It’s the gold standard in medical research – the double-blind, placebo-controlled trial. By double-blind, we mean that neither the researcher nor the patient knows what treatment the patient receives. Placebo-controlled means that some patients get placebo while others get an actual treatment.
Imagine you’ve developed a game-changing new treatment and you pit it against placebo in a research trial. You’d better hope it outperforms the placebo. If it doesn’t do as well as placebo, then there is no use for your groundbreaking treatment.
Or maybe there is.
The placebo effect is a term for what happens when a patient gets better from a treatment that has no medicinal effect. At one time we thought patients who had a placebo effect weren’t really all that sick to begin with. It was all in their heads.
More recently, researchers discovered actual biological change when the placebo effect is in play. When certain patients receive sham treatments, biochemical pathways are activated that cause an improvement in symptoms. For example, the brains of some patients with Parkinson’s disease or depression have been shown to release dopamine in response to placebo treatment. Since these diseases are related to dopamine metabolism, the patients experienced an improvement in symptoms.
Other research shows that if a patient is told a treatment is more expensive, they often have a better response to it than to an identical, but “less expensive” placebo.
The most baffling research, to me, shows that some people will respond when they know they are being given a placebo!
Some new information uncovers the very foundation of the placebo effect. In an article published in April’s Trends in Molecular Medicine, researchers identified components of the human genome that make individuals more susceptible to the placebo effect. That’s right. We are genetically predisposed – or not – to respond to placebo.
It is likely that there are many genes responsible for various responses to placebo. Just as each disease affects a different chemical pathway in our bodies, different genes will be responsible for our response to placebo for each disease. So you might have a great placebo effect with respect to irritable bowel syndrome, but not much of a response when treated with a sugar pill for lower back pain.
This information has several implications. First, it will allow researchers to eliminate patients who are genetically inclined to respond to placebo from clinical trials. This way the true effect of a treatment over no treatment will be clearer. To be sure, there are ethical issues in this area that must be sorted out, but the potential for a better understanding of actual drug effect versus placebo effect is huge.
It also opens the door for personalized treatment. Patients with the BRCA1 gene pursue more aggressive screening or preventive treatment for breast cancer. In the same way, physicians will customize treatment for disease based on a patient’s placebo genes. This might mean lower doses of medication. It could even mean exercises to activate the placebo effect and avoid other treatments all together – if you have the right genes.
These advances are still in the future, but the study of the placebo effect is fertile ground for researchers. We will see this field of medicine grow significantly in the years to come.
For now, it’s important to remember that the mind-body connection is a real thing. More real if you have the right genes, but real nonetheless. Concepts like meditation, stress reduction, visualization and other “new agey mumbo-jumbo” can offer real medical benefit. So don’t dismiss them without a fair try. You never know how you’ll respond.
Amy Rogers MD is not a practicing physician and nothing written here should be taken as medical advice from either Amy or AssetBuilder. Medical decisions should be made with care in consultation with your health care provider.