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Patients in study who knew they were taking placebo still felt better

Doctors surprised that sugar pills had effect anyway

By Deborah Kotz
Globe Staff / December 23, 2010

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Take two sugar pills and call me in the morning. That could become the new mantra of doctors everywhere if a new Beth Israel Deaconess Medical Center study showing the power of the placebo holds water in the real world.

The researchers got some astounding results when they gave placebos — gelatin capsules filled with nondigestible cellulose — to patients suffering from irritable bowel syndrome for three weeks. Nearly 60 percent reported an improvement in their symptoms compared with 35 percent of the patients who took nothing beyond their usual treatments.

But here is the kicker: The placebo takers knew they were popping the equivalent of sugar pills, yet they still said they experienced less abdominal pain, constipation, or loose stools during the study.

In previous studies demonstrating the placebo effect, patients were told they would be given a medication or a sugar pill, that there was a possibility they could be on a real drug.

“There are some things going on that we don’t quite understand,’’ said study author Dr. Ted Kaptchuk, an associate professor of medicine at Harvard Medical School. “We know that placebos represent some kind of self-healing capacity; it could be that taking a pill triggers a sort of unconscious conditioning in our body to begin the healing process.’’

It could also be that the patients were simply helped by seeing doctors who were sympathetic to their symptoms. After all, 35 percent of the study participants who did nothing other than check in with the doctor during the study reported an improvement in their symptoms.

Kaptchuk emphasizes that placebos work best for conditions during which people appraise how they’re feeling; think mood disorders like depression or chronic pain conditions like IBS, fibromyalgia, and osteoarthritis. These are subjective measurements, not objective lab findings that can be quantitatively measured. “I don’t think placebos will improve cholesterol or hypertension,’’ he said, “or shrink a tumor.’’

But they can make people feel better — at least in this small study of 80 volunteers, all of whom were eager to participate in a mind-body experiment. That’s how the study was described in an advertisement to recruit participants, so it might have been biased in favor of those who believe in the placebo effect.

Kaptchuk said the findings need to be replicated in a larger experiment, which he and his colleagues are now planning. Most likely, the high effectiveness rate — better than some prescription medications for irritable bowel syndrome — will drop somewhat with a larger pool of individuals.

If placebos turn out to help even when patients know the pills are fake, it would surmount an ethical dilemma for physicians. Some doctors lie to patients, making them think a placebo is real medication to foster belief in the pill’s healing power. The American Medical Association and others discourage this practice, because it denies patients informed consent.

“We were looking for an honest strategy for dispensing placebos to patients, and I think we showed it can work,’’ Kaptchuk said. Perhaps that will get doctors to stop giving what he calls “impure’’ placebos to patients, such as antibiotics for a cold or vitamins for tension headaches.

About half of 679 American physicians surveyed in a 2008 British Medical Journal study that Kaptchuk co-authored reported giving placebos to their patients, with the vast majority dispensing something other than a sugar pill. Ninety-five percent of doctors who prescribed placebos told their patients they were prescribing “medicine.’’

Deborah Kotz can be reached at dkotz@globe.com.