November 11, 2009

Alternative Medicine Success Largely Due To Placebo Effect

Human expectations and the power of the mind may be behind the success of many natural health remedies, according to an Associated Press report on Tuesday about the use and potential risks of alternative medicines.

Known as the placebo effect, people sometimes feel better after taking a dummy pill or a faked treatment simply because they expect the treatment will work to improve their condition. 

In other words, the brain has the ability to alter physical symptoms, such as pain, anxiety and fatigue.

The healing power of the placebo effect was recently demonstrated during tests of a new drug that relieves the symptoms of lupus. The test found that one in three participants felt better after they received the dummy pills instead of the actual drug. 

The placebo effect plays a large part in alternative medicine, which includes therapies and herbal remedies based on beliefs versus science, the Associated Press said. 

Such therapies are often used to relieve subjective symptoms such as pain.

"It has a pejorative implication "” that it's not real, that it has no medicinal value," said Dr. Robert Ader, a psychologist at the University of Rochester in New York who has researched the subject.

But placebos can have real and beneficial effects, he said.

"Much of the results of certain alternative procedures are largely placebo effects, unless you believe there are people who exert magical powers so they can hold their hands over your body and cure you of disease," Ader told the AP.

"Make you feel better? That's entirely possible, especially if you believe it."

Scientists say the placebo effect accounts for roughly one-third of the benefits of any treatment "” even carefully tested ones.  

This conclusion dates to a historic report in 1955 called The Powerful Placebo.   The groundbreaking report, in which H.K. Beecher analyzed dozens of previous studies, found that 32 percent of patients responded to a placebo.

Beecher's conclusions were supported by subsequent studies, which found that placebos could increase pulse rates, blood pressure and reaction speed when people were told they had taken a stimulant.  The reverse held true in people were told that a placebo drug would make them drowsy.

Scientists do not yet completely understand how the placebo effect works, but there are many possible explanations.

Brain imaging shows that beliefs can indeed drive biological changes, including alterations in levels of chemical messengers and stress hormones that signal pleasure and pain.

Emotions, too, can trigger physical changes.  For example, in a child with croup, crying constricts the airways, making it difficult to breathe.  Many had believed a cool mist would be helpful in these cases, but hospital tests with croup tents disproved the idea, said University of Virginia pediatrician Dr. Owen Hendley.

However, the same remedy tried at home may produce different results.

"The child sits in the lap of the mother and the mother holds the mist maker close to the child. The child settles down, the mother settles down. The setting, and the mother feeling that it is helping, makes everybody calmer," and the child actually is able to breathe better, Hendley told the AP.

If not for the placebo effect, "physicians would not be nearly as successful as we are," said Dr. Thomas Schnitzer, a Northwestern University arthritis specialist.

Dr. Schnitzer helped lead a large study that found glucosamine and chondroitin supplements performed no better than dummy pills in relieving arthritic knee pain.

Doctors sometimes use the placebo effect to help their patients.   In one survey, many doctors reported giving patients sugar pills or vitamins at times in order to induce a placebo effect.

The University of Maryland Medical Center's shock trauma center is providing some patients Reiki therapy, which claims to use invisible energy fields manipulated by a special "master" to heal the patient.

Dr. Richard Dutton, the center's anesthesia chief, compares the technique to self-hypnosis, and says it is similar to Lamaze classes that teach pregnant women breathing exercises to distract them from labor pains.

After Roy Armstrong was injured in a motorcycle crash last year, his family agreed to the treatment.  The 39-year-old had experienced cardiac arrest and suffered many broken bones.

With Armstrong on a breathing machine, nurse Donna Audia and her partner circled his bed, waving their arms and touching his head while humming and rubbing a crystal bowl with a wand.

Armstrong was too sedated to recall the treatment, but "I think in some way it helped him to get better," his wife said.

Armstrong is still recovering with physical therapy.

"You can call it a placebo effect, you can call it a chicken soup effect. It's all about creating the right mental state in the person. The patients tell us they seem to like it," said Dutton.

And that is the goal of pain management, he said.

"If 30 percent of your patients improve on placebo, why not give it to them?"

Positive studies on alternative medicines have lacked comparison groups that received a fake treatment, making it impossible to compare the success rates.

Acupuncture is particularly hard to research in this way. 

But one U.S. study found that true acupuncture was better at relieving knee arthritis pain than phony acupuncture.

However, a European study with twice as many participants and a more realistic placebo procedure found the phony treatment to be just as good.   The scientists concluded that pain relief was attributable the placebo effect.

Advertisements and patient testimonials can often promote a placebo effect. 

Last year, the U.S. Federal Trade Commission reached a settlement over ads for a product called Airborne, which was touted as being able to prevent airborne transmission of germs.

"Products like Airborne are what we call `credence products'," said commission lawyer Rich Cleland.

"That's a fancy word for saying it's difficult or impossible for consumers to determine if the product has done anything for them," he told the AP.

"Part of that is because of the placebo effect. Part of that is because people don't want to believe they've been ripped off."
Barbara Domen, a former kindergarten teacher in Caswell Beach, N.C.

She told the AP she had been susceptible to colds, and had used Airborne several times a year when traveling on planes.

"It worked for me," she said.

It could be because since she retired,  "I'm away from all the germs," she added, but said she skipped taking the product on one flight and had caught an awful cold.

"Maybe it's psychological, but I think I'll continue to use it."

Some placebo effects are due to mental conditioning, or believing that something you did helped your condition when in fact it may have played no role whatsoever.

Insomnia is one such example, said University of Pennsylvania psychologist and neuroscientist Michael Perlis.

If you have difficulty sleeping one night, the added exhaustion makes it highly likely you will sleep well the following night, he told the Associated Press.

And if you were to take a sleeping pill, you might believe you slept well because of the pill, he said.

So do any herbal remedies actually improve insomnia?

"Not that I know of," Perlis said.

"But all of them have potential to be useful with time. It has nothing to do with them "” it has everything to do with conditioning."

Alternative medicine is now considered mainstream within the United States, with more than one in three Americans now using such treatments.

Tuesday's Associated Press report was one in an occasional  series on alternative treatments.


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