Placebo Effect: The Ingredients of Sham Medicine

placebo effect

The placebo effect has been known about  for decades, yet few researchers can be as dedicated to its understanding than Ted Kaptchuk, B.A., who is an associate professor of medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts. A Harvard Medical School study conducted by Kaptchuk and his colleagues was published in the February 2006 issue of British Medical Journal that demonstrated the power of the placebo effect, which is very likely one of the main ingredients of why sham medicine or treatments sometimes work.

In the study, 270 participants who experienced arm pain from repetitive use were given either acupuncture treatment or a sugar pill that was supposed to reduce pain. Researchers in this single-blind, randomized control trial found that the subjects had less pain with acupuncture treatments than those who took the anti-pain pill. Objectively, however, the results indicated that there were no significant outcome differences between both treatments. Unlike most experiments which compared the effects of a real treatment with a fake treatment, Kaptchuk’s study was designed to compare what some may consider to be two fakes.

Two years later, another study by Kaptchuk and his colleagues was published in the same literature that examined the affects of placebo effect on patients with irritable bowel syndrome (IBS). This time, a control group who did not receive any treatments was used. One experimental group received acupuncture only while another experimental group received the same treatment with “patient-practitioner relationship” that involved patients receiving attention and empathy. Practitioners who were licensed acupuncturists were required to touch the hands and shoulders of the patients and spend “at least 20 seconds lost in thoughtful silence” with the third group. The study found that patients who received the most care felt better than those with less or no care, even if the treatment was no different.

However, just because a placebo “works” does not necessarily mean it always has a positive outcome. “Sham treatment won’t shrink tumors or cure viruses,” Kaptchuk said on Harvard Magazine.Kaptchuk had spent over 15 years studying the placebo effect and how it effects human physiology. He also earned a diploma for Traditional Chinese Medicine from Macao Institute of Chinese Medicine in Macao, China, in 1975, which makes Kaptchuk one of the few professors at Harvard Medical School who does not hold a Western medical degree.

Current studies on the placebo effect are rather ambiguous, since most of these studies’ trials are poorly blinded, referring to whether or not the researchers and the subjects know who is given the placebo or real treatment. In a well-blinded study neither party knows who is receiving which type of treatment until the study is over. Although most people think of a placebo as a “sugar pill,” it can be many things, such as objects, rituals, places, medical beliefs or suggestions, and relationship between the patient and the practitioner or self-help group, according to a meta-analysis published in a February 2014 issue of BioMed Central. The response to a placebo can be positive or negative: placebo effect or nocebo effect, respectively.

Researchers from Belgium and Canada who conducted the meta-analysis reviewed over 200 trials that  tend to have a “consistent failure to report on study blinding in journal publications.” This made it impossible for the researchers to determine if the studies were really double-blinded and had accurate outcomes. Frederik Feys, Ph.D., from Vrije Universiteit Brusseland, and colleagues wrote that it is “naive to assume” that a randomized control trial can separate placebo effect from the actual intervention effects, especially with patient subjectivity. Researchers suggest that future studies should further examine factors that contribute to blinding and their health outcomes under “subjectively assessed conditions.”

The question for many is whether, if a placebo effect makes people feel better, it really matters if the ingredients are considered sham treatment or medicine. Researchers also question whether is it ethical for health practitioners to give a dummy treatment that makes people think that  they are getting better.

“I don’t think it’s ever okay to deceive in health care,” said licensed massage therapist Alice Savito in an online interview with Guardian Liberty Voice. Savito practices in St. Louis, Mo. “Those who respond to studies that show, for instance, acupuncture is not better than a placebo, and then say, ‘It’s creating a placebo effect, so that’s good,’ are missing the point. First, if you are really offering caring touch and are focused on human attention, you don’t have to contaminate that with lies about ‘meridians’ or whatever. And you don’t need to use modalities, like needles, that carry the risk of infection or pneumothorax. And there’s the ethics of taking the time and money of someone who should be using their scant resources for medicine that does treat their condition.”

Claiming that the placebo effect can “cure” or “treat” illnesses, pain, or disorders may be considered as an act of fraud whether the treatment is sham or real medicine. For example, in January 2008 Seventh Circuit Chief Judge Frank Easterbrook wrote that the company that made Q-Ray Ionized Bracelets was guilty of fraud and ordered them to pay a fine of almost $16 million after the Federal Trade Commission filed its case in May 2003 for “false and misleading advertising claims.” In defense, Q-Ray said that they are not sham medicine because the product produced a placebo effect that alleviated chronic pain for people. However, Judge Easterbrook did not agree. He compared the bracelet with a sugar pill that alleviates symptoms “even though there is no apparent medical reason.” Charging $200 for a bracelet or any device that claims to bring a miracle cure to chronic pain “but works no better than a dummy pill is a form of fraud.”

By Nick Ng

Harvard Magazine
British Medical Journal 1
British Medical Journal 2
BioMed Central
Interview with Alice Sanvito, LMT
Federal Trade Commission