Study Suggests Placebos Don't Have To Be Secret To Work

from the this-is-important dept

I travel an awful lot, and for a while I used to come down with a cold fairly frequently after traveling (one of the usual hazards of air travel). Somewhere along the way -- a few years back -- someone suggested that I try Airborne, the tablets you drop into some water that fizz up and put a bunch of random vitamins and whatnot into your system. From the beginning, I was pretty skeptical about it (I don't tend to believe in such things), but figured I didn't have much to lose, and started taking Airborne when I travel. Since then, I can't recall ever ending up sick during or after traveling. There have been a few times when I felt like I was coming down with something, but then I'd take an Airborne and feel fine again by the next day. It was weird.

Still, I wasn't all that surprised, two years ago, when a report came out blasting Airborne, with the FTC fining the company, saying that there was "no credible evidence" that it worked. I thought about stopping my routine, but after thinking about it, I kept doing it (and was happy to see that Airborne actually became much cheaper after this). And it still worked for me -- even though I was now more convinced than ever that it's merely a placebo. But since then I have been really curious about this idea, as to whether or not someone could take something, even believing that it was a placebo, and have it still work. I even would joke about it with people, that even though I knew it didn't work, I was going to keep taking it until I had proof it didn't work.

Since then, I've become more and more interested in the concept of the placebo effect -- not really even believing my own story (sample size of one, plus confirmation bias, makes me distrust my own evidence...). Last year, we wrote about how the pharma industry was downplaying the placebo effect, even though there was growing evidence that people taking placebos were actually getting better, and it was leading more and more drugs to fail to pass clinical trials, since they didn't outperform placebos. The general reaction to this was to assume the drugs didn't work (which could be true), but very little effort was put into figuring out how come some people taking the placebos did seem to get better. There has been some research done in this area, but a major problem is that pharmaceutical companies have been refusing to share the data from their various clinical trials that would provide much needed data about the placebo effect.

The latest bit of research on this issue (which Mike mentioned in his recent DailyDirt post), is that some researchers have done a study which at least suggests that (as I found with Airborne) even when patients know that they're taking a placebo, it can still have an actual beneficial impact on their health. Now, this is just one study, and it's rather limited, but it's an intriguing area of research that I hope will get a lot more exploration as well. Mike wrote it off to bad control experiments, but I'm wondering if there's something more here.

Again, what would be really helpful is if pharmaceutical companies would release the data they already have from various clinical trials, which would allow for a much deeper analysis of the placebo effect. But, of course, they don't see much benefit in doing that. They want monopolies on drugs -- and evidence of a working placebo effect could harm their business prospects, even if it did lead to a better understanding of how to actually make people healthy. I have no doubt that certain drugs really do make people healthier. But if we could figure out how people are made healthier in the absence of drugs -- even when they know they're getting a placebo, we might get closer to really understanding certain elements of health that could actually serve to make future drugs a lot more effective in keeping people healthy (and, potentially also get past thinking of healthcare as being drugcare, when there's a lot more to keeping people healthy than just pharmaceuticals).

Over four years ago, Andy Kessler came out with his book, called The End of Medicine, which highlights how unfortunate it is that our healthcare system is really dominated by the pharmaceutical industry, where the focus is on "what drugs can be sold," rather than "what can actually make people healthy." In Kessler's book, what suffers are unique technologies that make people healthy, but have trouble getting approval for use (or money for research) because they don't fit into the usual drug classification systems. But it seems that the same sort of thinking applies to the lack of serious effort behind understanding the placebo effect. Hopefully, that's starting to change...


Reader Comments (rss)

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  1.  
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    chrisn, Dec 27th, 2010 @ 12:25pm

    Mind Over Body

    Really placebos are all about the impact of the mind over the body. I haven't been sick in over 16 years, and I'm confident that its purely from the fact that I'm confident that I won't GET sick.

     

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    pringerX (profile), Dec 27th, 2010 @ 12:51pm

    Psychosomatic

    It's like the people who claim to be allergic to wireless signals. Their physical symptoms have been documented to be real, but obviously unassociated with the presence of wireless signals. The mind does have considerable power over the body. The tricky part is figuring out where the limits are; it's probably also different for different people. For minor things like colds, where the stakes are fairly low, the placebo effect might be fine. But clearly more research has to be done before you can apply them to more serious ailments.

     

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    Ryan Diederich, Dec 27th, 2010 @ 12:51pm

    I agree with the above...

     

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    Ryan Diederich, Dec 27th, 2010 @ 12:51pm

    I agree with the above...

     

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    Ryan Diederich, Dec 27th, 2010 @ 12:54pm

    I agree with the above...

    As long as you are confident in yourself and your health, you will rarely get sick. I practice this as well. I am and have always been able to "will" away illnesses.

    This is not to say that I am immune to all disease, the occasional flu gets me every once in a while.

    I wish people would wake up and realize how powerful the mind and body are. Your brain controls every chemical level in your body, and you control your brain.


    Ive also administered placebo to several family members. I can remember using food coloring and sugar in water and telling them it would make it better. Typically it did.

     

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    James, Dec 27th, 2010 @ 12:56pm

    Science Based Medicine Writeup

    The folks at the Science Based Medicine website did a great review and writeup of this study.

    Unlike what the more general media has been reporting it looks like the study showed a very minor improvement and despite the authors saying they gave them participants labeled placebos they couched it in language clearly implying they were magical. And the study was done by a group that spends its time looking at fake medicine.

    This of course throws the small improvement into more doubt. If you want to read the full article it's here. Placebo effects without deception? Well, not exactly…

    So there could be something interesting but its still very much in the early stages of any research. I know I'll still be listening to the GP and Pharmacist when I need some proper medical help. :)

     

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    Chargone (profile), Dec 27th, 2010 @ 12:59pm

    Re: Mind Over Body

    i wonder if this is associated with a bit of japanese err... folk logic? a saying, anyway:
    "idiots don't get colds"

    the thought being that they're too stupid to realise they even Can get sick... so they don't.

    one doesn't have to be an idiot to trigger a similar effect if it works... just convince one's mind/body/whatever that it can't happen.

     

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    slacker525600 (profile), Dec 27th, 2010 @ 1:11pm

    wired had an interesting piece a while back

     

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    Jose_X, Dec 27th, 2010 @ 1:29pm

    Re: Mind Over Body

    I don't like to take pain killers or anything if I can at all avoid it because I like my body/mind to figure out how to get itself better without any help. I don't think it's healthy to be in pain, but as long as I can avoid being overwhelmed I look for things to do to distract, relax, etc, and ease the pain away as quickly as possible (and hopefully without having to work myself too hard since doing so would be unsustainable). I become much more tuned with what patterns might hurt me (frequently interpreted as "pain me" or change my functioning from expectation). I am forced into studying my body and how I react to things. I'm my primary doctor. I really don't trust outside unnatural agents too much (medicine or the people that subscribe them or say they are good for you). This isn't to say I reject help, but I do live in peace largely and at low cost and prefer to get help when I pretty much have failed convincingly (ie, when I haven't found a way to control pain or some other reaction or adjustment on my body and am not willing to try further.. which is odd). Not surprisingly, a primary tool I use is avoiding suspected "high" risk threats.

    I suggest that people that take medicine at least consider reducing or not taking something here or there.. but only really if you first believe that these agents have a very real chance of failure and actually of perhaps hurting your long term chances of being able to heal yourself or to engage in a mind-body learning/exercise opportunity (and you would like the freedom from not being stuck on medicine). Where you don't believe an alternative exists, then by all means make the small sacrifice so you can get on with life.

    This approach I take is related to how much I like to understand things and build theories and that I know how little we potentially know about many complex interactions. I'm always willing to look at "irrefutable" (or other) evidence, but most people can't provide it because we naturally learn the "facts" most of the time and leave it at that. I guess when you enjoy deducing things, for better or worse, you are more susceptible to developing experience/awareness/theories that will contradict some particular advice.

     

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    Jose_X, Dec 27th, 2010 @ 1:52pm

    Re: Psychosomatic

    >> For minor things like colds, where the stakes are fairly low, the placebo effect might be fine. But clearly more research has to be done before you can apply them to more serious ailments.

    One thing to keep in mind is that a failure of the body can be because of a failure of some proper "exercise" or other or can be greatly reduced by making a small adjustment.

    Consider a very large and very complex computer program that has been homed over a very long time via natural selection -- this is our body. There might be a very simple set of input context when using that program that might lead it to perform spectacularly, but it might fail convincingly if some small part of that context is missing.

    Adding "medication" would amount to letting a group of youngsters that have only recently in this evolutionary development started trying to understand this massive body of source code add some software here or there (in tinker fashion) to try and neutralize the supposed negative effects of the main software. If instead the owner of the program can figure out that some small change to the input context can make a positive difference, then that might be better in the long run.

    Our bodies are very complex and we should always remember the law of unintended consequences http://en.wikipedia.org/wiki/Unintended_consequences when we try to interfere with it using means that are very distinct from what the human species has experienced through progressive evolution. To me, to rely on an outside agent is an admission that I failed to find a natural solution that might very well exist and be fairly simple to execute and have decided instead to surrender myself over to the youngsters.

     

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    Mike Masnick (profile), Dec 27th, 2010 @ 1:54pm

    Re: Science Based Medicine Writeup

    Unlike what the more general media has been reporting it looks like the study showed a very minor improvement and despite the authors saying they gave them participants labeled placebos they couched it in language clearly implying they were magical. And the study was done by a group that spends its time looking at fake medicine.

    Yeah, actually all of that is in the Guardian writeup I link to. It's why I said this is a very limited study... But, still, a good point.

     

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    Jose_X, Dec 27th, 2010 @ 2:08pm

    Re: Re: Psychosomatic

    To clarify, I am not saying that science is garbage. I am saying that we should weigh the risks but always have humility towards evolution and less faith-trust in wonderful new solutions hatched in a laboratory recently. The lab result might be very close to natural or might be excellent, but we should be wary unless we are at a crucial juncture and anticipate problems if we don't get help soon.

    For example, there is a real risk in avoiding antibiotics and various other external aids under various contexts. In these contexts, there is a high risk of death or serious injury and taking the medication has a result of improving these results substantially. However, for most cases, the time span is much longer and people have time to try and prod Mother Nature.

    There are other issues. A person may prefer to indulge in something and simultaneously take the scientific remedy to its negative effects so that they can "live life to the fullest". That might be best for them (or for me in some cases I don't doubt); however, I do find that a part of living life to the fullest for me frequently is deriving solutions and also finding sustainable low cost blah blah solutions.

    Sorry to have polluted this thread.

     

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    Anonymous Coward, Dec 27th, 2010 @ 4:01pm

    Social Network for healthcare

    http://www.patientslikeme.com/

    The drug companies don't want to share their studies but people can do their own.

    The website above is just wonderful for that.

    More info about the website.
    http://www.ted.com/talks/jamie_heywood_the_big_idea_my_brother_inspired.html

     

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    Scott, Dec 27th, 2010 @ 4:35pm

    re: "They (the pharmaceutical industry) want monopolies on drugs" -- clearly they don't have a monopoly on things you could take to make you feel better. (Please see the thriving nutraceutical, homeopathic, chiropractic, etc. industries)

    Anyway, there are only monopolies on specific drugs (before their patents expire), not drugs in general. Anybody with a couple billion dollars to burn on development and clinical trials is welcome to make a new drug... at which point they'll become a member of the pharmaceutical industry. Your assertion is the equivalent of saying that the automotive industry has a monopoly on cars.

     

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    Jeff, Dec 27th, 2010 @ 10:24pm

    Placebo xanex? Damn this is gunna be a good year.

     

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    Darryl, Dec 28th, 2010 @ 1:46am

    If you know its a placebo, then its not a placebo anymore

    The latest bit of research on this issue (which Mike mentioned in his recent DailyDirt post), is that some researchers have done a study which at least suggests that (as I found with Airborne) even when patients know that they're taking a placebo, it can still have an actual beneficial impact on their health.

    Except, medical trials of drugs, involve a double blind method, and patients do not know if they are taking the real drug of the placebo..

    By definition, if you know its a placebo, it not longer IS a placebo, and some people just get better by themselves, without a placebo and without drugs.

    The idea of medical trials using a placebo, is that yes, some people on the placebo will get better, but hopefully more people will get better from the group that are taking the active drug.. that is the effacasy of the drug..

    So the fact that people do get better while taking the placebo is not unusual, and if they knew it was a placebo, then it would not be a placebo, by definition..

    They simple do not make that knowledge available during the trial..

    I dont know why you find it such a surprise that people can get better by themselves.. regardless of the drugs they are taking or not taking.

    Rarly does a placebo cause the reduction in the size of a cancer or reduce an AIDS suffer's T-cell count..

    Medical studies of drug, or drug trials, rarly study a group where they give no medication at all, not a placebo nor the active drug..

    that would be more interesting for the study of the placebo effect. the differece between the group that takes the placebo and a group that is not taking anything..

    But they dont do that, they dont have to, they just know that the placebo effect has some but a small effect, and that the main thing is the difference between the placebo group and the active drug..

    the more people who get better with the placebo.

     

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  17.  
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    Darryl, Dec 28th, 2010 @ 1:58am

    Re: Re: Psychosomatic

    Medication and medical treatments have been around probably for as long and humans have been around, if not longer in other species.

    it would have to be one of our most ancient sciences, every culture has a history of using various substances found in nature to aid recovery, or for medical treatment.

    and medical development evolve the same way today, they try it out and see if it works.. that is what they have allways done.

    yes, it might be like letting kids run around in your, but what level are we in any form of technology development?

    still kids,, but we've been doing medicine alot longer than we have been doing electronics, mechanics, farming ect..

     

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    vivaelamor (profile), Dec 28th, 2010 @ 6:09am

    Re: I agree with the above...

    "As long as you are confident in yourself and your health, you will rarely get sick. I practice this as well. I am and have always been able to "will" away illnesses."

    I would be interested to hear how you tested this.

     

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    vivaelamor (profile), Dec 28th, 2010 @ 6:29am

    Re: If you know its a placebo, then its not a placebo anymore

    "By definition, if you know its a placebo, it not longer IS a placebo, and some people just get better by themselves, without a placebo and without drugs. "

    Which definition is that? Many dictionaries don't even recognise the relevance of whether the patient is informed and those that do tend to have alternative definitions which don't include it. Not even the etymology supports your assertion. From the Oxford Dictionary:

    "a medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect.
    • a substance that has no therapeutic effect, used as a control in testing new drugs.
    • a measure designed merely to humour or placate someone.
    Origin:
    late 18th century: from Latin, literally 'I shall be acceptable or pleasing', from placere 'to please'".

    Was that the premise for your post or did you have another point that I missed in the confusion?

     

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  20.  
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    Anonymous Coward, Dec 28th, 2010 @ 6:09pm

    Re:

    You don't need a billion dollars to do that.

    The approach today to develop a drug is simple, they try every combination possible.

    What you need really is a distributed framework to divide the work into the thousands of laboratories around the world.

    Another thing that is needed is people to start producing all those old medications that no longer have patents on the cheap and start research on things that Big Pharma don't want to get involved like "cures" for diseases they don't want to cure anything they want to sell drugs so they develop treatments but a cure for anything.

    Big Pharma spend most of its money in propaganda and trials, the research actually cost little to no money.

    Today we can do the trials at no cost at all see the Patients Like Me initiative, besides there is opensource projects trying to unify hospitals and clinics collect data on trials if that is successful that means a lot less money will need to be spent on those things, but of course this goes against Big Pharma that don't want to share that knowledge with anyone.

     

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  21.  
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    Gene Cavanaugh, Dec 28th, 2010 @ 6:48pm

    Study Suggests Placebos Don't Have To Be Secret To Work

    Some time ago, I tried some local (has to be local!) bee pollen in my breakfast to alleviate my severe allergies. No dice for about six months, but (when I was seriously thinking about stopping) I saw some improvement. Note that today I have no allergies of any type; though I can't explain some of them by bee pollen - maybe the plant allergies were a trigger? Don't know.
    ALL my doctors claimed it was placebo effect. One even smiled and talked about "voodoo" and stomach acids destroying things, etc.
    Not too long ago I chanced across a pretty rigorous study (since suppressed - AMA, anyone?) that said local bee pollen seems to be very effective against allergies with long usage. So, placebo effect? I think it just shows that experts are human also.

     

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    Scott, Dec 29th, 2010 @ 8:58am

    Re: Re:

    @Anonymous coward: You can distribute the work across many labs, but that really just slows down research (which means it's ultimately more expensive). In my time as a researcher, I've found that it's more important to have high-powered research centers that contain most of the resources you need (chemical synthesis, biochemical screening, animal testing, etc.) to enable quick decision making and turn-around on data. I'm involved in cross-lab research now, and it's a nightmare.

    It's important to understand that clinical trials ARE research. They are insanely expensive, high-risk experiments in people aimed at figuring out whether or not a compound will have it's intended effect while being safely tolerated. It's fair to say that many clinical trials are aimed at benchmarking drugs against each other to provide a marketing advantage, but many really are basic science.

    The assertion that Pharma isn't interested in "cures" is hogwash. A drug that cures a disease is a competitive advantage over other medications, which means it could be priced correspondingly higher. Pharma already sells cures to some types of cancers. Drugs that completely cure Hepatitis C in some people will be hitting the market soon. Most vaccines, which actually prevent disease, have been discovered and sold by Big Evil Pharma.

    The lack of a cure is always due to a lack of understanding of the underlying biology -- not some corporate conspiracy. That's not to say that there aren't some pretty evil shenanigans that go on within pharma, but they aren't holding back miracle treatments.

     

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