They were the “no option” patients, people with advanced heart disease who had used up all their bypass surgeries and who were running out of ways to stay alive.
But when they joined a study testing laser surgery and a heart drug that grows new blood vessels, remarkable things happened. Their crippling chest pain improved. They had fewer angina attacks. They were able to exercise longer during a stress test on a treadmill. Sophisticated nuclear scans showed an improvement in blood flow to their hearts and heart function. And they didn’t improve for just a week or two weeks or six months. They were still better two years later – a result all the more incredible considering they actually received no active treatment.
Yes, a catheter was inserted into an artery and slowly pushed up to the heart. Investigators then went through all the motions of making the patients believe they were using a satellite-guided laser to drill holes into their heart muscle. But the laser was never actually switched on. Another group of patients got “sham” injections of salt water, instead of a growth protein.
“We gave these patients big headphones, we played loud music and the only person who knew whether they were receiving treatment or a placebo was the operator, who was not involved in their follow-up,” says lead author Dr. Roger Laham, an assistant professor of medicine at Harvard Medical School in Boston.
The surprising study, published in August’s issue of the American Journal of Cardiology, adds to growing evidence that the placebo effect not only triggers true physiological changes in the body; it lasts longer than thought.
“The traditional thinking was, ‘Well, the patient improves for a couple of weeks after you give them treatment because they have a better outlook on life and then they kind of go back and regress to what they were,’ says Dr. Laham. “What this study shows is, in fact, that is not the case. What does happen instead is that these patients improve, and their improvement is as sustained as the ones given active treatment.”
This is bad news for researchers and drug companies, who try hard to quash the placebo effect when testing new drugs in order to know how real a medicine’s effect is. But rather than stifle it, others are racing to mimic it. They are testing different genes, as well as endorphins and hormones that are elevated following a placebo response.
“There is no role in medicine for deceiving patients.” Dr Laham stresses. Deceit by any definition “is not very ethical and no licensing body would condone a doctor palming a ‘pill’ made of sugar, starch or chalk off as real medicine.
“However, it’s going to be important to see what is in this deceit, or what the placebo effect entails. I’m certain there are certain physiologic effects that do occur. We’re only just starting to scratch the surface.”
U.S. researchers are already testing placebos in the treatment of children with attention-deficit disorder, and in adults with autoimmune disease such as lupus. In fact, depending on the drug and the sickness involved, placebos – inert substances that contain no active substances – do as well, or better, in anywhere from 5% to 82% of patients studied. Conditions that respond to placebos include coughs, colds, bronchitis, asthma, herpes, duodenal ulcers, congestive heart failure, arthritis to name but a few.
Finally medicine is catching up to, or rather rediscovering the truth which originated with Hippocrates, the father of medicine: “The mind is the great healer.”
