Research Shows Placebos May Have Place In Everyday Treatments

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If you're just joining us, it's WEEKENDS on ALL THINGS CONSIDERED. I'm Laura Sullivan. Doctors have known about the placebo effect for centuries. That's when a fake drug - a sugar pill, for example - makes sick people feel better. But in Western medicine, placebos have been looked down on, by doctors. Now, researchers at some of the top medical schools in the country are proving that placebos could have a place in everyday treatments.

We wanted to find out how, so I spoke with Ted Kaptchuk. He is the authority on the placebo effect and the director of placebo studies at Beth Israel Deaconness Medical Center. Ted, welcome.

TED KAPTCHUK: Thank you for inviting me, Laura.

SULLIVAN: So placebos are essentially fake drugs. These are sugar pills - just something that is not, in any way, supposed to make you better. How do they compare, in your studies, to real drugs?

KAPTCHUK: For a lot of medications, the placebo effect is a big part of what the effect of the medication is. Placebos don't do anything. That's an oxymoron, to say a placebo does something. But it's what surrounds the placebo that is what's doing things. That's the symbols; the rituals; doctor-patient relationship; and the power of imagination, trust and hope.

For example, if you give powerful drug - reliever - like morphine - and these experiments have been done - and you give it to the patient surreptitiously, without them knowing, in an IV, it has a very strong analgesic effect. It stops pain. But if you give that same dosage in an injection that the patient sees going into their arm, it has double the effect.

SULLIVAN: Why does that work? Why are we susceptible to that?

KAPTCHUK: Well, there are many ways of answering that "why" question. One way is a psychological way. We have expectations; we have previous experience; we have non-conscious awareness. And we're in a medical environment, and we're used to that environment producing beneficial results. The ritual of medicine activates particular areas in the brain that actually will reduce pain, or at least reduce the sensations that we have in relation to pain.

SULLIVAN: Is it that the ritual of medicine - sitting in front of a doctor, telling him or her your pain; or going through the process of an appointment, taking a pill - does it make us think we're feeling better, or are we actually getting better?

KAPTCHUK: Well, I don't think it's only thinking. I think there's some evidence that if you expect things to happen, it happens. But I don't think you expect to get better, and that makes you better. I call it the Romeo and Juliet effect. We know what's going to happen to Romeo and Juliet. We watch it. But when we watch it for the fourth time, the fifth time, tenth time, we get all excited. We get emotionally involved. When we're sick, we get emotionally involved. Those rituals, even though they may be drama, they affect us more deeply than drama because our real lives are at stake.

SULLIVAN: Hmm. You know, I found your asthma study fascinating, because you had this group of people. They were all on placebos, and they were reporting to you that they were feeling better. And you actually went in expecting - when you looked at their lungs - to see that they were getting better. And what you found was that there was really no improvement at all, in their lungs.

KAPTCHUK: Yeah. What we found was that the patients reported the same amount of relief with the fake medicine as they did with the active medicine. And it was a really interesting study, showing that objective pathophysiological measures don't seem to be modified by ritual self-appraisal. How we experience ourselves is very much affected by the ritual of medicine.

SULLIVAN: Do you think that there's going to be a time where we're going to use placebos on people because they seem to work, in some cases, as well as regular drugs?

KAPTCHUK: I think the bottom line is, we're never allowed to deceive people - give people placebos without them being informed of what we're doing. That's the bottom line. Is it possible to give people a placebo, and tell them it's a placebo; meaning, it's an ethical thing to do. Will that unleash changes that will actually improve illness?

We've done two experiments like that. They're small; they're pilot studies. We're hopeful that maybe this will pan out in the future; that we can actually, instead of putting people on drugs right away, maybe put them on the ritual of medicine, and see if that's enough. So I see there's a place for it, but it's still in infancy whether this is really an option or not.

SULLIVAN: Ted Kaptchuk is a professor of medicine at Harvard Medical School, and the director of placebo studies at Beth Israel Deaconness Medical Center. Ted, thank you so much for joining us.

KAPTCHUK: Thank you for giving me the opportunity of being with you. Transcript provided by NPR, Copyright NPR.

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