There is something very empowering about the placebo effect and the idea that we can heal ourselves. For decades, we’ve known about the placebo effect, but we’ve been unable to use it ethically in healthcare. One of the primary obstacles to using placebos in healthcare, was informed consent. It was thought that placebos necessarily required deception – the patient had to believe it would work. However, renowned placebo researcher – Ted Kaptchuk – realised that no one had ever put that theory to the test. So he began a research programme into identifying if people could respond to honest placebos – placebos that they knew were placebos. The results have changed how we think about placebos in healthcare.
Ted Kaptchuk decided to construct experiments that openly prescribed sugar-pills to patients. First, he decided to target irritable bowel syndrome (IBS) given that it’s a chronic condition, very hard to treat effectively and previous research has demonstrated it is responsive to the placebo effect. Patients were divided into two groups. One group received no treatment/placebos and the other group were given sugar-pills. Both groups received a doctor’s consultation, with a doctor who was instructed to interact positively with the patient and to really engage with them and to listen to what they say. In the placebo group, the sugar-pills were prescribed honestly – it was explained to the patient that these were placebos and that given the existing evidence on IBS and the placebo effect, placebos might help improve their symptoms.
In the study, they found that the IBS patients who received no treatment, still experienced a 30% improvement in their symptoms, but that the IBS patients who received placebos had a 60% improvement in their symptoms. So, the positive and engaged interaction with the doctor appears to have had some effect upon the patient, but the act of taking placebos – even when they knew they were taking them – increased the benefits to double what they would be without the placebos.
A limitation of this research, is that there’s no objective way to measure the symptoms of IBS. Instead the researchers had to rely upon the patients to report their symptoms accurately. However, this is obviously open to bias – if the patient thinks their symptoms are improving, they would report this, even if there was actually no change in their disease physiologically. But, this absolutely does not negate the positive results of this study! Even if the effect here is psychological, patients experienced a significant improvement and some patients reported that the improvement was life-changing.
While placebos have caused objectively measurable changes in conditions like acute pain and Parkinson’s disease, Ted Kaptchuk will be focussing on functional diseases (physiological diseases which have no known organic basis) or conditions with a psychosomatic component for a while. The brain has a stronger influence upon these conditions, so it is the most logical target to explore in the earlier stages of research.
With further research into open-label placebos (placebos that are not used deceptively), there is greater potential for clinical use. Physicians may be able to offer open-label placebos when no other treatment is working, or perhaps to improve the effects and reduce side effects of a conventional treatment. Placebos themselves are low cost and have no side effects, which means that it many cases, it may be worth a try – if used sensibly, there’s little to lose if it doesn’t work.
But Kaptchuk’s research, also shows us how important it is for a doctor to positively engage with the patient in a consultation. We now know, that in IBS at least, a positive interaction with the doctor can improve symptoms by 30%! If it works in IBS, it’s likely to have effects upon a range of conditions and more research needs to be done to identify exactly how a doctor can interact and communicate with the patient to improve their outcome.