Sugar Pill or Fake Acupuncture?

The April 2006 issue of Discover magazine reported the results of a study titled “Sham device v. inert pill: randomized controlled trial of two placebo treatments.”  The purpose of the study, as reported by Jessica Runinsky, was to determine if doctors can manipulate the placebo effect.

The “placebo effect, ” according to Wikipedia (the free encyclopedia) “…is the phenomenon that a patient's symptoms can be alleviated by an otherwise ineffective treatment, since the individual expects or believes that it will work.” This placebo effect has long been debated as a valid control for scientific study, since it is well documented to have its own beneficial effects that may, in some cases, be as effective as the treatment for which it is being compared.

Researcher Ted Kaptchuk decided to compare two placebo techniques, sugar pills and pretend acupuncture (retracting needles), to see which one had the greater placebo effect. Subjects were experiencing chronic arm pain and hoping for pain reduction. None of the 266 subjects received any “real” treatment for their pain, although all of them thought they were.

While both ‘non-treatments’ had pain-reducing effects, the results of the study clearly showed that not using acupuncture was more effective in reducing pain than not taking medication. A substantial percentage of both groups (25% for acupuncture and 31% for sugar pills) experienced side effects ranging from red or swollen skin to dizziness, nausea, rashes, headaches and nightmares, so evidently the placebo effect has both good and bad effects.

I guess the control group for this study should have been a group of people who just stayed home and didn’t seek any help at all. However, I expect that a significant number of them would have had a reduction in pain just from the fact that over time, some pain goes away or moderates.

What this study tells me is that a placebo is, in fact, a treatment, as opposed to no treatment, as most research studies would have you believe. It treats people’s mental perspective on their situation and gives them hope. That is also the major benefit of religion, so perhaps religion is a placebo for life. Some sage once said that life is an experiment without a control group. I think that is a good thing, especially if being in the control group involved no life. But life is full of placebos. For example, people with close family and friends live longer than people without this support group. Placebo effect? 

College students who attend class seem to do better grade wise than students who miss lots of classes. I wonder how much of this is due to the placebo effect. I propose a study involving three groups of students. All three groups would be enrolled in the same college course. Group one would attend all classes given by a professor who was lecturing on the course content. Group two would attend all classes given by the same professor who lectured, but not on content relating to the course. (I’m told that this is not uncommon.) The third group would not attend classes, but would take the examinations. I suspect group two would perform better (grade wise) than group three, even though they were not exposed to any more course content. The placebo effect of being in a fake lecture may be much the same as fake medical treatment.

A close cousin of the placebo effect applies to the money we spend. We are more apt to appreciate and value an item or experience if we spent money for it, than if the same item or experience was free. The aforementioned placebo study cost the National Institutes of Health a little over 1.6 million dollars. How much validity would we give it if it cost nothing?

Doing something has long been touted as being better than doing nothing. Even if the something being done is valueless, it has a placebo effect in that the person doing something valueless feels better about him or herself than does the person doing nothing. This might well explain the phenomenon of bureaucracy.

We feel better about seeing a doctor than not seeing a doctor, even if the doctor didn’t do anything but talk to us. Good bartenders do the same thing, but don’t have the added benefit of credentials, so they serve us a placebo. A study was actually done where two groups of people were given significant quantities of a beverage and told it was alcoholic, but only one group was actually served alcohol. After a number of drinks, many of the non-alcoholic drinkers began exhibiting the same drunken behaviors as if they were actually drunk, even though their blood alcohol level was zero. (Don't ask me to cite this study because I can't recall who, where or when.)

One conclusion to be drawn from all of this is that what we think can be as important as what we do, and often it can be more important - which is why learing how to think is the most important thing to learn in school. I can think of many more examples of this, but now I’ve got to stop thinking and go and do something.