What’s up with placebo pills?


This article about the placebo effect first appeared in Cosmos Weekly on October 1, 2021. For more stories like this Subscribe to Cosmos Weekly.

the website for Zeebo Relief tablets reads like any other suspiciously vague alternative health treatment. “Help us harness the power of your mind and body,” enthuses the website. The pills have been “used” in published clinical trials (it is always “used” with these things, not “proven effective”) for “chronic pain, stress, and performance”. They apparently allow you to shape your own experiences and “focus” on “concentration, clarity, calm, and symptom relief”.

But there is one major difference between Zeebo and homeopathy that deserves at least some attention, if not respect: Zeebo is open to the fact that their pills have no medicinal effects. They are “honest placebo pills”.

“You are the active ingredient,” emphasizes the side. The idea is that you take the pill knowing it won’t do anything, but – through the psychology or biology, or possibly the magic of the placebo effect – your symptoms will subside. The pills currently cost $ 20 (about $ 27) per bottle plus shipping; the price fluctuates.

Placebos play a crucial role in clinical trials. Without placebos, it is difficult to distinguish between the effects of the drug being tested and the effects of simply participating in the study – whether positive or negative.

But clinical trials have never been the only home for placebos. We know that people who believe they are receiving medical treatment often get better anyway, and there have been examples over the past centuries of people trying to turn it into real medical treatment.

This interest has increased over the past ten years. A 2010 Cochrane review found that while placebos weren’t effective in most cases, they were modestly good at relieving pain and nausea. Since then, studies have sprung up that advocate the use of placebo, especially for chronic pain, but also for other diseases.

These studies, most of which are small and none definitive, involve Professor Chris Maher of the University of Sydney’s School of Public Health.

Without placebos, it is difficult to distinguish between the effects of the drug being tested and the effects of simply participating in the study – whether positive or negative.

“Over the past two or three years I’ve read a lot of comments and editorials where people overstate the research and very strongly suggest that clinicians should use placebos in clinical care, which really seems like a real thing to me, an unwise move,” he says.

Maher is the lead author of a current perspective by doing Medical Journal of Australia You caution against taking any of these studies too enthusiastically. The proven effects of placebos are modest, the paper argued, and the studies that showed the most promising results are almost all small and curious in method.

“What sets most research apart is its poor quality,” says Maher.

“For example, it is widely believed that the color of the placebo capsule affects its effects. People think that a red pill works better than a white pill. But if you go back and look at the research […] the people involved did not actually take the pill. You just put pills on a table and then asked people with no health problems, ‘Which of these pills do you think is the strongest?’ “

Other studies on open-label placebos have theoretically shown even more promising effects. One prescribed an open-label placebo for three weeks for lower back pain and then claimed participants experienced benefits after five years.

“They did that by throwing away the control group data, and most clinical trials just looked at that and said, this is just crazy, why would you do that?” Says Maher.

“There is no pain reliever that you would take for three weeks for chronic low back pain and you would claim an effect five years later.”

Maher says that in placebo research, especially open placebo research, two things happen.

“There are people who follow the usual rules of science and pretty much sum things up. And there is another group of people who seem intent on making the placebos mysterious and powerful. “

He believes this is of particular concern as the prescription of placebos among Australian health workers could increase. A 2019 paper by doing Australian Journal of General Practice found that 39% of Australian general practitioners had given their patients an inert placebo at least once and 77% had used an “active” placebo: a drug that worked but did not treat the patient’s condition (e.g. viral infections).

Professor Mark Morgan, who both teaches undergraduate students and works as a general practitioner, and also chairs the Expert Committee on Quality Care at the Royal Australian College of General Practitioners, is less concerned about these statistics. For one, it’s a small study: there were only 136 participants in the survey that was used in the study. On the other hand, some terms in the survey were vague.

“Some of the things that were called placebos weren’t placebos depending on the application. Those would be mild treatments, ”says Morgan.

One example is saline spray, which was described as a placebo in the study. “If you say to someone, ‘This is a salt water spray to clear your nose,’ I wouldn’t say it was a placebo. It won’t cure anything, but it could help with symptoms if used. “

Morgan says it is a major breach of trust to prescribe truly useless placebos without telling the patient that they are useless.

I think the concern about prescribing or using a treatment, knowing that the treatment will not do anything for the person, is that you are actually violating some trust.

– Professor Mark Morgan

“I think the concern about prescribing or using a treatment, knowing that the treatment is not doing anything for the person, is that you are actually violating a certain trust,” he says. “The person’s trust is fragile, but it is also very valuable and necessary for future treatment, the person’s trust, and the medical advice they may receive.”

The study also addresses another important issue for general practitioners: 40% of placebo prescribers said their patient was expecting or requested treatment.

“Again, this is not really a placebo. It is the bowing to pressure and expectations that I think can be overcome in really good conversations, ”he says.

“To what extent should a family doctor respond to a treatment request if he knows that this treatment is unlikely to be of any use to the patient? I think it comes down to the adult-to-adult conversation and ultimately the mutual decision-making. They explain from the patient’s perspective what potential harms and costs for that patient are compared with the potential benefits. It’s a conversation we have every day about antibiotics for coughs and colds and sinus congestion. “

Both Maher and Morgan agree that the placebo effect has some benefits in certain situations, but it shouldn’t replace medical care.

“I think there is still some research to be done on how people’s expectations of treatment affect the outcome of that treatment. I suspect the answer is a little, but not as dramatic as some people think, “says Morgan.

“Something about the therapeutic ritual influences the effects of the treatment, so it may have something to do with the fact that the doctor is empathetic and the clinician is calming,” says Maher.

“[If] We actually define all of the other things that are going on in the very rich clinical setting and then measure them and see if there are any related effects that could be a useful thing.

“But if we’re still in the ‘it’s all about the red pill’ phase, I think it’s pretty simple for me.”

In short – spend that $ 20 (plus shipping) on ​​something more tangible.

This article first appeared in Cosmos Weekly on October 1, 2021. To see more in-depth stories like this, subscribe today and get access to our weekly e-publication, as well as access to all previous issues of Cosmos Weekly.

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