Materialism reaffirmed

[Barry Stoller <bstoller@xxxxxxxxxxxxxxxxxx>]

New York Times. 24 May 2001. Study Casts Doubt on the Placebo Effect.
Excerpts.


In a new report that is being met with a mixture of astonishment and
sometimes disbelief, two Danish researchers say the placebo effect is a
myth. </P> <P> The investigators analyzed 114 published studies
involving about 7,500 patients with 40 different conditions. The report
found no support for the common notion that, in general, about a third
of patients will improve if they are given a dummy pill and told it is
real.

Instead, the researchers theorize, patients seem to improve after taking
placebos because most diseases have uneven courses in which their
severity waxes and wanes.

In studies in which treatments are compared not just with placebos but
also with no treatment at all, they said, participants given no
treatment improve at about the same rate as participants given placebos.

The paper appears today in The New England Journal of Medicine. Both
authors, Dr. Asbjorn Hrobjartsson and Dr. Peter C. Gotzsche, are with
the University of Copenhagen and the Nordic Cochran Center, an
international organization of medical researchers who review randomized
clinical trials.

Dr. Donald Berry, for example, a statistician at the M. D. Anderson
Cancer Center in Houston, said: "I believe it. In fact, I have long
believed that the placebo effect is nothing more than a regression
effect," referring to a well- known statistical observation that a
patient who feels particularly terrible one day will almost invariably
feel better the next day, no matter what is done for him.

Another physician, Dr. Jonathan Moreno, director of the Center for the
Biomedical Ethics at the University of Virginia, said it rang true to
him. "Maybe it is one of the urban legends of medicine," he said.

Dr. Hrobjartsson and Dr. Gotzsche said they began their study out of
curiosity. Over and over, medical journals and textbooks asserted that
placebo effects were so powerful that, on average, 35 percent of
patients would improve simply if they were told that a dummy treatment
was real. The investigators began asking where this assessment came
from. Every paper, Dr. Hrobjartsson said, seemed to refer to other
papers. And those papers referred him to other papers.

He began peeling back the onion, finally coming to the original paper.

It was written by a Boston doctor, Henry Beecher, who had been chief of
anesthesiology at Massachusetts General Hospital in Boston and in 1955
published a paper, "The Powerful Placebo" in The Journal of the American
Medical Association. In his paper, Dr. Beecher, who died in 1976,
reviewed about a dozen studies that compared placebos with active
treatments and concluded that placebos had medical effects.

"He came up with the magical 35 percent number that has entered placebo
mythology," Dr. Hrobjartsson said.

But, Dr. Hrobjartsson said, diseases naturally wax and wane. And no
matter how sick the person is, a truly bad spell will almost inevitably
be followed by a period in which the condition seems to improve. What if
the natural variation in a disease's course is behind the placebo
effect, they asked?

"Of the many articles I looked through, no article distinguished between
a placebo effect and the natural course of a disease," Dr. Hrobjartsson
said. "This is a very banal error to make, but sometimes banal errors
are made."

He and Dr. Gotzsche began looking for well-conducted studies that
divided patients into three groups, giving one a real medical treatment,
one a placebo and one nothing at all. That was the only way, they
reasoned, to decide whether placebos had any medical effect. But they
worried that there might be so few such studies with a treated,
untreated and placebo group that they would never be able to answer the
question.

"We thought if we could find 20, that would be a huge success," Dr.
Hrobjartsson said.

To their surprise, they found 114, published between 1946 and 1998. The
conditions included from medical disorders, like high blood pressure,
high cholesterol levels and asthma; behavioral disorders and addictions,
like alcohol abuse and smoking; neurological diseases like Alzheimer's
disease, Parkinson's disease, and epilepsy, and infections, like
bacterial infections and the common cold.

When they analyzed the data, they could detect no effects of placebos on
objective measurements, like cholesterol levels or blood pressure.

Dr. John C. Bailar III, an emeritus professor at the University of
Chicago who wrote an editorial accompanying the placebo paper, said the
findings called into question some mind-body beliefs.

These are arguments that use the placebo effect to conclude that the
mind can so profoundly affect the course of a disease that people should
be able to harness this power and think themselves well.



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Barry Stoller

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