A simple sugar pill may help treat a disease — even if patients know they're getting fake medicine.
The finding, reported online Wednesday in the journal PloS One, may point the way to wider — and more ethical — applications of the well-known "placebo effect."
"The conventional wisdom is you need to make a patient think they're taking a drug; you have to use deception and lies," said lead author Ted Kaptchuk, an associate professor of medicine at Harvard Medical School. And, Kaptchuk added, it seems many doctors do this: In one report, as many as half of rheumatologists and internists surveyed said they had intentionally given patients ineffective medication in the hopes it would have a positive result.
Kaptchuk, however, wondered whether the deception was needed. When he first tried to persuade fellow researchers to explore a sort of "honest" placebo, "they said it was nuts," he said. After all, didn't the whole effect hinge on people believing they were getting real treatment?
Patients were easier to enlist. "People said, 'Wow, that's weird,' and we said, 'Yeah, we think it might work.' "
The researchers enrolled 80 people suffering from irritable bowel syndrome, explaining the experiment while framing it positively — they called it a novel "mind-body" therapy.
Half the patients were given a bottle with the word "placebo" printed on it. The pills it held, they were told, were like sugar pills. The patients were told they didn't even need to believe in the placebo effect, but had to take the pills twice daily.
The other half were given no treatment at all.
At the end of the three-week trial, 59% of the patients taking the placebo said their symptoms had been adequately relieved, far outstripping the 35% in the non-treatment group.
"We were all taken aback," Kaptchuk said. "We triple-checked the data before we decided it was real."
The results, which Kaptchuk said need to be replicated in a longer, larger study, show that placebo pills could be useful for chronic pain, depression and anxiety, among other ailments, without the need for deception.
"My personal hypothesis is this would not happen without a positive doctor-patient relationship," Kaptchuk said.
"What seems to be the active ingredient is the warm, personal relationship," said Dr. Howard Brody of the University of Texas Medical Branch in Galveston.
Tor Wager, a cognitive neuroscientist at the University of Colorado at Boulder, said this and future research may help change the way doctors treat their patients.
"In terms of medical research, there's been a big gap between what people feel is true in the clinic and what is scientifically investigated," he said. "This study takes a step toward filling that gap. It shows the human context essentially does matter."