PLACEBO EFFECTS AND TREATMENT RESPONSES

There has been a lot written recently about the placebo effect and how it shows that medications are ineffective because they are not more effective than placebo.  In these studies, the placebo response is often in the 30-50% range as is the response to the active treatment being studied. Placebo controlled studies are ones where if we were in the study, we would not know whether we were getting the actual treatment or are receiving everything but the active component of the treatment. Thus, we would think we were getting the treatment but we would not be.  Thus, the placebo response is the response to the belief that we are getting the treatment.  In medication studies, the treatment would be the medication.  It is quite amazing to me that believing that we are getting medication can lead to a benefit as if we wer getting the treatment. This response only occurs if we believe that we are getting the medication.

I have often heard people say that if there is a placebo response close to the response to the actual treatment [medication in this case] that the treatment is not effective.  Studies have repeatedly shown that responses to treatment are improved considerably if medication is combined with different forms of therapy and I wonder if this would also help the placebo responders to improve their outcomes. Another important fact to be aware of is the limitations of studies that involve larger numbers of people as the statistical analyses show correlations but not causations.  Also, the studies are short duration and often do not generalize to real life experience with the medications.  In fact, the placebo controlled randomized studies identify potentially useful medications that then are prescribed by your doctor and you then become part of the larger study determining the effectiveness of the medication.  This is very important as it requires more time and dosing adjustments to fine tune the use of medications to determine how effective they are.  There are two problems that prevent this from occuring.  First, it takes time with each person to assess their response to medication and to help them to determine how they are responding.  Unfortunately, it is not common for physicians to take the time that is needed. Second, there is no mechanism to feedback information about how you responded or are responding to the medication in order to update the research.  Thus, there is no way to update research with your experiences and then decisions about treatment remain limited to the initial, time limited studies.  This is another reason that treatments [like medications] are considered to be ineffective.