Placebos: the little lies that can heal
August 19, 2001

It's the greatest wonder drug of all time. It lifts your depression,
bolsters your sex life, relieves your chest pain, even makes your hair
grow.

It's the placebo, the dummy pill. Experts estimate that 30 percent of
any treatment's benefit comes from the expectation it will make you
better. Placebos are 60 percent as effective as the pain-relievers now
in your medicine cabinet.

Two thousand years after Hypocrates endorsed sham treatments,
 they're still as popular as ever.

Except now, for the first time, there's a debate about whether the
"placebo effect'' is for real.

In May, Danish researchers concluded it's not. They looked at
8,500 placebo-taking volunteers in various studies. They reported
in the New England Journal of Medicine that placebos had no
effect on their illnesses. The University of Chicago's Dr. John
Bailar wrote the accompanying editorial: He says the effect of
placebos has been "grossly overstated.''

But last week, Canadian researchers showed the opposite.
They gave patients with Parkinson's disease injections
of saltwater. But they told those patients they were getting
a drug that would raise their levels of a brain chemical called
dopamine. The result? The dummy injections raised dopamine
levels 19 percent, just as much as injections of a real drug.

I'm not surprised. When I worked in the emergency room,
we routinely gave saltwater injections to Demerol abusers.
We told them it was Demerol, then we somberly told them
to lie on stretchers so they wouldn't collapse when the
narcotic hit. Minutes after their injections, they'd be
pleasantly asleep.

We even stocked placebo pills, impressive horse-size tablets
with polka dots. We jokingly named the pills "placebin.''

Such pills are still used all the time but not so obviously.
They're used when your harried doctor gives you an
antibiotic for what he knows is a simple cold. Or he gives
you allergy pills for what he knows is no allergy at all
(a recent study found two-thirds of patients who get
allergy pills lack allergies).

You get the pills partly to get you out of the office, but
also because many doctors still believe you benefit more
from a useless drug than from no drug at all.

And many studies back that up: They show placebos
don't just make people "feel better,'' they produce physical
changes that are hard to believe.

In baldness studies, researchers count the hairs of rapidly
 balding men. In one study, 42 percent of men taking a
placebo either grew hair or had no further hair loss. Other
studies show placebos open up the lungs of asthmatics
and make warts disappear.

Placebos have power, but that includes the power to harm.
First, to harm the doctor-patient relationship. "It's basically
a kind of deception,'' says Bailar. Placebos may have been
called "lies that heal.'' But they're still lies. And lies create
mistrust.

And placebos harm doctors. Physicians don't like deceiving
people any more than anyone else.

And patients don't like being duped. When study volunteers
find out they're taking placebos, many feel insulted. Worse,
their illness soon comes back, more aggressive than ever.

Even the sham treatments themselves can be harmful,
as when surgeons tested fetal brain implants by cutting
into some patients brains and giving them no treatment
at all. Researchers said the sham surgery was necessary
because the cutting, pain and scars of surgery have a
healing power all their own.

The placebo effect is a two-edged sword. It's voodoo,
deceit, and a reminder of just how little we understand.
But it does exist, and it can heal.

Dr. Michael Breen is the medical editor at
WBBM-Channel 2.

SOURCE: The Chicago Sun Times
http://www.suntimes.com/output/health/cst-nws-breen19.html

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