Friday, January 28, 2011
Placebo should be the Gold Standard
"Placebos should be the gold standard," says Melanie Thernstrom, author of The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering
When placebos work, there are no side effects.
A recent study of a commercial drug that reduces the frequency of hot flashes in menopausal women showed that while the drug did help slightly more women than a placebo, that the women who took the placebo did not have a return of the hot flashes when they stopped taking the pills, but the women who took the drug went back to their pre-drug state. In other words, if the placebo works, the problem is solved permanently.
Now there's an even more exciting study. At Harvard Medical School, people who have irritable bowel syndrome were divided into two groups. One group received no treatment. The other group was given placebos. The bottles were labeled Placebo. The people who were given these pills were told they contained no active ingredients.
"For three weeks, the patients were monitored. By the end, researchers reported, 59 percent of the placebo-takers re-ported adequate symptom relief, but only 35 per-cent of the others re-ported such relief. Al-so, on other outcome measures, placebo-takers were found to double their improvement rates to a degree roughly equiv-a-lent to the effects of the most powerful medications for the condition."
Another study showed that a common knee surgery is no better than a placebo:
In the study, 180 patients with knee pain were randomized into three groups. One group received debridement, in which worn, torn, or loose cartilage is cut away and removed with the aid of a pencil-thin viewing tube called an arthroscope. The second group underwent arthroscopic lavage, in which the bad cartilage is flushed out. The third group underwent simulated arthroscopic surgery; small incisions were made, but no instruments were inserted and no cartilage removed.
"During two years of follow-up, patients in all three groups reported moderate improvements in pain and ability to function. However, neither of the intervention groups reported less pain or better function than the placebo group. Indeed, the placebo patients reported better outcomes than the debridement patients at certain points during follow-up. Throughout the two years, the patients were unaware of whether they had received real or placebo surgery."
I find all this fascinating because I'm at an age when surgery and prescription drugs are common answers to common health problems. I'd like to see guidelines for situations in which placebos should be tried before anything else. Since time alone cures many ills, people should be given a choice that doesn't involve surgery or pills.