Week of May 24, 2000
The "placebo effect" is astonishingly large. Between 35 and 75 percent of patients report feeling better from taking an inert pill during trials of new drugs. But what is the placebo effect, and how does it work. And if placebos can help so many people feel better, should they be used as treatment? Guests include Dr. Jon Levine , professor of medicine and the director of the National Institutes of Health Pain Center at the University of California, San Francisco Medical Center; Dr. Walter Brown, clinical professor of psychiatry at Brown University School of Medicine and Tufts University School of Medicine; Dr. Fred Quitkin, professor of Clinical Psychiatry at Columbia University; comedian David Brenner; New York Post columnist Gersh Kuntzman; and commentator John Hockenberry.
The program begins with New York Post columnist Gersh Kuntzman. When Viagra was first released, Gersh's editor asked him to take the drug and write about the results, even though Gersh does not suffer from erectile disfunction. But was his response a result of the drug, or the placebo effect? He wonders … aloud. You can read Gersh Kuntzman's columns each Monday in the New York Post, or at the New York Post's web site.
Next, Dr. Goodwin speaks with Dr. Walter Brown, clinical professor of psychiatry at Brown University School of Medicine and Tufts University School of Medicine and Dr. Fred Quitkin, professor of Clinical Psychiatry at Columbia University.
Dr. Brown explains that placebo is Latin for "I shall please." He says that the placebo effect includes all responses to treatment other than the intended response. He says that people who are treated with a placebo are getting all the other elements of treatment that everyone gets, other than a proven medication. Dr. Brown suggests that 90 percent of all so-called alternative therapies involve placebo responses.
Surgery is a powerful recruiter of the placebo effect, Dr. Brown says. He also points out that 25 percent of patients treated with a placebo for moderate high blood pressure will move into the normal range of blood pressure within a year, compared to 55-70 percent of those who get active medication. Twenty percent of patients with migraine headaches who are treated with placebos get relief, and 20-40 percent of those with peptic ulcers get relief with placebos, he says.
Dr. Goodwin asks Dr. Brown how placebos work. Dr. Brown says that there are a number of components involved. One is the effect of expectation. People who expect to get better have a better chance of actually getting better than those who don't, he says. Another component is conditioning. If someone has gotten treated in the past, a similar experience may provoke the placebo response. Stress reduction is also a factor. Patients often find relief and comfort in a treatment setting, and that may make them feel better.
Dr. Goodwin asks the guests if placebos should be used as treatment, since they seem to work, in many cases. Dr. Brown says that placebos are sometimes as effective as drugs in treatment of mild depression and panic disorder, so there may be some situations where a physician can honestly tell a patient that he is suggesting something which contains no drug, but which has helped others with that patient's condition.
Dr. Quitkin says he does not agree that drugs for depression and panic disorder are no more effective than placebos. But he adds that some people feel better as soon as they call or see the doctor, and for those people, a closely watched placebo treatment might be a possibility.
Dr. Walter Brown can be contacted through the Brown University School of Medicine web site or you can write to him c/o Brown University School of Medicine, 38 Brown Street, Providence, RI 02912. Dr. Quitkin can be contacted through the Columbia University web site, or write to him at Columbia University, 630 W. 168th Street, NY, NY 10027.
To learn more about the placebo effect, check out www.innerpharmacy.com.
The next guest is comedian David Brenner, who takes a humorous look at the placebo effect.
Dr. Goodwin then talks with Dr. Jon Levine, professor of medicine and the director of the National Institutes of Health Pain Center at the University of California, San Francisco Medical Center. Dr. Levine explains that when a patient receives a therapy, the act of administrating therapy activates endorphins in the brain that inhibit pain.
Dr. Goodwin asks if certain types of pain respond more readily to placebos. Dr. Levine says that all but one type seem to respond. That type is neuropathic pain, injury to the nerves themselves.
Dr. Goodwin asks if it's possible to respond to a placebo, even if you know it's a placebo. Dr. Levine says that it is. He believes that is because the patients' belief in the system outweighs the information that they are being given a placebo. Dr. Levine also points out that in his studies, he's found that patients given a bitter, colored placebo have higher response rates than those given one without taste or color. Dr. Levine explains that the clinical problems in which the nervous system plays an important role are those where you're most likely to see placebo responses. He mentions asthma and arthritis as conditions that seem to worsen under stress, and therefore have higher placebo responses.
To learn more about Dr. Levine and his work, check out the University of California Medical Center web site, or write to the University of California Medical Center, 3333 California Street, San Francisco, CA, 94143.
Next, John Hockenberry gives his view of the placebo effect.
Finally, Dr. Goodwin talks to Dr. Charles Jennings, editor of the journal Nature Neuroscience. They discuss a recent paper in Nature, in which the authors manipulated the brains of young ferrets so that nerves usually attached to the part of the brain concerned with hearing were attached to the portion concerned with vision. The ferrets perceived auditory input as light. This is significant, Jennings says, because it means that brains are not necessarily hard-wired at birth, that there is plasticity.
Dr. Charles then talks about a study that shows promise for developing new anti-anxiety drugs that don't make people tired. He said that a team had located the receptors for anxiety reduction, and those for sedation, and that they were able to target the former without targeting the latter.
Finally, Dr. Jennings talks about a study that looked at microwave radiation, the kind that comes from cellular phones. The scientists exposed worms to small amounts of the radiation, and found that it induced the heat shock response, which is how cells respond to overheating or other damaging stimuli. He said that this study needs to be interpreted with caution. For more information on these studies, check out the Nature Neuroscience web site, or you can write to Dr. Jennings at Nature Neuroscience, 345 Park Avenue South, New York, NY 10010.
