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Thinking makes it so

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Bryan Hubbard is Publisher and co-editor of WDDTY. He is a former Financial Times journalist. He is a Philosophy graduate of London University. Bryan is also the author of several books, including The Untrue Story of You and Secrets of the Drugs Industry.

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Thinking makes it so

June 26th 2017, 21:52
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Here's a very radical thought: suppose it's all placebo. Does the thought that a remedy will work actually make it work—whether you've been given a prescription drug, a placebo or dummy drug, or a homeopathic pill?

The idea that the mind can make us feel better when we're given any kind of pill isn't new to medicine. It's the basis of the double-blind placebo-controlled trial, where a group of participants is given either an active drug or a 'dummy' placebo drug, and no one—not even the researchers—knows which they've been given. The drug is deemed a success if its positive effects outperform those of the placebo, even if by just a few per cent.

But with fraud now so rife in medical research—it's been reckoned that around 70 per cent of studies have been 'massaged' to get a positive result for the drug company, which has invariably funded the whole project—was there really ever any difference between the drug and its dummy version?

It's not just that we feel better—a relaxing piece of music or a hot bath might achieve something similar—but people given a placebo report that physical symptoms, even long-standing ones, have disappeared. Linda Buonanno, of Methuen, Massachusetts, said her chronic symptoms of irritable bowel syndrome (IBS), which she described as worse than labour pains, reversed after she took a placebo pill for just four days. The intense cramps, bloating, diarrhoea and pain, which she had endured for 15 years, suddenly went away and have never returned.

Here's the most extraordinary part of Buonanno's story: she knew she was being given a placebo. She was taking part in a study run by Ted Kaptchuk, at Harvard Medical School, who has been studying the placebo effect for years. For this study in 2010, he wanted to push the envelope and run an 'open-label' placebo trial, where half the 80 IBS sufferers, including Buonanno, were told they were being given a placebo, while the others were given no treatment at all.

Even though they knew they were taking a sugar pill, Buonanno and her fellow sufferers reported "significant" improvements in their symptoms, including a fivefold reduction in pain, as determined by an independent IBS measure.1

Kaptchuk repeated the experiment six years later when he treated 83 chronic low back pain sufferers with open-label placebos, although this time, half of them carried on with their usual treatment, such as pain-killing medications and massage. Again, the placebo delivered the best results, with pain and disability reduced 1.5 times—and similar results were found when the two groups switched treatments.2

Looking beyond Kaptchuk's work, Jeremy Howick of Oxford University led a team that looked at 24 reports and found five trials, involving 260 participants, which had used open-label placebos for a range of health problems, including IBS, depression, allergic rhinitis (hay fever), back pain and ADHD. Overall, the approach had "positive clinical effects compared to no treatment," Howick concluded. In other words, the placebos worked.3

But how can a dummy pill cause physical changes—especially when the patient knows it's a fake? One theory is that patients are subconsciously boosting their levels of endorphins and neurotransmitters when given a placebo by a trusted doctor who may, in the past, have helped them to positively recover. Another suggestion is that the patient's expectations of the placebo working may be raised by the knowledge that it helped others who've had the same health problem.

But neither theory explains why conventional treatments have failed—as those same conditions are in place when a real drug is prescribed—whereas the placebo succeeded.

Kaptchuk thinks the answer may be found in a new theory known as 'embodied cognition'. This suggests that the brain isn't the centre of everything, but that our body, and the experiences it has had, influence cognition itself. But, again, this doesn't entirely explain why conventional treatments have failed.

So, going back to our radical idea at the beginning, suppose everything is a placebo (or nothing is, whichever you prefer). On its own, the therapy per se is not the essential point; instead, it's just one component of a complex mix that may include trust in a doctor, belief in the therapy, the current mental state of the patient, support from family and friends, and so on. Only when
all of these aspects are positive does healing become possible.

Just a thought, I know—but then, a thought may be all you need.

References

1) PLoS One, 2010; 5: e15591

2) Pain, 2016; 157: 2766-72

3) J Evid Based Med, 2017; doi: 10.1111/jebm.12251

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