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Stop Popping Placebos

June 06, 2001

Like the Wizard of Oz healing wounded travelers with hope and trinkets, the notion that doctors can cure about a third of their patients with a simple sugar pill seems too good not to be true.

Perhaps that's why it took researchers half a century to seriously challenge the "placebo effect" after Boston anesthesiologist Henry Beecher dreamed it up in 1955.

Beecher claimed that he essentially could trick 35% of his patients into fighting sickness by having them gulp down sugar pills.

Alas, the time may have come to awaken from Beecher's dream.

In the May 24 edition of the New England Journal of Medicine, two Danish researchers subject the theory to some long overdue scientific scrutiny. They find it closer to myth than to medicine.

University of Copenhagen researchers Asbjorn Hrobjartsson and Peter Gotzsche conducted rigorous analysis of about 7,500 patients with 40 different conditions. They found that people receiving a set of standard treatments plus a placebo fare no better than people receiving the standard treatment alone. The researchers speculated that health benefits attributed to sugar pills were in fact due to the body's own healing processes.

Most medical experts are coming to agree that the committees that oversee research at universities nationwide should be more vigorous about barring researchers from putting a patient on a placebo when medical evidence suggests that another treatment would be more effective.

However, it's wildly premature to conclude, as some editorialists did last week, that the Danes have somehow proved that the mind has little influence on the course of disease.

Anecdotal evidence to the contrary abounds.

Many of us are convinced that we are more susceptible to viral and other infectious illnesses at times of stress and overwork, and many of us know widows or widowers who seem to have been at greater risk of fatal illnesses in the months immediately after the death of a spouse.

On a more scientific front, researchers working in the still-callow field of psychoneuroimmunology have shown that non-pharmaceutical treatments, wherein caring doctors listen to patients and help them understand their illness, can influence the brain's own chemicals, such as endorphins and catecholamines, in ways that promote healing.

Thanks in part to aggressive TV ad campaigns by pharmaceutical companies, Americans are far more inclined than citizens of any other developed nation to think that popping a government-approved drug is the best way to get well.

The Danish study does strike a blow against "sham" sugar pills, but it should not be misconstrued as a resounding cheer for "real" prescription medications. The researchers also did suggest, after all, that the human body is perfectly capable of healing many minor ailments on its own without help from any pills, whether they are made of sugar or approved by the FDA.

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