Wednesday, August 26, 2009

The placebo effect

Very interesting article (via Matt Yglesias) about the placebo effect, and particularly how it is increasing, culturally dependent, and recently studied more directly.

I've always wondered why it was not the focus of study, but exclusively the baseline for study of other drugs, and why there is not a protocol (the ethical dilemmas should not be impossible to address) in place for directly prescribing placebos in cases where it is is likely to be effective and when, for example, side effects of "real" drugs are severe in general or for a particular patient. Doctors self-admittedly already do this by prescribing ineffective treatments - why can they not simply prescribe a placebo and call it something else (and I mean really brazenly: prescribe Valium and give them sugar pills, don't prescribe drug RG8789 which is secretly a sugar pill). This should at least be allowed in situations where the patient has previously signed on to such a program (maybe as an option through your insurance plan that any doctor can see - or as an option with each individual doctor or hospital, although I suspect that the more often you say "yes you are allowed to lie to me", the more you expect to be lied to, and the less effective is the placebo effect, so ideally it would be through insurance, which is both rarely changed and psychologically removed from the actions of particular doctors during particular office visits.)

Anyway there are lots of really interesting points in the article and this question of making placebos a mainstream remedy was not really one of them, that's just my own interest. More relevantly, placebo effects are highly culturally sensitive (drug companies now like to go offshore to run trials) and are increasing over time (possibly due to the success of pharmaceutical advertising raising our expectations of the effects of pills in the last 20 years). They have certain known chemical mechanisms (opioids released in the brain under stress, which reduce pain and moderate heart rate and respiration), and many un-understood mechanisms (blue pills typically reduce anxiety except in Italy where it is the national soccer team's color...). The placebo effect is more potent when fake drugs are administered with higher frequency, but can be a long-term benefit, contrary to popular wisdom. And, most intriguingly, it can be very very strong.