On a Pill and a Prayer

Many people know the term “placebo effect,” but they probably don’t know how much placebos play a role in their lives. In light of our looming health-care crisis, it is time for government and industry alike to embrace and harness the peculiarities of this phenomenon.

The term “placebo” has been around for centuries; it originates from the Latin for “I shall please,” which then developed into a derogatory term for a medication aimed at pleasing the patient more than healing him. Today, it refers to a simple sugar pill used in clinical trials as a control to judge the effectiveness of new drugs. Ironically, the placebo today tends to equal or even surpass modern pharmaceuticals in effectiveness: the “placebo effect.” Placebos are relevant in our lives in not just medicine, however—many elevator “door close” and street crossing “press to walk” buttons are placebos.

Harnessing the placebo effect does not seem a particularly easy, or even feasible, task: beating the best of 200 years of scientific discovery, invention, and insight with just inert sugar. But the evidence remains embarrassingly clear that the placebo effect is real—and more important than we may care to admit. A recent article in Wired magazine explained the trend: “From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent.” And 50 percent of drugs that fail during clinical trials do so because they cannot improve upon the sugar pill. Pills for Crohn’s disease, schizophrenia, and depression have unexpectedly come up short against the placebo. Even surgical procedures and gene therapies have been proven no better than a skin incision or saline solution, which are in themselves placebo treatments.

In case this seems disturbing news, know this—new treatments are not getting weaker; instead, the placebo effect is actually growing stronger. Drugs like Prozac have flunked follow-up studies on effectiveness when the placebo effect literally doubled in size. And the most comprehensive reviews of antidepressant medications have revealed that the placebo effect has grown significantly stronger since the 1980s.

While the exact mechanism of the placebo effect is still unknown, researchers have discovered and elaborated upon the power of expectations. Not surprisingly, the U.S. pharmaceutical industry is familiar with the concept. In 2004, it spent $23 billion on marketing, crafting an image of safety, health, and well-being through television and print ads as well as the aggressive pursuit of trusted doctors and health-care professionals. Indeed, the positive effects of many modern medical treatments including cough medicines, antibiotics in the case of some infections, and the majority of back and arthroscopic surgeries have been proven to be the result of culturally ingrained expectations of their usefulness. Not one of the listed treatments beats a less expensive alternative.

What does this mean for our current health system? Some would call for the stop of such underperforming treatments, and this is not so unreasonable. Consider the complications that can result from surgery, and the antibiotic resistance that can develop from an improperly administered regimen—especially if the antibiotics aren’t doing anything a sugar pill couldn’t do. Doctors perform over 600,000 back surgeries a year to the tune of $20 billion. Surely some of the savings from eliminating back surgeries alone could go a long way toward funding health-care reform. This idea gains even more traction when you consider that, if subjected to the FDA approval process right now, back surgeries and any number of prescription or over-the-counter drugs would be summarily dismissed as failing to outperform the placebo level.

What the growing placebo effect shows is not so much the failure of modern medicine as much as the success of the modern production of beliefs. The modern health-care narrative is so firmly entrenched that it needs no introduction. You are sick; you visit the doctor; he diagnoses the illness; he prescribes the appropriate medication; you get better. Often this process, and not the actual treatment, cures us with its normality. This is why 55 percent of Chicago doctors have prescribed a placebo treatment to their patients.

All of this is not to deemphasize the importance of modern medicine. There are certainly drugs and treatments on the market that continue to significantly improve upon the placebo effect—but equally important is the perception and the culture of health care.

The government should see this as a sign that advertising works and duly subsidize or commission media campaigns targeted at lesser-known, cost-effective drugs. Even better, it should support new types of treatments, bringing their effectiveness into public consciousness and increasing the placebo effect associated with them. But even more importantly, the government should extend the provisions for research on the comparative effectiveness of different treatments and of different treatments against a placebo. We should be pleased that placebos provide these opportunities for saving money to use in health care—now we must pursue them.

Michael A. Sun ’12, a Crimson editorial writer, lives in Currier House.