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If you're going to take fake medicine, make sure it's the expensive kind

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If you're going to take fake medicine, make sure it's the expensive kind

Drug trialson Parkison's disease patients using placebos in place of real medicine suggest that cost could be the key to effective treatment

PUBLISHED : Thursday, 29 January, 2015, 10:06pm
UPDATED : Friday, 30 January, 2015, 1:17am

The Washington Post

elderly-xinhua.jpg


Parkinson's is a progressive neurological disease with no known cure. Photo: Xinhua

When patients with Parkinson's disease received an injection described as an effective drug costing US$1,500 per dose, their motor function improved significantly more than when they got one supposedly costing US$100, scientists reported.

But in a stunning illustration of the placebo effect and the power of human expectation, the motor improvements occurred even though neither injection contained any medicine at all.

The research, said an editorial in the medical journal Neurology, which published it, "takes the study of placebo effect to a new dimension".

The study 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.

Parkinson's is a progressive neurological disease with no known cure.

"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 the study published online on Wednesday.

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 the 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 Programme 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 their efforts will help, Kaptchuk said.

In the study, 12 Parkinson's patients were told they were receiving injections of a new drug to help their brains produce dopamine, the neurotransmitter deficient in Parkinson's patients, instead of their regular drug, levodopa. They were told that one injection was a US$1,500 version of the drug and another was a US$100 version. In fact, they were given common saline solution both times.

The researchers found the patients performed better on motor skills tests when they believed they were on the expensive drug, an effect that increased when they were given the expensive placebo first.

Neither placebo was quite as good as levodopa, but the expensive version came close. There was no follow-up to determine how long the improvements lasted because the patients were put straight back on their regular drug regimens.

"I attribute this to patients' perception of greater quality intervention when cost is higher than what they would have been accustomed to," said Alberto Espay of the Gardner Centre for Parkinson's Disease and Movement Disorders at the University of Cincinnati, who led the study.

When the researchers looked at functional MRI tests of the participants' brains, however, they found that the cheap placebo activated certain areas more than the expensive one, a result they did not expect. Espay suggested patients might have been trying harder when they believed they were on a less costly medication.

Espay said the challenge now is to harness the knowledge in patient care. Because outright deception is ethically impermissible, other ways of enhancing the effectiveness of medication should be explored, he said.

Additional reporting by Reuters


 
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