Placebos May Be A Powerful Tool That Medicine Has Overlooked

Physicians believe placebos work only if patients think they're getting medicine. In other words, doctors have to deceive patients. But there might be a way to get placebos to work without deception.

NOEL KING, HOST:

The placebo effect - it's when people who participate in clinical trials feel better after taking sugar pills, and it's pretty common. Researchers have asked whether doctors can use placebos as a tool to heal people. But there is an ethical hurdle. Most doctors believe placebos work only if patients think that they're getting actual medicine - if they're being deceived, essentially. But there might be a fix. NPR's Shankar Vedantam has the story.

SHANKAR VEDANTAM, BYLINE: For a decade, Linda Bonanno (ph) organized her life around the inevitability of pain. Intestinal problems constantly interfered with her daily routines.

LINDA BONANNO: I couldn't even move. It was worse than labor pains. You're better off having a baby than what I went through.

VEDANTAM: Bonanno didn't know what was causing the pain. One doctor told her she was lactose intolerant. She cut out dairy, but it didn't help. Then one day, she saw an ad on TV.

BONANNO: And my eyes perked. I went, oh, what's this?

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VEDANTAM: A nearby hospital was running a trial for patients with intestinal pain. Bonanno was screened for the study and diagnosed with irritable bowel syndrome or IBS. A physician running the trial gave her pills to take, but then the doctor told her that the pills were a placebo.

BONANNO: Oh, I was disappointed. I knew it was a sugar pill. And I thought, he made me come all the way down here to take a sugar pill.

VEDANTAM: Why tell Bonanno the pills were a placebo? Wouldn't this prevent them from working? That's the question that has intrigued Ted Kaptchuk.

TED KAPTCHUK: I'm director of the Program in Placebo Studies at the Beth Israel Deaconess Medical Center.

VEDANTAM: Kaptchuk realized that doctors had made an assumption.

KAPTCHUK: That deception or concealment is necessary for people to respond to placebo - and I sat with myself for a long time, read the literature. And I said, you know what? No one's tested that ever in history.

VEDANTAM: No one's tested that because for centuries, scientists have used placebos in a more limited fashion; to deflate the claims of con men and to test the efficacy of drugs and medical interventions. Kaptchuk decided to run a study. He hypothesized that the placebo effect might not be just about pills. It might be connected to the trust between patients and doctors, to the rituals of medicine. Patients, including Bonanno, were told upfront that they were getting a placebo. They were also given a kind doctor who treated them like a person, not just a number. Even though Bonanno was disappointed to get a placebo, she followed her doctor's orders.

BONANNO: I said, this is not going to work if it's a sugar pill. And it wasn't until the fourth day I realized I wasn't sick anymore.

VEDANTAM: The pain that Linda had suffered through for a decade vanished.

BONANNO: I felt fantastic. I had no IBS. I was taking those pills every day. And I couldn't believe it.

VEDANTAM: Many other patients in the study got similar relief. Volunteers who received the placebo reported twice the improvement in their quality of life as those who received no treatment. Now, this was a small trial. But since Kaptchuk published the study in 2010, he's looked at the effects of transparently using placebos for other medical conditions. He's found similar, sometimes better results for low back pain and cancer-related fatigue. How can it be that patients get better on placebos when they know they are getting placebos? Kaptchuk says, even though patients know they are getting pretend treatment, all the rituals of the doctor-patient relationship are still intact and these have healing benefits.

KAPTCHUK: Those things happen not because you think but because you do. You perform, and you enact. The placebo effect is embodied in what patients and doctors do. It's way below and much stronger than thinking you're going to get better, and you get better.

VEDANTAM: Bonanno isn't exactly sure why the placebos work for her, but she thinks there's one clear factor - her deep faith in her healthcare provider, Ted Kaptchuk.

BONANNO: He has a lot of patients. He's extremely intelligent. Something about his personality - very calming. When you talk to him, you feel like you had a complete body massage.

VEDANTAM: Contrast this with the impersonal interaction she had with the doctor who diagnosed her with lactose intolerance.

BONANNO: He was the kind of doctor that just, like - a patient at the deli, you know? (Laughter).

VEDANTAM: Placebo trials like this one are relatively new. There's a larger body of research looking at how placebos affect patients who don't know they received a pretend treatment. Some researchers who've looked at that larger body of studies are skeptical.

ASBJORN HROBJARTSSON: My name is Asbjorn Hrobjartsson. I'm a professor at the University of Southern Denmark.

VEDANTAM: Hrobjartsson has analyzed hundreds of placebo controlled studies. In general, he does not find a very strong placebo effect.

HROBJARTSSON: There's no indication, based on the trials we looked at, that there is a very large effective placebo on very many patients across very many conditions.

VEDANTAM: That said, he did find variations even in these studies that use the placebo effect in a more limited fashion. The effect was larger in conditions like pain and nausea, where patients reported their own outcomes, than in cases like hypertension, where doctors measured the outcomes. The placebo effect was also larger when treatments looked and sounded more dramatic. Just studying placebos can be offensive to some patients who felt dismissed by doctors in the past. In 2018, researchers from Northwestern University published a study. It showed that sugar pills can be effective in treating some people who suffer from chronic pain. Some of the very people who might benefit from that insight - patients in chronic pain - took to Facebook to describe how demeaned they felt. One woman wrote, this is one of the worst insults to those who have true chronic pain. This kind of pain is not all in their heads. I asked Bonanno what she thought about reactions like these.

BONANNO: They should be more concerned in knowing that if they could take something to get rid of it, that should be their main concern.

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VEDANTAM: Bonanno's experience suggests we want two different things from our doctors. The first is skill. We want to know that our doctor can give us the right diagnosis and treatment. But we also want doctors to attend to our suffering, not just to our illness. When both kinds of needs are met, doctors and patients are more likely to get the outcome they both want - healing.

Shankar Vedantam, NPR News.

KING: And you can hear more about placebos on the Hidden Brain podcast and radio show.

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