Doubt cast on power of placebo

Doubt cast on power of placebo

Study finds sham treatment less effective than once thought

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May 23 — Defying the conventional medical wisdom that dummy pills or other fake treatments can help patients through the power of the mind, researchers found the “placebo effect” lacking in dozens of studies.


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‘The shoe is on the other foot now. The people who claim there are placebo effects are going to have to show it.’
— DR. JOHN C. BAILAR III
author of accompanying editorial

THE SURPRISING finding led the researchers — Drs. Asbjorn Hrobjartsson of the University of Copenhagen and Peter C. Gotzsche of the Nordic Cochrane Center — to conclude in this week’s edition of the New England Journal of Medicine that, “Outside the setting of clinical trials, there is no justification for the use of placebos.”
In many medical studies, patients in one group receive an experimental new treatment, while a comparison group gets a lookalike dummy pill or other placebo. Neither the patients nor the doctors know who is getting what. The goal is to see if medicines being tested do more good than people’s will to get better.
Studies occasionally include a third group not getting a placebo. Those patients receive nothing, or just get the standard treatment for a condition if the study is testing whether combining a new treatment with the current one is better.


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The Danish researchers combined the findings of 114 such studies from around the world, involving dozens of conditions ranging from colds and seasickness to Alzheimer’s disease and schizophrenia, to see how the sham treatment stacked up to no treatment.
In most of the studies, the placebo group fared about the same as the group getting no treatment. The exceptions were studies of pain treatments and some others with subjective results, meaning patients reported how much symptoms bothered them, rather than having an objective measure such as blood pressure.
Placebo recipients in the pain studies averaged a 15 percent reduction in pain, and patients in the other subjective studies had even smaller improvements.
Many past studies and textbooks suggest that about one-third of patients given placebos in medical experiments get better, presumably because they believe they are getting an effective treatment. But such studies do not take into account the natural history of disease, which can wax and wane in severity.

STRONG REACTIONS
“The shoe is on the other foot now. The people who claim there are placebo effects are going to have to show it,” said Dr. John C. Bailar III, a just-retired professor of health studies at the University of Chicago who wrote an editorial accompanying the research in Thursday’s New England Journal of Medicine.

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Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania and MSNBC Breaking Bioethics columnist, said: “I was shocked by this study. This just goes completely against the grain.”
Dr. Stephen Schneider, a professor of medicine at University of Medicine and Dentistry of New Jersey in New Brunswick, has worked on many trials where patients on placebo improved. He said some of those patients would have gotten better with no treatment. In addition, he said, simply participating in a medical study induces patients to eat better, exercise more or otherwise pay more attention to their health.
Schneider and Caplan said many doctors routinely prescribe placebos to reassure patients who want every possible treatment.
That includes giving antibiotics to people with colds, which cannot help, recommending heavy doses of vitamin C for the flu, or prescribing a drug that is unlikely to work but might give hope to a patient with a terminal illness.
Richard Gracely, a scientist specializing in pain research at the National Institutes of Health, noted that Hrobjartsson’s report did not state how much the active treatment in the 114 studies helped patients.
Gracely said that might be important because the magnitude of the placebo effect in past studies generally was proportional to the active treatment’s effect.

Bailar noted placebos may still turn out to be valuable for treating pain but wrote, “At present, I could not want to prescribe or receive a placebo without some reason that was far more specific than weak evidence of some general ‘placebo effect.’”
Placebos are not always innocuous, he added, “They may divert patients from seeking more effective treatments, they may mask symptoms that need attention, they add to the cost of treatment, and they may have unexpected psychological effects,” such as serving as a reminder to feel ill, he said.

The Associated Press and Reuters contributed to this report.

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