By Nick Bitterlich
From secondary school onwards we are taught that our science experiments need to produce quantifiable or qualitative results under normal and abnormal conditions. In addition, all variables other than the dependent and independent must be controlled. Human trials therefore deal with a major issue as our involvement introduces consciousness and therefore variability. One method researchers have attempted to circumnavigate this is placebo drugs, substances that resemble a clinical drug but include no active ingredients. This in theory should introduce a layer of control by minimising the human element of expectations regarding efficacy.
Previously, placebo effects had the negative reputation of signalling failure; if the inactive drug has the same effect as the treatment the latter is of no use. We would deem the response a patient demonstrated as inauthentic and dismiss any significant improvement as “luck” or “chance”. Recently, the scientific community has come to the consensus that this outcome shouldn’t result in the dismissal of the existing drug as a failure. Instead, this should imply another underlying pharmacological mechanism may be psychologically stimulated. A study by PLOS Biology identified the release of endorphins and dopamine leading to greater pain relief activity in the middle frontal gyrus brain region in placebo patients. In other words, the body begins to heal itself because all its indicators force it to believe its conditions must’ve improved.
Interestingly enough, the outcome and success of a placebo study can be studied both subjectively and objectively as a 2011 Harvard study demonstrated. This study showed that subjective results had been influences whereas quantifiable data had not. A group of 39 individuals with asthma were treated with albuteral, a bronchodilator, and a placebo inhaler respectively. Following a quantifiable test of lung function (FEV1) the active ingredient proved better in increasing lung volume. However, when asked about their perceived conditions both the placebo and albuteral produced identical improvements in breathing ability (Harvard Health, 2012). Even if there is no quantifiable improvement, patients are still likely to believe their condition has become better.
Shockingly, this phenomenon is far more common than expected – 12% of questioned British doctors in an Oxford study admitted to having used pure placebos (Philby 2012). Psychological treatment effects and patient reassurance was used as justification for this. Professor George Lewith of the University of Southampton stated “doctors are generally using placebos in good faith to help patients” (Philby, 2012). Occasionally the real ‘treatment’ would pose a great risk to the patient due to its array of side effect and, in these instances, it would make sense to administer, or at least try, a harmless and potentially successful cure: the placebo. Similarly, treatments are also not available and thus doctors see no option other than to prescribe a placebo. This poses a fundamental debate of whether a should deceive a patient at the cost of improving their health.
The power of expectation patients hold is furthermore of interest in this discussion. Red vibrant pills have been deemed more effective than ones of a blue color because of their connotations of alertness and health. Branded packaging, cultural background, and advertising power influence the perception of the effectiveness of aspirin (Goldacre, 2009). Pharmaceutical companies have managed to create a cult following for their products through exposure and an increased sense of trust compared to unbranded counterparts despite the presence of the same active ingredient.
The power of the placebo doesn’t end there. One may think they are only effective if the patient has been fully deceived. Nonetheless, this is disproven by a study by the director of Harvard’s placebo program, Dr. Ted Kaptchuk, who performed several “open-label” studies. Although the patients were informed about having ingested a “powerful” placebo, the use of a placebo was still 20% more effective compared to no treatment (Harvard Health, 2012). This finding would suggest medical professionals do not need to keep such information from their patients, regardless of context. Furthermore, this implies that although patients were aware they were being prescribed a placebo, their body still reacted to an impotent pill as if it contained an active ingredient. Therefore, it appears regardless of unknowingly or consciously ingesting a placebo the effect similar, highlighting just how powerful this phenomenon has become. Nevertheless, the underlying debate remains over the ethicality of placebos still remain.
References:
Goldacre, B., 2009. Bad science: A blueprint for how not to do research. The Guardian, 13.
Harvard Health. (2012). Putting the placebo effect to work – Harvard Health. [online] Available at: https://www.health.harvard.edu/mind-and-mood/putting-the-placebo-effect-to-work [Accessed 3 Sep. 2020].
Harvard Health. (2017). The power of the placebo effect – Harvard Health. [online] Available at: https://www.health.harvard.edu/mental-health/the-power-of-the-placebo-effect [Accessed 3 Sep. 2020].
Philby, C. (2013). The placebo effect: doctors admit prescribing unproven treatments,. [online] The Independent. Available at: http://www.independent.co.uk/life-style/health-and-families/health-news/the-placebo-effect-doctors-admit-prescribing-unproven-treatments-unnecessary-tests-and-pills-with-no-8542666.html [Accessed 3 Sep. 2020].
Imperial Bioscience Review 