Placebos: why are we not using them as a first-step treatment?

Drugs in containersThe BBC’s Horizon programme is always a fascinating insight into science and the recent programme about the power of placebos was no exception. A placebo is a treatment or drug that attempts to address symptoms of conditions or improve performance, but with no active ingredients or processes. The key is to convince the taker of the placebo that the placebo is a genuine drug or procedure.

The programme had a number of powerful demonstrations of the power of placebos. Cyclists were able to improve their performance, the symptoms of Parkinson’s Disease were significantly reduced and¬†symptoms of irritable bowel syndrome were also reduced.

This reminded me of a weakness in the medical establishment, that of research-based medicine. You’d think doctors were scientists who prescribe based on scientific results. You’d be wrong. The medical establishment is alleged to shun scientific analysis and misrepresents medical research data. Ben Goldacre argues even an optimistic proportion of medical treatment would add up to only 50%-80% of treatments being evidence-based according to speciality. Hopefully your treatment will be one of them.

This is why I was pleasantly surprised by the example of a doctor that changed a surgical procedure he had practiced for 15 years for a placebo procedure. The randomised selection of patients experienced a ‘fake’ procedure, including a script-based performance by surgeons. There was no statistically significant difference in the pain relief experienced by patients. Another doctor prescribed a placebo as an alternative to a drug course for Parkinson’s disease with similarly positive results. Test patients were able to experience life as someone without the condition. Placebos rely on the body’s own pain relief mechanism, favouring natural over intervention.

If placebos are so effective, why aren’t doctors prescribing them? Doctors are over prescribing drugs. Anti-biotics are at a critical point due to over prescribing by doctors. Conditions such as depression and autism are treated with cocktails designed to interact with our brains at a chemical – and unnatural – level.

In my opinion, patients should perhaps be prescribed a placebo in the first instance for certain conditions. I don’t want to question the legitimacy of psychological illnesses such as depression, but I am a strong believer in self-help as a first step to treating anxiety, depression and other such illnesses. Meditation has been proven as an effective treatment for anxiety and depression; an effective treatment that is free. Counselling and hypnosis are also valid and effective treatments. (How a doctor can prescribe anti-depressants without counselling is beyond me.)¬†In the absence of GPs prescribing “self-help” such as meditation, perhaps placebos could be used. A placebo could be prescribed as a first stage drug for patients. Studies have shown positive results for depression, so I believe this could be a positive first step for patients unwilling to “self-help”. Perhaps they could experience the same benefits but not subject themselves (and those around them) to the effects of aggressive anti-depressives.

Of course, wider access to placebos will intrinsically reduce their effectiveness as people start to “grow wise” to the practice, reducing the effect of the placebo. Again, the Horizon episode suprised me even here. Patients with Irritable Bowel Syndrome were prescribed placebos and were told so. They were told although the drug was a placebo, perhaps her own body would help her condition. Yet again, placebos were identified as being effective in reducing symptoms whilst the drug was taken.

Perhaps one reason why the medical establishment are not looking to natural methods or placebos as an opportunity to help patients rely on their own healing capabilities is due to the influence of pharmaceuticals. Your GP is the interface between you and a catalogue of expensive drugs, paid for by a state body which can achieve economies of scale for bulk purchase, satisfying the pharmas’ desire for profit. Your busy GP has to get through their patients for the day whilst personally addressing each and every patient’s concerns. It is easy to appreciate how drugs can be turned to as a “quick fix” for patients, helped by marketing departments of the pharmaceuticals who – whilst they cannot offer much more than a mousemat to help them sell their drugs – exert real influence on doctors’ routes of treatment.