Placebo works even without deception

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Pills without active ingredients can be amazingly helpful: They relieve pain, lower blood pressure, and help against depression. For a long time it was assumed that the belief that a real drug was received is the basis of the effect. But apparently it also unfolds in patients who know very well that they are taking a dummy drug.

Giving patients placebos regularly plunges doctors into a moral dilemma - on the one hand they save them unnecessary stress or even an addiction, but on the other hand they deceive and incapacitate the people who trust them - albeit for their benefit.

Effect without deception

A current study shows that secrecy is not absolutely necessary for the beneficial effect: in back pain patients who received placebos in addition to their usual pain medication, the symptoms improved by a third as a result. This applied to both the permanent pain and the pain peaks.

And that despite the fact that the pill box with the drug-free dummy drugs had big and wide emblazoned “placebo pills”. So that the test subjects could clearly understand exactly what this meant, they were informed about the placebo effect for 15 minutes at the beginning of the study.

Real drugs work worse on their own

This also applied to the control group, which received no placebos. The study also reduced their pain - but only by nine percent. And while the participants in the placebo group were able to cope better with their ailment in everyday life thanks to the dummy medication, there was no effect at all in the control group.

“These results turn our understanding of the placebo effect on its head,” says study director, Ted Kaptchuk of the Beth Israel Deacones Medical Center in Boston. The effect is not, as long thought, necessarily generated by the expectation of the patient to receive an active drug.

Sham drugs activate regions of the brain

"Interacting with doctors, taking pills, all the rituals and symbols of our health system - our bodies react to them," says Kaptchuk. Every time a tablet is taken, regions of the brain that influenced the symptoms may be activated - even if it is clear that it is a placebo.

The patients themselves were open to the experiment: "They were curious about what was going to happen and were happy about this new approach to treating their pain," reports first author Cláudia Carvalho.

More than imagination

It has long been known that the placebo effect is more than just imagination. Various experiments have shown that the body releases effective messenger substances after the administration of a placebo: pain-relieving opiates, for example, or dopamine, which relieves the tremors of Parkinson's patients without medication.

Because he's so powerful, every new drug has had to assert itself against him since the 1970s. In so-called double-blind studies, the patients then receive the actual drug or a placebo, whereby neither the test person nor the doctor knows who is receiving what. This is the only way to determine what effect the active ingredient develops on its own - namely minus the placebo effect.

Sensitive effectiveness

How strong this is depends on a number of different factors. On the type of complaints, for example, but also on the personality of the patient. Even if a drug is offered in a new make-up, this can reduce the effect of the placebo.

However, the relationship between doctor and patient is particularly important: the more trusting it is, the stronger the placebo effect. Carvallho also says: "Without a warm and friendly relationship, it may not function at all." In times when there is always little room for doctor-patient conversation, this is thought-provoking.

Source: Cláudia Carvalho et al .: Open-label placebo treatment in chronic low back pain. PAIN, 2016; 1 DOI: 10.1097 / j.pain.0000000000000700

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