Sunday, December 26, 2010

Placebo Effect Is the Power of Attention

If you have an illness, it helps to pay attention to it. That’s the conclusion I draw from a recent clinical study on the effectiveness of placebo.

A placebo has the outward physical form of a medication, but it contains materials known to be relatively inert in medical terms. It could be a capsule filled with a combination of sugar, starch, silica, and gum. All of these substances have metabolic significance in larger quantities, but not in the amount that would fit inside a capsule. The intriguing thing about placebos is that they cure diseases. They aren’t consistently effective, of course, but they may be nearly as effective as the drugs that people take for illnesses. A pharmaceutical agent is considered particularly potent if it is twice as effective as a placebo.

In the 20th century, the effectiveness of a placebo was generally attributed to the power of belief. People taking a placebo were told that they were, or might be, taking a drug that was known to be effective in treating the illness that they had. They weren’t told they were taking a placebo, because then, it was thought, the placebo effect would vanish.

Like most things in commercial medicine, this understanding of the effect of a placebo was accepted as fact for ages without ever being clinically tested. Now it has been tested, and the results are surprising.

One group of patients in the study were told that they were taking a placebo with no effective ingredients. It was a pill delivered in a bottle labeled “Placebo,” so there wasn’t much room for doubt that it was just a placebo. The other group of patients received no treatment. According to the belief theory of placebos, the result of the placebo should have been about the same as the result of no treatment at all, since the patients were told that the treatment was only a placebo. But in fact, the placebo group had twice the medical improvement of the group that didn’t receive any treatment. It was a statistically significant difference, more significant than that found for many drugs in common use.

In my opinion, what this study suggests is that the placebo effect is the result of attention, rather than belief. The patients taking the placebo were taking an action relative to their illness. It may have been only a token action, but it still focused their attention on their illness for a few moments every day.

The idea that the placebo effect is the result of attention might seem inconsistent with the observation that people who simply worry about an illness don’t tend to get much relief from their worry. But there is a difference between worrying about an illness and paying attention to it. Worry focuses attention on imagined scenarios, often frightening stories of what might happen, so perhaps it does not really include much attention to the present situation.

Similarly, belief is essentially little more than a set of stories, which may be mostly imaginary. Stories do have some power, but when it comes to curing illnesses, it appears that attention is more important.