"Medical marijuana" may well be just "placebo effect"

How a simple sugar pill from the doctor may not be a thing of the past
The placebo effect is so powerful that doctors want to make more use of our ability to 'trick ourselves better’, says Liz Bestic
By Liz Bestic 7:00AM GMT 14 Mar 2011
Not so long ago, it wasn’t unusual for your friendly GP to have at hand a bottle of sugar pills for patients’ minor aches and pains. While sugar pills are no longer on offer, a report out last week revealed that half of all German doctors are happily dishing out placebos to their patients for ailments such as stomach upset and low mood.

The study, published by the German Medical Association, said that placebos – here defined as sham treatments without any active constituents – from vitamin pills to homeopathic remedies and even surgery, can prove effective as treatments for minor problems and are completely without side effects.

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So if placebo treatments are such a good thing, should UK patients be getting them?

The power of the placebo first came to light during the Second World War. Morphine was in short supply in military field hospitals and an American anaesthetist called Henry Beecher, who was preparing to treat a soldier with terrible injuries, feared that without the drug the operation could induce a fatal heart attack.

In desperation, one of the nurses injected the man with a harmless solution of saline. To Beecher’s surprise the patient settled down as if he had been given morphine and felt little pain during the operation. Dr Beecher had witnessed the placebo effect.

Wind forward 70-odd years and the story of the placebo continues to fascinate, even though in the UK placebo treatments are usually confined to clinical trials, as a comparison with “real” treatments. Recent research suggests the placebo effect is not confined to subjective areas such as pain but may bring about physical changes. In one (albeit small) trial, published in the journal Science, people with Parkinson’s disease given placebo injections showed significantly higher dopamine levels in the brain, similar to the effects of medication.

Interestingly, the German study found that the efficacy of a placebo can depend on the size and colour of a pill and on its cost (with more expensive placebos being more effective) and that injections work better as placebos than tablets.

What causes the placebo effect? No one really knows; but the idea of the healing power of the mind is nothing new. The discovery in the 1980s of the rich supply of nerves linking the brain with the immune system, which led to a new branch of medical research known as psychoneuroimmunology, clearly goes some way to explain it.

Nor does the placebo have to be a pill or injection: just seeing your doctor can work wonders. Edzard Ernst, professor of complementary medicine at the University of Exeter, believes that the key is the relationship between the patient and the doctor or therapist.

“Trust can generate a placebo response. People are already anticipating getting better when they come to the surgery. If the doctor then gives that patient an aspirin for a headache and does it in an empathic manner, the aspirin will have a pharmacological effect and the therapeutic relationship will generate the placebo effect,” explains Prof Ernst.

One widely publicised analysis of clinical trial data on modern antidepressants from the University of Hull found that leading brands of antidepressants worked little better than placebos. Subsequent reporting by the press concluded that antidepressants were useless. However, this failed to mention that the patients’ response to placebos was “exceptionally large”. In other words, it wasn’t that antidepressants didn’t work – but that placebos worked very well. “If the drugs are no better than a placebo, then why not give a placebo which has none of the nasty side-effects?” argues Irving Kirsch, professor of psychology at Hull and lead researcher.

But others say using placebo treatments other than in clinical trials poses an ethical dilemma. While it is not illegal for a doctor to prescribe a placebo if they believe it is in the best interests of the patient, Dr Tony Calland, chair of the BMA’s Medical Ethics Committee, says: “Long ago doctors would give people medication that was scientifically of no value. These days, we believe patients should have an informed choice. Giving a patient a placebo without telling them is regarded as unethical and deceptive.”

But if deception is the problem, could patients be informed they were getting a placebo? A recent study of 80 patients with irritable bowel syndrome at Harvard Medical School in Boston showed that, even though patients were told, their symptoms still improved, compared to those who had no treatment.

Dr Calland points out there is a bigger problem with the placebo response. “In one patient it may be very strong while in another it may be virtually non-existent,” he says. And placebos do not work for everything: they cannot alter blood sugar levels in diabetics, mend a broken leg or cure cancer.

“To hope you will get a placebo effect would simply be not very good medicine,” Dr Calland argues. “Why not just give a treatment that actually works?”

http://www.telegraph.co.uk/health/8376919/How-a-simple-sugar-pill-from-the-doctor-may-not-be-a-thing-of-the-past.html