’t stick with it simply because your guru, doctor, minister, or the voices in your head are saying it is working. Look for positive results and listen to your body. If you feel good then you are probably doing the right treatment for you. Even if it is a placebo.
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
Howick J, Bishop FL, Heneghan C, Wolstenholme J, Stevens S, et al. (2013) Placebo Use in the United Kingdom: Results from a National Survey of Primary Care Practitioners. PLoS ONE 8(3): e58247. doi:10.1371/journal.pone.0058247
“Neurophysiologic correlates of side effects in normal subjects randomized to venlafaxine or placebo” Hunter AM, Leuchter AF, Morgan ML, Cook IA, Abrams M, Siegman B, Debrota DJ, Potter WZ. Neuropsychopharmacology, 30(4):792-799, April, 2005; epub 2004 Dec 22
“Pretreatment neurophysiological and clinical characteristics of placebo responders in treatment trials for major depression” Leuchter AF, Morgan M, Cook IA, Dunkin J, Abrams M, Witte E. Psychopharmacology (Berl), 177(1-2):15-22, December 2004 (epub 14 Jul 2004)
“Changes in brain function of depressed subjects during treatment with placebo” Leuchter AF, Cook IA, Witte EA, Morgan M, Abrams M. American Journal of Psychiatry, 159(1):122-129, January, 2002
Brono Klopfer, Psychological Variables in Human Cancer, Journal of Prospective Techniques 31, 1957, pp. 331-40.
Kaptchuk TJ. Placebo controls, exorcisms, and the devil. Lancet 2009; 374:1234-5.
Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN,Nam BY, Nguyen LT, Park M, Rivers AL, McManus C, Kokkotou E, Drossman DA, Goldman P,Lembo AJ. Components of the placebo effect: a randomized controlled trial in irritable bowel syndrome. BMJ 2008; 336: 998-1003. PMCID: PMC2364862.
Starfield, B. (2000). The Journal of the American Medical Association (JAMA) Vol 284, No 4. Johns Hopkins School of Hygiene and Public Health.
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