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Sunday, February 21, 2010

The Awesome Power of Placebos

Placebos are a very curious subject. By definition these are sham pills, often called sugar pills, or treatments that are given in a study as comparators to the active drug or treatment. Sometimes disparaged as trickery, placebos are now earning a respected place among the medical cognoscenti. As witness to this, a review article in this week's Lancet, Biological, clinical, and ethical advances of placebo effects, concludes that placebos indeed can induce meaningful and helpful clinical effects, and that further research is needed to define how best to transparently harness these effects to the patient's benefit.
Well. Who knew that those inert sugar pills, simulated treatments, and other forms of quasi-medical quackery would legitimately earn the right to reside in the therapeutic armamentarium? (Apologies to nonmedical folks reading this; that's the constellation of remedies, medications and procedures that can be considered in the treatment of ailments).

The review article cites some very interesting observations made in studies. For example, when drugs given without the patient's knowledge by a computer pump are compared to those given by a physician, those given by the physician result in more therapeutic benefit. This would be the self-same medication at the same dose. Similarly, pain medications given by injection are rated as providing more pain relief than oral drugs. Same drug. Clearly something besides receptors or other bodily mechanisms is at work here.

The authors cite research identifying psychological factors such as expectation and/or desire for the relief of symptoms such as pain, and conditioning as important in allowing placebos to work, but also tantalizing findings related to pathways in the brain in additional to the well-known opioid receptors that seem to be activated.

Perhaps most interesting is the frontier of research into placebos and how to harness their power to improve treatments. Ethics must also be considered here; is it okay to treat a patient by tricking him or her into a certain belief, even if that belief triggers the desired end? Hmmmm. But as Rick points out in the podcast, the great thing about placebos is they're free of side effects.
Other topics this week include research into King Tut's pedigree in this week's JAMA, aspirin use and breast cancer recurrence prevention in this issue of the Journal of Clinical Oncology, and brain activity in those in a persistent vegetative state in NEJM. Until next week, y'all live well.

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