A new study shows that dummy pills or placebo can act in asthma patients effectively making them think that real and fake drugs were doing the same level of good, even though the real medication actually had a much greater physical effect on their lungs. The effect was so strong that it convinced patients they were breathing much better even if they hadn't taken a real drug and hadn't actually improved much, as measured by a breathing test.
“It gives me a little bit of pause in terms of thinking about how I should approach patients and how I may be able to heal just by being there for them -- the art of medicine may be as important as the giving of the medicine,” said Dr. Michael Wechsler, lead author of the study and a pulmonologist and associate director of Brigham and Women’s Hospital’s asthma research center.
Study co-author Dr. Ted J. Kaptchuk, an associate professor of medicine at Harvard Medical School explained, “The placebo doesn't change the actual breathing in asthma patients. But it changes people's experience of what's going on as much as a real drug does.” He added that the ritual of treatment itself is very powerful, and that in the study “it was apparent that the placebos were as effective as the active drug in making people feel better.”
The new study aimed to find out how the effect of a real drug compares to a fake drug in two areas: the actual effect (in this case, on a patient's ability to breathe) and the perceived effect. For this the team recruited 39 asthma patients who were randomly assigned to be treated with an albuterol asthma inhaler (a common treatment), a placebo inhaler and a sham (fake) acupuncture treatment (in which acupuncture needles are used but the clinician does not stimulate any known acupuncture points ). They also underwent sessions of being treated with nothing at all. The visits were three to seven days apart for a total of 12 interventions in all.
Results showed that overall the albuterol inhaler improved exhaling by 20 percent. Each of the other approaches (including no treatment) improved it by just 7 percent overall. Overall patients thought both inhalers (the real and fake ones) and the sham acupuncture improved their breathing by about the same amount (the albuterol inhaler by 50 percent, the fake inhaler by 45 percent, and the sham acupuncture by 46 percent). They thought doing nothing only improved it by 21 percent.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City said there are too many unanswered questions. For one, he said, “How reliable are patients in terms of their subjective reporting of their symptoms? When a patient tells you that they feel better, and you think they really need more than what you're doing, should you stop? It really calls into question what we're doing, whether it's good enough to help the patients feel better.”
The study authors had a similar view of the placebo effect. Due to the wide gap between asthma patients' self-reports and their actual lung function, the researchers concluded that for optimal asthma care, health providers should test lung function rather than rely on patients' self-assessments.
“All medical procedures (active or inert) are meaningful,” wrote Daniel Moerman of the University of Michigan-Dearborn in an editorial that accompanied the study. “The decor of the office, the lights of the operating room, the computers on every lap, the magical prescription pad, and the caring nurse, piles up meaning with increasing power regardless of what may be in the capsule or syringe. These meanings create expectations that can dramatically modify the effectiveness of even the most powerful proven treatments.”
The study appears in the July 14 issue of The New England Journal of Medicine. It was funded by the National Center for Complementary and Alternative Medicine.
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