Placebo or Platitude?

The first widely accepted report on placebo effect was written by an anesthesiologist who claimed in 1955 that 35 per cent of patients got better with nothing but a fake pill. Eventually, placebos became part of the gold standard of Western research and drug-testing protocol. They were viewed as a tool to improve objectivity of investigators and the accuracy of results.

Only recently has the placebo itself been embraced as a subject of scrutiny, and opinions on this phenomenon vary. Some even question its existence. In 2001, University of Copenhagen researchers reviewed 114 clinical drug trials, involving 7,500 participants, and found next to no statistical evidence of a placebo effect.

More scientists, however, believe it is real and are more concerned with determining how placebo works, and how much. One current train of logic suggests that if placebo is beneficial enough on its own — without the side-effects — why would we need treatments and drugs? This issue was highlighted in May 2002, when researchers who’d analyzed 96 studies on antidepressants reported that 75 percent of patient response could be duplicated by placebo. More than half of participants who took sugar pills responded equally well to “treatment” as those given real antidepressants.

“Most people think of placebo as a simple matter of imagination, a case of ‘mind over matter, writes Gabor Mat?MD, in When the Body Says No (Alfred A. Knopf, 2003). “Although induced by thought or emotion, this placebo effect is entirely physiological. It is the activation of neurological and chemical processes in the body that serve to reduce symptoms or to promote healing.”

Indeed, growing evidence shows placebos cause observable physiological changes. Medical imaging has revealed how taking a sugar pill can change a patient’s brain activity and neural networking, if only temporarily. Swedish and Finnish researchers, using an advanced scanning technique, reported in their findings that placebos activate the same brain circuits as painkilling drugs. Placebos have been shown to not only boost activity in areas of the brain responsible for mood and memory in patients with clinical depression, but also brain dopamine levels in Parkinson’s patients (Parkinson’s worsens as dopamine levels decrease).

This psychological/physiological debate is just one that a group of Canadian scientists hopes to address in a series of six new projects intended, at Health Canada’s instigation, to boost Canada’s supply of placebo research.

Better understanding of placebos, researchers hope, will eventually improve drug delivery information. Currently, a drug’s effectiveness is considered the difference between the responses of the placebo and drug groups.

But some people have raised questions about the morality of using placebos with patients who believe they’re receiving real drugs (and other treatments). Even Canada’s own scientific guidelines prohibited placebos in most research until six years ago. Back then, one could only prescribe placebos if the ailment was so minor it could go without drug treatment, or if conventional intervention was unavailable for some reason.

Now, regulations state that administering placebos is acceptable so long as trust is maintained in the doctor-patient relationship. Accordingly, upcoming studies by the Placebo New Emerging Team (NET) will include asking permission to “deceive” participating patients when necessary. Initial funding of $1.2 million comes from the Canadian Institutes of Health Research.

Meanwhile, as study of placebo continues, drug companies haven’t refrained from attempting to profit on this apparently inherent human capacity for self-healing. Last August, the US Food and Drug Administration (FDA) approved the first prescription placebo. Eleven pharmaceutical companies have created placebo pills or liquids.

The first to hit the market, Sucrosa from AstraZeneca is basically powdered sugar and ranges in doses from one to 40,000 milligrams. Analysts expect Sucrosa to pull in sales of more than $25 billion a year.

GlaxoSmithKline is hot on the heels with two placebo versions of their own. One’s a 40-mg pill called Appeasor, marketed to ages 55 and up. The other’s a cola-flavoured beverage, Inertia, for middle-aged women. Finally, lest they miss out, Eli Lilly’s Pacifex, is a green 400-mg triangular tablet.

“For years, scientists have been aware of the effectiveness of placebo in treating a surprisingly wide range of conditions,” said Jonathan Bergen for the FDA’s Center for Drug Evaluation and Research. “It was time to provide doctors with this often highly effective option.” An AstraZeneca spokesperson concurred, “We couldn’t be more thrilled to finally get this wonder drug out of the labs and into consumers’ medicine cabinets.”

What seems to be forgotten amid all this special packaging is the fact that placebo (belief) lies within the individual. In fact, while Western science continues to dissect placebo with fervour, other medical traditions would view the endeavour as misguided.

Eastern healing traditions do not separate the mind, body, and spirit in matters of health and well-being. Thus, placebo (belief) is always viewed as part of the whole. Any healing journey would automatically contain the mental, emotional, or spiritual components traditionally discarded by orthodox medicine.

From the perspective of traditional Chinese medicine (TCM), “There’s no such thing as a placebo,” says Harreson Caldwell, a TCM practitioner at the Caldwell Clinic in Vancouver. According to ancient Chinese philosophy, chi (energy) follows intention.

For instance, as an acupuncturist, he says, “If your intention [for] isn’t there, you’re not going to get results [in].” This also means researchers conducting tests involving placebo - and not just participants in those tests - are able to influence the outcome of results through their chi.

Hence, objectivity - the basic of Western scientific thought - is a myth, because everything is interconnected. This is why, Caldwell says, the more we mix the scientific medical point of view with TCM, the worse mess is created.

Caldwell notes that the belief of the patient is very important. He teaches his patients meditation to let go of fear and other negative, damaging emotions. “The mind can heal you, or kill you. With toxic thoughts, we make ourselves ill,” he says.

In the end, the power of positive thinking will undoubtedly play an increasing role in health, healing, and our definition of effective medicine. For placebos, as understanding advances and beneficial applications widen, the future is nothing but bright.

Power of placebo. Mind over matter. Call it what you wish, interest in this field has increased alongside that of complementary medicine. Many, if not most, alternative therapies, such as traditional Chinese medicine and Ayurveda, acknowledge a connection between mind, body, and spirit that has largely gone unacknowledged by modern Western science - until now.

Psychoneuroimmunology is the scientific term to describe the study of the mind-body connection. The underlying acknowledgement is that a person’s mental and emotional state contributes to the onset of, and conversely, the recovery from disease.

It’s possible to improve the body’s immune response by fostering positive emotions and a calmer state of mind through yoga, meditation, tai chi, art therapy, journaling, and guided relaxation.

To some people, this built-in power is not only reassuring, but also worth cultivating. “To use our own thoughts is one of the most powerful and least damaging therapies out there,” says Jane Parish, a health-care consumer in Vancouver, BC. “If you believe it works, it works. Why not use it?”