Choose the blue pill or… the sugar pill

The placebo effect is a powerful phenomenon in medicine. Believing you are taking a medication that will improve your symptoms can exert physiological changes that actually make you feel better, even if the medication itself is useless.

It’s not uncommon to find sugar pills more effective than the drug pharmaceutical companies have spent millions of dollars developing, particularly antidepressants.

This well-known problem always needs to be accounted for in clinical trials. Placebos are regularly compared with trial medications to determine whether the positive effects of the tested drug are not simply due to the act of taking a tablet.

Just as expectations of improvement can yield a positive outcome, a pessimistic outlook can lead to the opposite. This other phenomenon, known as the nocebo effect, occurs when the sham medication negatively affects the patient, actually worsening their symptoms or creating new ones.

Could doctors take advantage of this placebo effect to help their patients? It poses an ethical dilemma. A doctor could prescribe a multivitamin to a patient under the guise of improving their symptoms, knowing that it has no specific effect on the patient’s disease. On one hand, the patient may feel a lot better, with no risk of side effects. On the other hand, an element of deception has been required to benefit the patient and lying to the patient undermines the trust they have in their doctor.

What if there was a way to achieve the same effect without lying?

Ted Kaptchuk, Professor of Medicine at Harvard Medical School, has spent a career investigating the placebo effect. He has questioned the dogma that the placebo effect only occurs when the patient is unaware of what they are taking.  Instead, Kaptchuk has put forth a revolutionary idea: patients will still benefit from the placebo effect even when they are told exactly what they receiving – nothing.

His team decided to test this theory in patients with irritable bowel syndrome (IBS). One in five Australians have IBS and experience the associated crampy, abdominal pains the frequently accompany constipation, diarrhoea or both. IBS is a ‘functional gut disorder’, meaning we don’t know exactly what’s wrong and as such have no good treatments. Patients’ best bet currently is to find out which foods are more likely to trigger symptoms and modify their diet accordingly.

In the study, featured in PLOS One, 80 patients with IBS were selected to receive either an ‘open-label placebo’ twice a day or receive no treatment at all. Patients in the placebo group were explicitly told that the pill was inactive and similar to a sugar pill.

The discussion was framed positively, focusing on how powerful the placebo effect can be and that it has been shown in “clinical testing to produce significant mind-body self-healing processes”. They were then followed up with questionnaires about changes in their IBS symptoms.

The results were astonishing. After three weeks, the group knowingly taking the inactive pills reported both a reduction in symptoms and improvement in their quality of life. The group receiving no treatment, as you can imagine, reported no change.

Although a relatively small study, Kaptchuk has repeated these findings in different settings. Last year a study published in Pain trialled patients with chronic low back pain on an open-label placebo and found they reported a reduction in their pain scores. At the trial’s completion, the group receiving no treatment were offered the chance to switch to the inactive pills and be followed-up. They, too, subsequently experienced relief from their pain.

Given the significant problems with prescription opioid addiction, having an alternative ‘medication’ for patients with chronic low back pain with virtually no side effects could provide relief to both frustrated patients and doctors.

It also appears we can achieve this without needing to resort to concealment, illustrating just how powerful the mind is in translating our psychological responses into physical manifestations.

Apparently it doesn’t matter whether you choose the blue pill or the red pill. Simply taking any pill might be enough.

The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.