One patient stands out in the memory of Stephen Straus, M.D., for her remarkable recovery, more than 10 years ago, from chronic fatigue syndrome. The woman, then in her 30s, was "very significantly impaired," says Straus, chief of the Laboratory of Clinical Investigation at the National Institute of Allergy and Infectious Diseases. "She had no energy, couldn't work, and spent most of her time at home." But her strength was restored during a study to test the effectiveness of an experimental chronic fatigue drug.
"She and her parents were so thrilled with her recovery that they were blessing me and my colleagues," recalls Straus, the principal investigator on that study.
Like many drug studies, the chronic fatigue medication trial was a "placebo-controlled" study, meaning that a portion of the patients took the experimental drug, while others took look-alike pills with no active ingredient, with neither researchers nor patients knowing which patients were getting which.
It's human nature, Straus explains, for patients and investigators alike to try and guess in each case: Is it the real drug or a dummy pill? But people shouldn't kid themselves, he says, that they can consistently tell the actual drug from the sham by seeking out tell-tale signs of improvement.
Turns out, the woman's quick turnaround from chronic fatigue occurred after taking placebo pills, not the experimental drug. Straus says, "She was amazed by the revelation that she'd gotten better on placebo."
Research has confirmed that a fake treatment, made from an inactive substance like sugar, distilled water, or saline solution, can have a "placebo effect"--that is, the sham medication can sometimes improve a patient's condition simply because the person has the expectation that it will be helpful. For a given medical condition, it's not unusual for one-third of patients to feel better in response to treatment with placebo.
"Expectation is a powerful thing," says Robert DeLap, M.D., head of one of the Food and Drug Administration's Offices of Drug Evaluation. "The more you believe you're going to benefit from a treatment, the more likely it is that you will experience a benefit."
To separate out this power of positive thinking and some other variables from a drug's true medical benefits, companies seeking FDA approval of a new treatment often use placebo-controlled drug studies. If patients on the new drug fare significantly better than those taking placebo, the study helps support the conclusion that the medicine is effective.
Benefiting from Belief
Researchers have been studying the placebo effect for decades. In 1955, researcher H.K. Beecher published his groundbreaking paper "The Powerful Placebo," in which he concluded that, across the 26 studies he analyzed, an average of 32 percent of patients responded to placebo. In the 1960s, breakthrough studies showed the potential physiological effects of dummy pills--they tended to speed up pulse rate, increase blood pressure, and improve reaction speeds, for example, when participants were told they had taken a stimulant, and had the opposite physiological effects when participants were told they had taken a sleep-producing drug.
Yet, even after 40 years, big questions remain about the interplay of psychological and physiological mechanisms that contribute to the placebo effect. Today's brain imagery techniques do lend support, though, to the theory that thoughts and beliefs not only affect one's psychological state, but also cause the body to undergo actual biological changes.
The phenomenon needn't baffle us, says Michael Jospe, a professor at the California School of Professional Psychology who has studied the placebo effect for more than 20 years. He points out that all people experience physiological reactions to anticipation and stress--something like the fight-or-flight response--that help them to survive and cope. When you step out of your office and a spider jumps out at you, Jospe analogizes, "you'll get a fright and have a physiological reaction. And the next time you go out that way, the thought that it could happen again can produce a physiological reaction before you even open the door." So, he says, the relationship between a thought and a negative psychophysiological reaction like fear is something we experience daily.
That goes for positive associations, too, Jospe continues. "The placebo effect is part of the human potential to react positively to a healer. You can reduce a patient's distress by doing something which might not be medically effective." It's like kids and Band-Aids, Jospe says. "When you put a Band-Aid on a child and it has stars or comics on it, it can actually make the kid feel better by its soothing effect, though there's no medical reason it should make the child feel better."
There is no medical reason, either, that look-alike placebo tablets used in a 1997 study of benign enlargement of the prostate gland should have made the study participants feel better. But in this Canadian study, more than half of the men who got the placebo pills reported significant relief from their symptoms, including faster urine flow. Researcher J. Curtis Nickel theorized that the patients' positive expectations of the experimental drug's benefits may have caused therapeutic smooth muscle relaxation by decreasing nerve activity affecting the bladder, prostate and urethra. Study participants on placebo complained of side effects, too (sometimes called the "nocebo" effect), ranging from impotence and reduced sex drive to nausea, diarrhea and constipation.
It's this powerful placebo effect, coupled with the fact that many medical conditions involve a natural course of better and worse periods (arthritis and multiple sclerosis are examples of diseases with flair-ups and lulls), that can make it difficult to know if a health upswing should be credited to a drug effect. One way to account for such variables in a drug study: give one group of patients placebo and another the experimental drug, and see if the drug group's health improvements sufficiently surpass those from placebo. In Straus' study, the chronic fatigue syndrome drug failed to adequately demonstrate its superiority over dummy pills
Posted by SouthernCO (Member # 11167) on :
What a surprise that there is a human being who suffers from an imagined ailment. Maybe that is why hypochondria is in the medical books.
Is the author trying to convey that CFS may be a imagined illness? If so, then so may be fibromyalgia? And chronic Lyme disease? And babesiosis? And MS?
And the mainstream drs wait with baited breath.
May they all get bit by deer ticks.
Posted by Kendrick (Member # 10990) on :
I think it's worth a try, to someone who is sick. Otherwise, if the placebo doesn't work, move on to finding the actual problem.
It just annoys me when doctors say this about a patient, and can't back it up... due to being lazy.
Posted by Vermont_Lymie (Member # 9780) on :
quote:Originally posted by Joe Ham: Greatcod, Just imagine how many people could be cured with my Double Strength Placebos. I have a fresh supply on hand; write for discount pricing. Joe
Posted by Greatcod (Member # 7002) on :
I'll take a six pack.
Posted by Al (Member # 9420) on :
I went to my doctor last week and told him I was really, really sick, He asked "How do you know your sick? I said The placebos you gave me last week aren't working !
[ 11. June 2007, 03:06 AM: Message edited by: Al ]
Posted by Greatcod (Member # 7002) on :
My intent in posting this was mostly to point out that the faith a person has in the treatment and the healer can be very powerful. That as human beings our reports of how well a treatment works can be significantly influenced by our mind sets. Its a major problem for conventional medicine and for alterative treatments as well. Given that Lyme is an up and down thing anyway, and that some people experience significant remission without any treatment, it can be very difficult to determine the true effectiveness of any protocol. Important to my sanity as I wander through the minefields of Lymenet's many testimonials of what works.
Posted by Soleilpie (Member # 8481) on :
Al
It would be illegal for a doctor to give you a placebo without your consent.
If you're a research subject, then that's a different story.
However, you still have to consent to being given the actual drug or placebo while in a study.
I suppose if your doctor has his own pharmacy at his office, then he could illegally give you a placebo w/out your knowledge.
But I think most people go to a pharmacy not directly affiliated with physicians, like Walgreens and CVS.
Posted by Al (Member # 9420) on :
Soleilpie, It was an attempt at humor, sorry it didn't come out that way. I deleted that part. al
Posted by GiGi (Member # 259) on :
As long as you call it "our illness" - "my illness" -- you can depend on it, it is going to remain yours.
Your body follows your brain.
Posted by Kendrick (Member # 10990) on :
quote:Originally posted by GiGi: Your body follows your brain.
Your body follows your brain... and your brain follows your body.
To be more precise--> There is a correlation between your body and mind.
When your body doesn't feel good, nether will your mind, and when your mind doesn't feel good, neither will your body.
Again, it's worth a try, but if positive thinking killed diseases, I would have never gotten sick. (and I'm not gullible to think that I'm the only one)
I can go into 100 pages about conditioned response, and people correlate things to their senses, with sight and hearing being the most important.
Conditioned responses, which is the same as prejudices, allow us to see that healthier people are more positive. But the cause and effect are miscontrued that being positive leads to being healthy.
Prove that being positive leads to being healthy, as the cause and effect, as opposed to being healthy leads to being positive, as the cause and effect. There's no way too.
You can prove that being healthy can lead to positive thinking. Excercising is the greatest 'mood-booster', and helps those with moderate/mild depression/anxiety.
Posted by Aniek (Member # 5374) on :
The placebo effect exists and is real. This doesn't mean that people who get reduced symptoms from a placebo never had an illness.
As the article says with the prostate gland, the placebo may have resulted in relaxed muscles. The people still had the problem, but they thought it was being treated which may have reduced stress, leading to relaxed muscles, and therefore reduction in symptoms.
I also believe that the placebo effect may sometimes exist because our brain is kicking our immune system into action. We think we are getting a medicine, so our bodies start acting as if something is being cured. So our bodies start fighting something they otherwise wouldn't fight.
Another explanation is that when you are chronically ill, it does effect you psychologically. Your stress increases and this can cause an increase in symptoms. The placebo effect may be a stress reduction, so the additional symptoms from stress are reduced. You still have some symptoms, but not as many.
There was a recent thread of how people feel better on vacation. Another thread about how people feel better when they have their mind focused on other things. That all shows that our mind interacts with the symptoms.
This article isn't say people with the placebo effect aren't sick. It's saying that people can have a reduction in symptoms from believing they are taking a beneficial medicine. Reduction in symptoms isn't the same as cure.
Posted by on :
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