DR MICHAEL MOSLEY: Should doctors now prescribe dummy pills to ease pain? (…and tell you they’re fake)
How would you feel if you went to see your GP with severe pain caused by a bad back or irritable bowel syndrome (IBS), and you were told they had just the thing to help — a placebo; a pill containing nothing but rice flour or sugar.
That possibility has come closer, thanks to a new study showing that giving patients an ‘honest’ placebo, one where they know they are getting a dummy pill, can be extremely effective at reducing pain.
And with a recent report from the Office of National Statistics showing that deaths from taking high-strength painkillers, such as tramadol and codeine, have doubled over the past ten years, there is clearly a need for safe and effective alternatives.
I’ve been involved in studies of the placebo effect, including one where we recruited more than 100 patients with chronic back pain and told them they were either getting a powerful new painkiller or a placebo. In fact, they were all given a placebo
But if the placebo effect is so effective, why don’t doctors make more use of it?
I’m a huge fan of the placebo effect. I think it’s remarkable that you can give someone a bright-coloured pill, which contains no active ingredient, and this will reduce their pain.
But it is also misunderstood. The assumption is that people who respond either weren’t ill in the first place or are credulous. Neither is true.
I’ve been involved in studies of the placebo effect, including one where we recruited more than 100 patients with chronic back pain and told them they were either getting a powerful new painkiller or a placebo. In fact, they were all given a placebo.
In this study, which was published last July in the European Journal for Person Centred Healthcare, nearly half the patients reported significant pain relief, despite swallowing dummy pills.
As I was told by Dr Jeremy Howick, an expert from Oxford University who designed our study, people who respond best to a placebo are not gullible; they are simply more open minded, especially when it comes to new experiences.
So how does it work? Well, a couple of years ago I watched an intriguing experiment carried out by Manchester University’s Human Pain Research Group. They started by attaching electrodes to a volunteer, Jack, so they could measure his brainwave activity. Then he was given two identical-looking creams and told one was a normal moisturiser, and the other may or may not contain an anaesthetic.
In reality, they were both just moisturisers. He was asked to rub cream from one tub into his left arm, the other into his right.
Next, they heated Jack’s arms with a laser, which he had to rate for painfulness on a scale from one to ten. What they didn’t tell him was that while his left arm got a full blast, his right arm had a weaker zap. They did this several times until Jack was convinced the cream he’d rubbed on his right arm contained an anaesthetic.
Finally, they gave his right arm a full blast with the laser. Amazingly, when that happened, part of Jack’s brain, the frontal cortex, began producing large amounts of brainwaves called alpha waves and this immediately moderated the pain signals reaching the brain.
This, and other research they’ve done, suggests the placebo effect works by ‘persuading’ your brain to express more alpha waves, thereby dialling down the pain, although no one knows why the waves work in this way.
But if the placebo effect is so effective, why don’t doctors make more use of it?
My sister, Susie Stead, has just published a book, Stephen From The Inside Out, about a friend who, when young, was labelled ‘schizophrenic’ and spent more than 25 years in psychiatric wards. Stephen wasn’t diagnosed with autism until his late 40s
Well, there is a belief among doctors that a placebo treatment works only if patients think they are getting a ‘real’ pill. And that would mean lying to patients, which is unethical. A new study, however, involving people with IBS suggests the placebo effect can work even when you know you are taking a placebo. IBS affects around 20 per cent of adults in the UK and can cause crippling stomach cramps, as well as bloating, diarrhoea and constipation.
There is no known cure, though lifestyle changes can help.
To see whether giving patients an ‘honest’ placebo can help, researchers from the Beth Israel Deaconess Medical Centre in the U.S. recruited 262 people with IBS.
The patients were randomly allocated to three different groups. One group was told it would be getting placebo pills, containing no active ingredient, though the patients were also told that taking the pills could improve their symptoms. The second group was told it would get either a placebo or a pill containing peppermint oil (which can help with IBS), but didn’t know which.
A third group acted as a control and received nothing.
Those given a pill were asked to take it three times a day, 30 minutes before meals, for six weeks. At the end of the study, the patients in both of the pill groups reported a much bigger improvement in their symptoms than the control group.
Seventy per cent of those swallowing pills reported at least a 50-point improvement in their symptom score, while 30 per cent reported their score had increased by at least 150 points, which was considered a ‘very strong’ response.
I wasn’t surprised. In our back- pain study, most of the patients who got relief from taking our placebo pills said they wanted to continue taking them, despite knowing that they were swallowing nothing but ground up rice.
It seems you don’t have to deceive people to tap into the power of the placebo, at least for certain conditions. If you trust the doctor prescribing them, then simply taking pills which you have been told might do you good, really can help.
There’s a powerful connection between the microbes living in your gut, known as the microbiome, and your brain. Not only does your microbiome influence your mood, but there is evidence that children with severe autism can be helped by changing their gut bacteria. More on that in a moment.
The popular image of autism is either of a child rocking to and fro, barely able to speak, or someone who is brilliant at science but bad at human relationships. The truth is more complicated. Autistic spectrum disorder (ASD), can range from those who are severely affected to those who simply find it hard to communicate and interact with other people.
A recent study by the University of Cambridge suggests that around 1.76 per cent of children in England are on the autism spectrum, a higher figure than previously thought.
What’s tragic is that so many people with ASD have been misunderstood or misdiagnosed. My sister, Susie Stead, has just published a book, Stephen From The Inside Out, about a friend who, when young, was labelled ‘schizophrenic’ and spent more than 25 years in psychiatric wards. Stephen wasn’t diagnosed with autism until his late 40s, and none of his talents, including his extraordinary memory and aptitude for poetry, was celebrated in his lifetime.
While autism can’t be ‘cured’, speech and social therapy can help. There is also research that suggests changing the gut microbiome with a faecal transplant (using a treated sample from a donor) can improve some of the symptoms and behavioural problems associated with severe autism.
Evidence for this comes from a small study by researchers at Arizona State University in the U.S. At the start of the study, 83 per cent of the children were rated as having ‘severe’ autism, but two years after the transplant, only 17 per cent were rated ‘severe’. The parents also reported significant improvements in their language, interactions and behaviour.
The researchers are now carrying out a bigger, placebo-controlled trial in adults.
Sleeping well? This is not a rhetorical question, I really want to know. So much so that I recently launched, with the help of researchers from Oxford University, what we are hoping will be the UK’s largest ever sleep study.
If you fill in our questionnaire — find it by googling ‘BBC2 Horizon Sleep Census’ — you will get your own personalised sleep score and discover where you are on the owl-lark spectrum, i.e. the extent to which you’re better suited to late nights or early mornings. We’ll be using the anonymous data to build a detailed picture of what we all do to get a good night’s sleep, as well as the impact that sleep has on how we think and feel.
I will report back on our findings later in the year.
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