Though placebo treatments like sham pills and saline injections aren’t “real” in the sense that they’re not active drugs, they are real in the sense of producing actual physiological effects. Recent research shows the chemical responses people have to such treatments, even when they know they are taking something that’s a placebo.
Using neuro-imaging techniques to map the brain, one new study showed how placebo treatments had some of the same effects as pharmaceutical drugs in reducing symptoms of depression. Researchers took 35 people with serious depression and gave them a “new anti-depression drug” that was actually a sham. Then, for a second round of testing, they got a real drug.
Not only did the placebos induce a biological response, but those patients reacting most strongly to the placebos also reacted most strongly to the real drug. Placebo response predicted a good part of whether individuals would find the real treatment effective.
The study has several implications says an editorial in JAMA Psychiatry. First, it provides “additional rationale for the use of open-label placebo as a possible first-line treatment for depression.” In other words, before handing someone some mind-altering drugs, give them the dummy version first. It will have some of the same impact, at least some of the time.
The research also shows that some of our reaction to drugs is in a sense self-induced. “Nested within the response to the antidepressant therapy, there is a substantial placebo response,” the editorial says. Testing people with placebo first could allow clinicians to pre-screen responsiveness to actual drugs and then perhaps amplify the effects.
Placebo research is an expanding field. Scientists like Harvard University’s Ted Kaptchuk are exploring the importance of “context” in treatment–what he calls the “drama” or “theater” of medicine. That may lead to the use of placebos as “actual” treatments, or new thinking about how we organize clinics and hospitals (even the design of a doctor’s office could be important).
Though there are ethical questions about lying to people, placebo research potentially could allow us to reduce how many real drugs we have to take. For several reasons, from lower costs to less toxicity for patients, that would be a good thing.