Dismissed by most researchers, the placebo effect used to be a medical curiosity apart from the serious business of drug development. But that’s been changing quickly. These days, the medical community is treating the phenomenon with more respect, and even investigating the possibilities of harnessing placebo for real treatment. There may be cases where doctors could prescribe fake pills and saline injections (some already do it). And, there certainly could be occasions where doctors focus more on the context of drug delivery–the so-called “therapeutic encounter”–in order to boost a drug’s effectiveness.
A new study shows how that context is important. Researchers recruited 66 migraine sufferers, and compared their reactions to several combinations of real and sham treatments. To set a yardstick, the patients first agreed not to take any medication when they had an attack, and to record the severity of their pain so it could be compared later. Then, the researchers issued six treatments to each patient as they experienced subsequent migraines, recording results for a total of 450 episodes.
The researchers labeled treatment envelopes three ways: with “Maxalt” (a well-known relief pill), “placebo,” or with “Maxalt or placebo.” In four cases, the label was correct. In another two, the envelopes were purposely mis-labeled. The aim: to understand how expectations affect patient responses.
Volunteers were twice as likely to say the treatment worked when they were told the drug was real than when it was marked inaccurately as a fake. Also, they reported similar levels of relief when they thought the placebo was a real pill as when they got Maxalt thinking it was a sham. The study estimates that 50% of the drug’s effectiveness is down to placebo effects.
“Every word you say counts, not only every gram of the medication,” Ted Kaptchuk, a Harvard professor and a leading light in placebo research, told the Associated Press. “The more we gave a positive message to the patient, the bigger the placebo effect was.”
The experiment was conducted at Boston’s Beth Israel Deaconess Medical Center, and the results are published in the journal Science Translational Medicine. Researchers still need to understand the internal processes that cause placebo. But as they do, it’s likely that the research will move ever further into the mainstream. One day doctors could come to see the context for treatment as more important to improving effectiveness.