The most reliable clinical studies compare a treatment that is being tested with a fake treatment (called a placebo). Generally, half the people in the study get the treatment and half get the placebo and the then the two groups are compared. In the case of pills the placebo is often a sugar pill. Researchers can even test the effectiveness of a surgical procedure by comparing it with a sham or fake procedure. In these studies (called randomized controlled trials or RCTs), patients (and their healthcare teams) don’t know who is getting the pill or procedure being studied and who is getting the placebo. The reason for this is that patients sometimes get better when they are given a placebo because they believe they will get better (called the “placebo effect”) or because their disease got better on its own.
So can patients get better just by believing they will get better? And can doctors actually prescribe placebos to help people get better?
Last year, Dr. Danielle Ofri wrote about this in a New York Times article entitled A Powerful Tool in the Doctor’s Toolkit. She recalled a time during her medical training when she was so frustrated with a patient who was complaining about pain that she finally gave him an injection of saline (a salt solution)…and his pain got better. She felt horribly guilty at the time but new research suggests that giving patients a placebo can work even if they know they are receiving a placebo.
The Program in Placebo Studies & the Therapeutic Encounter at Harvard Medical School does research to figure out how placebos work. The director is Ted Kaptchuk, a former acupuncturist and his team has done studies that suggest that some people may be more likely to respond to placebos than others based on their genes. One recent study from his group, discussed on NPR, looked at a medicine called rizatriptan (Maxalt) that is used to treat migraines. The researchers found that migraine patients taking Maxalt given in an envelope that was labelled “placebo” had similar improvement to patients taking a placebo given in an envelope labeled “Maxalt”. This suggested that the effect of the drug is influenced by what patients think they are taking.
Some scientists criticize the placebo research for being biased or for drawing conclusions that are not really supported by the studies. There is certainly not enough data to be able to use placebos in treating patients but the research shows that the brain can have powerful effects over the body.
The Robert Wood Johnson Foundation has funded a project to look at how placebos can be used in treating patients. The Program in Placebo Studies & the Therapeutic Encounter is working on this project with help from the Informed Medical Decisions Foundation and the Center for Primary Care at the Massachusetts General Hospital.
Hopefully, this work will teach us more about how the placebo effect works and if it can be used as a treatment to help people get better.