Placebos are 'medicine' too, researchers argue

Sugar pills deserve more respect.

That's the conclusion of international researchers who examined how scientists treated placebo medications in comparison to the "active" target drugs being tested against them in large clinical trials.

Although the name placebo is borrowed from Latin meaning "I shall please,'' the use of inert drugs is largely regarded as a somewhat shameful deception by many modern medical practitioners.

Yet scores of recent studies have shown that placebo remedies often work quite well – typically in 30 and often up to 70 percent of people who take them. It was once thought that the reactions were entirely psychological, built on hope and trust that the healer who gave them the pill was trying to help.

But advances in brain imaging and the understanding of mind-body connections have demonstrated there is a physical element to the placebo effect. For instance, one Michigan study on patients given a fake anti-pain cream before receiving a mild electric shock to the wrist were found to have activated regions of the brain that took an expectation of less pain and passed it along to the actual pain-sensing areas. Other research has shown the pills can regulate heartbeat and respiration, reduce stress hormones and influence release of brain chemicals.

Other research, like a 2010 Harvard Medical School study involving patients with irritable bowel syndrome, found that even when they were told they were getting inert pills that were supposed to improve symptoms "through mind-body self-healing process" more than half who got them experienced relief of their symptoms.

While trial by sugar pill was once the gold standard for proving the worth of new medicines, placebos have frequently beat out target drugs for conditions like depression or anxiety in recent years.

Researchers think that in many cases, patients simply believe that any pill they get is likely to make them better. And in some instances, scientists have found that providers working with placebo patients are simply nicer, or provide some additional counseling or monitoring that makes for better outcomes.

One widely-reported 2008 survey of nearly 250 Chicago area internal medicine specialists found that almost half had given a placebo to at least one patient during their career; less than 10 percent said they'd told the patient they were giving him or her a pill with "no specific effect."

Yet professional ethics codes, such as that of the American Medical Association, prohibit doctors from prescribing treatments that they consider to be placebos unless they inform the patient and the patient gives specific consent.

In many drug tests, patients – and often health providers-- are not told who's getting what, only that some will get a placebo and some the active drug.

But in the 45 trials examined by researchers from the University of Southampton, England, Harvard Medical School and Northern Arizona University, the wording of informational leaflets when discussing placebos did not reflect the new appreciation of what placebos can do, the team reported last month in the online journal PLOS One.

They noted that emphasis was given on the target treatment being more desirable to receive than the placebo and the target treatments were typically described as "real" or "genuine" while placebos were mainly referred to in comparison with the target drugs or described in negative terms, such as "dummy" or "fake."

And the leaflets usually mentioned both the potential benefits and adverse effects that might be brought on by the target drug, but seldom discussed any potential effects from placebos.

"We believe the health changes associated with placebos should be better represented in the literature given to patients before they take part in a clinical trial,'' Dr. Felicity Bishop, the lead researcher and a lecturer in psychology at Southampton, said is a statement.

Right now, the placebo effect is largely ignored in patient information pamphlets, which not only denies patients knowledge they should have, but could also affect results of experiments, the researchers said.

"There is an important issue of consent here – patients should be fully aware of possible health changes from all treatments in a trial before agreeing to take part,'' she added.

(Contact Lee Bowman at BowmanL@shns.com )

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