Parkinson’s disease patients secretly treated with a placebo instead of their regular medication performed better when told they were receiving a more expensive version of the “drug,” researchers reported last week in an unprecedented study that involved real patients.
The research shows that the well-documented “placebo effect” – actual symptom relief brought about by a sham treatment or medication – can be enhanced by adding information about cost, according to the lead author of the study. It is the first time that concept has been demonstrated using people with a real illness , according to an expert not involved in the study.
“The potentially large benefit of placebo, with or without price manipulations, is waiting to be untapped for patients with (Parkinson’s disease), as well as those with other neurologic and medical diseases,” the authors wrote in a study published online Wednesday in the journal Neurology.
But deceiving actual patients in a research study raised ethical questions about violating the trust involved in a doctor-patient relationship. Most studies in which researchers conceal their true aims or other information from subjects are conducted with healthy volunteers. This one was subjected to a lengthy review before it was allowed to proceed, and, in an editorial that accompanied the article, two other physicians wrote that “the authors do not mention whether there was any possible effect (reduction) on trust in doctors or on willingness to engage in future clinical research.”
Nor would such a ruse be allowed in clinical practice, said Ted Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter at Harvard Medical School.
“I don’t think it has a direct practical application,” Kaptchuk said. “Telling people something is expensive, that’s deception. That’s not allowed in clinical practice.”
Nevertheless, he said, the research is “provocative” and adds to the body of proof about how the placebo effect augments treatment of disease, especially when medication is provided.
While most people think of a placebo as a sugar pill that replaces a real medication, the impact more commonly comes from “the engagement between patients and clinicians,” in particular the way doctors create expectations that their efforts will help, Kaptchuk said. That includes a good relationship between doctor and patient; certain medical rituals, such as taking blood pressure and a medical history; and the “color, shape, number and cost” of the placebo drug, according to the institute’s website.
