Trying to Understand the Placebo Effect

Can a sugar pill really make you feel better? How do you explain it when a "sham" treatment helps to ease your pain? Were you destined to feel better anyway, or was it the placebo effect?

The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health, defines the placebo effect as "desirable physiological or psychological effects attributable to the use of inert medications." Placebos can also be active substances or real procedures that produce unexpected beneficial effects. For example, antibiotics may be considered placebos when prescribed for viral respiratory illnesses that are not expected to respond to antibiotic action.

The potential use of placebos for medical benefit and their continued use in clinical trials have recently been the subjects of considerable interest-and controversy-among the lay public and scientists alike.

As such, NCCAM has just embarked on an ambitious initiative to delve into the mysteries of the placebo effect; whether it is real or not; and if so, how best to utilize it in clinical practice.

"As a center that emphasizes clinical research, NCCAM needs to understand the placebo," said Dr. Stephen Straus, Director of NCCAM. "There are numerous aspects to tackle with regard to the cultural, social and genetic factors associated with placebo effects, what induces them, and how long they persist. There are also profound ethical issues that affect studies of the placebo, and questions about optimal clinical study designs to account for their confounding effects."

Moreover, he added, "the placebo effect has major implications for the conduct of all clinical trials."

Anecdotal History

Placebos first developed a negative connotation when the term was coined in the early 19th century to describe a medicine "adapted more to please than benefit the patient." With the era of "modern" medicine, particularly since the Second World War, this pejorative connotation was further reinforced when the randomized double-blind placebo-controlled clinical trial emerged as the standard strategy for medical research.

Yet, prior to this, medical practice routinely included what we now call placebos as part of standard patient care. A wealth of anecdotal evidence demonstrated that patients sometimes felt better and even showed marked improvements in health with no more than the suggestive influence of placebos.

In recent years, a growing number of researchers have begun studying this "mind-brain-body" interaction, including how it influences health and healing at the organismal, cellular, and molecular levels.

The major new research initiative by NCCAM is expected to result in important new findings about how placebos and placebo effects can influence-and possibly improve-clinical patient care.

SOURCE:
National Center for Complementary and Alternative Medicine (http://www.nccam.nih.gov)

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