The power of the placebo gains new prestige

Researchers look at not just the pill you take but also how you perceive it

Health & Fitness

July 28, 2002|By Stacey Burling | Stacey Burling,PHILADELPHIA INQUIRER

When Daniel Moer-man's back begins hurting, he reaches for a bottle of Advil, but he pauses a moment to talk to them before swallowing them.

"You are the best pills in the world," the University of Michigan-Dearborn anthropologist tells them. "This pain is going to go, and I'm only going to need two, not three."

He pauses again to think about the medicine spreading through his body before he washes the two pills down with a glass of water.

What Moerman is attempting to do -- and he says it works -- is use the placebo effect to make his Advil work better.

"I believe that belief makes a difference, and so I enhance my belief," said Moerman, a large man who routinely needed three pills before he began these little talks. He pointed out that a study found patients given real pain medicine reported more relief when they saw the doctor injecting it than when it was given secretly by IV.

"You and the drug are combining together to make a more powerful physiological response," he said

Moerman's approach to his Advil marks a significant change in how researchers think about placebo, said Arthur Kleinman, a psychiatrist who teaches medical anthropology and psychiatry at Harvard University.

Most people still think of placebos as sugar pills -- actually, they're usually made of milk powder -- that doctors give test subjects to measure the "real" effects of a drug they're studying. Some people get the drug, some the placebo. The difference between the two is the effect of the drug. The rest is commonly known as the "placebo effect."

But in the last decade, researchers have begun to see placebo as more than a pill. The placebo effect is another aspect of mind-body synergy, the result of what you think the pill can do for you.

"It's a reaction, a process," Kleinman said. "It's enormously important because it's one of the examples of how the social world and the body are in constant interaction."

Researchers have often wanted to minimize the placebo effect because it got in the way of pharmacological science. Now, some say, it makes sense to make the most of it in the doctor's office.

"People are realizing more and more that the placebo can be an aid to the clinician," said Andrew Leuchter, professor of psychiatry at UCLA. "We can work with patients to have greater relief of their symptoms than they would get from medications alone."

The placebo effect is experiencing a resurgence today in part because of new brain imaging studies that are giving it "new respectability," said Anne Harrington, who co-directs the Mind, Brain and Behavior Initiative at Harvard.

In a study published last summer, for example, Canadian researchers used PET scans to measure the effect of a saline injection on Parkinson's disease sufferers who had been told they would get either a drug or a placebo. Those who perceived benefit from the placebo released more dopamine in the brain than those who didn't.

Another study, published in January, mapped electrical brain signals after patients at UCLA took either an anti-depressant or placebo. In both cases, if patients became less depressed, there were changes in the prefrontal cortex. Oddly, though, activity decreased with the drug. With placebo, it increased.

"We've always thought placebos are no treatment, and this study clearly shows that placebos are not no treatment," said Leuchter, who led that study. "There's something potent going on here. It may not be curative, but it may be powerful."

In addition to mild depression, placebos also have an impact on pain, anxiety, panic, blood pressure and arthritis, experts said. But there is little evidence that they have much effect against cancer, schizophrenia or a bacterial disease like pneumonia.

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