In asthma cases, placebo just as good as drug

[Celebration]

http://healthland.time.com/2011/07/14/study-in-asthma-patients-placebo-treatments-feel-just-as-good-as-the-drug/#ixzz1S7kiyCys

Sometimes the mind provides the most powerful medicine of all. A new Harvard Medical School investigation in asthma patients shows that the "placebo effect" — in which patients experience real benefits from sham treatments — can be as effective as standard medical therapy.

The researchers recruited 39 patients suffering from chronic asthma and randomly treated them with one of four interventions: albuterol inhalers, which are a common quick-relief treatment for asthma symptoms; placebo inhalers; sham acupuncture (patients were led to believe that they were getting acupuncture needles, but their skin wasn't punctured); or no treatment at all.

The participants received one of the treatments randomly during their visits, cycling through all four; each visit was scheduled three to seven days apart, and each patient had 12 medical visits altogether.

The researchers then gauged changes in patients' asthma symptoms in two ways: by taking objective measurements of lung function right after the treatment and by asking patients if they felt better.

Not surprisingly, patients reported improvement in symptoms, by about 50%, after using the albuterol inhaler. But they also said their symptoms — including shortness of breath, wheezing and coughing — improved by about 45% with the placebo inhaler and by 46% with the fake acupuncture. There was no statistical difference between the albuterol and sham treatments. Patients who got no treatment said they felt 21% better.

[hedgehog]

1. I don't think that's what the article says. I think the research suggests

that the subjects were less stressed out by their symptoms as long as they thought they were getting treatment. Call it the opposite of white coat hypertension.

[just55650]

3. i agree

[saras]

2. I've seen other research suggesting the placebo effect changes over time

In particular, a major meta-study and summary of antidepressant studies noted that the placebo effect in that area has gotten measurably larger over time, and is now large enough that many antidepressants that once were considered enough better than placebo to justify commercial use now perform BELOW placebo, without their performance having changed.

It's the reason we do double-blind studies against placebo in the first place - because we CAN'T assume we know how strong an effect it is, we have to measure it each time.

In this case, though, a closer reading suggests something else.

"When researchers looked at the participants' lung function objectively, by measuring their maximum forced expiratory volume in one second (FEV1), patients who got the real albuterol inhalers showed a 20% increase in FEV1. Those who got the dud inhaler, fake acupuncture or no treatment all showed improvements of only about 7%."

Objectively, there is a 7% change that seems to indicate that people get somewhat better over time without any treatment. This may be a placebo effect for being in the study at all.

There's no difference between a fake treatment and no treatment, hence no placebo effect. There is a real, measurable effect for albuterol, some three times larger than the reference.

[laconicsax]

4. The study doesn't conclude what your source thinks it does.

http://www.nejm.org/doi/full/10.1056/NEJMoa1103319#t=abstract

The study itself was never about the efficacy of placebo vs. treatment, but the effect of placebo with regard to self-reported results.

The results clearly showed that albuterol worked and the placebo/acupuncture didn't--the albuterol inhaler showed a 20% improvement while the placebo, acupuncture, and no treatment each had a 7% improvement. The drug works whereas placebo and "sham" acupuncture are equivalent to doing nothing...go figure.

The researchers however, were investigating the effect of placebo on self-reporting and found that patients receiving the two placebo treatments thought they were doing better at the same rate as they did when the were actually getting better. With albuterol, patients felt they were doing better, and they were. With placebo and acupuncture, patients felt they were doing better, but weren't.

Although albuterol, but not the two placebo interventions, improved FEV₁ in these patients with asthma, albuterol provided no incremental benefit with respect to the self-reported outcomes.

Placebo is no substitute for actual treament--it only fools people into thinking they're doing better. That's what the study showed. Not that placebo is as effective as actual treatment, but that people think it is.