Sometimes the mind provides the most powerful medicine of all. A new Harvard Medical School investigation in asthma patients shows that the “placebo effect” — in which patients experience real benefits from sham treatments — can be as effective as standard medical therapy.
The researchers recruited 39 patients suffering from chronic asthma and randomly treated them with one of four interventions: albuterol inhalers, which are a common quick-relief treatment for asthma symptoms; placebo inhalers; sham acupuncture (patients were led to believe that they were getting acupuncture needles, but their skin wasn’t punctured); or no treatment at all.
The participants received one of the treatments randomly during their visits, cycling through all four; each visit was scheduled three to seven days apart, and each patient had 12 medical visits altogether.
The researchers then gauged changes in patients’ asthma symptoms in two ways: by taking objective measurements of lung function right after the treatment and by asking patients if they felt better.
Not surprisingly, patients reported improvement in symptoms, by about 50%, after using the albuterol inhaler. But they also said their symptoms — including shortness of breath, wheezing and coughing — improved by about 45% with the placebo inhaler and by 46% with the fake acupuncture. There was no statistical difference between the albuterol and sham treatments. Patients who got no treatment said they felt 21% better.
The question is, did the patients’ asthma symptoms actually improve? When researchers looked at the participants’ lung function objectively, by measuring their maximum forced expiratory volume in one second (FEV1), patients who got the real albuterol inhalers showed a 20% increase in FEV1. Those who got the dud inhaler, fake acupuncture or no treatment all showed improvements of only about 7%.
“Since there was no difference between either of the placebo treatments and the placebo ‘control’ [no treatment], we can report that there was no objective placebo effect with regard to change in lung function,” lead author Dr. Michael Wechsler, assistant professor of medicine at Harvard Medical School, said in a statement.
Still, the study shows that placebo treatments can have powerful effects on patients’ self-assessments of symptoms, offering just as much benefit as the real drug. It also shows that self-reporting isn’t really a reliable measure of symptom control. But the findings shed light on the potential usefulness of the placebo effect when it comes to clinical care.
“It’s clear that for the patient, the ritual of treatment can be very powerful,” noted study author Ted Kaptchuk, director of the program in placebo studies at Beth Israel Deaconess Medical Center. “This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”