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Please Pass the Sugar
. . . with a grain of salt

One of the world's greatest wonder drugs is not a drug at all. It's a placebo—a sugar pill or perhaps an injection of saline solution. There's no pharmacological component whatever in a placebo, but darned if it doesn't kill the pain, revive the spirit, cure what ails us.
Placebos even take the form of surgery. Arthroscopic knee surgery is a remedy for arthritis, but researchers have matched its effectiveness with a sham operation. They sedated patients, nicked their knees, woke them up, and told them the operation was a success. Two years of follow-up showed that pain relief and improved function were the same for placebo patients as for those who had real operations.
How do we explain the placebo effect? Some might say, "It's all in your mind." But the mind-body distinction isn't sharp. It's better to say that the mind can affect how the body copes with a problem.
In a recent study 50 percent of Parkinson's patients showed improved motor function after receiving a placebo—a saline injection. This improvement was not something the patients imagined. Parkinson's symptoms are typically caused by the failure of brain cells to produce dopamine, a neurotransmitter. Brain scans confirmed that just the anticipation of relief triggered dopamine production. Thinking they'd get better caused patients to have a real chemical response with a real effect.
Tor Wager, a psychologist at Columbia University, led a recent study in which test subjects were told that one skin cream would reduce pain while another wouldn't. Wager put the creams on two spots on the subjects' arms and then applied enough heat to produce a burning sensation. Brain scans and verbal reports indicated that subjects perceived less pain with the cream that "really worked," even though the creams were identical.
The opposite of the placebo effect also happens. This is called the "nocebo" effect. More than one out of five patients given a placebo reports unexpected adverse side effects. These patients have headaches, they can't sleep, they feel nauseated.
In one drug trial, some of the patients receiving a placebo were told they might experience gastrointestinal irritation. The subjects who heard the warning experienced more distress and were six times more likely to drop out of the trial altogether.
Placebos don't work for heart attacks or tumors. There are limits to the power of suggestion. But much of medicine revolves around relatively subjective forms of distress: chronic pain, upset stomach, and so on. That's where a sugar pill works its magic. "Our beliefs," says Wager, "have powerful influences on our experiences."
So the next time you feel under the weather, try the simplest cure first: Imagine yourself healed.
—Joel Achenbach
    Washington Post staff writer

Web Links

Consumer Healthcare Products Association (CHPA)
The CHPA, a manufacturers' association, partnered with the U.S. Food and Drug Administration to provide consumer information on the more detailed over-the-counter medicine labels required on products as of May 2002.

U.S. Food and Drug Administration: Center for Drug Evaluation and Research
Find dozens of links relating to the products regulated by CDER, including the
Inactive Ingredients Database.

U.S. National Institutes of Health, National Institute of Neurological Disorders and Stroke's_disease_backgrounder.htm
Start with this Parkinson's Disease Backgrounder to learn about the symptoms, causes, and treatments of the disease. In the United States, at least 500,000 people are believed to suffer from the disease and about 50,000 new cases are reported annually.

More Articles by Joel Achenbach
Read some of writer Joel Achenbach's columns for the Washington Post.

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Barsky, Arthur, and others. "Nonspecific Medication Side Effects and the Nocebo Phenomenon." Journal of the American Medical Association (February 6, 2002), 622-27.
De La Fuente-Fernandez, Raul, and A. Jon Stoessl. "The Placebo Effect in Parkinson's Disease." Trends in Neurosciences (June 2002), 302-306.
Moseley, J. Bruce, and others. "A controlled trial of arthroscopic surgery for osteoarthritis of the knee." New England Journal of Medicine (July 11, 2002), 81-8.
Shapiro, Arthur K., and Elaine Shapiro. The Powerful Placebo: From Ancient Priest to Modern Physician. Johns Hopkins University Press, 1997.
Talbot, Margaret. "The Placebo." New York Times Magazine (January 9, 2000), 34-9 passim.
Wager, T. D., and others. "Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain." Science (February 20, 2004), 1162-67.


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