Asthma sufferers feel better for placebos, US study finds

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The placebo effect is a real phenomenon and has been well documented and tested over many years, however until recently there has been little research on whether a placebo can really influence a disease such as asthma.

But a new study of asthma patients, in which the affect of placebos was compared with that of the recognised medical treatment albuterol, has concluded that once again the effect is real and measurable, at least in terms of relieving patients subjective symptoms.

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The study, led by investigators at Harvard Medical School (HMS), followed a cohort of 39 sufferers of chronic asthma, who were treated with an active albuterol inhaler, a placebo inhaler, sham acupuncture or no intervention at all.

Whilst the placebos had no effect on actual lung function (a key objective measure in treating asthma) they were as effective as albuterol in relieving symptoms and discomfort.

"We were trying to understand whether a placebo effect exists and, if so, whether it was similar with regard to both objectively and subjectively reported measures, and whether similar effects could be observed using different types of placebo," explained Michael Wechsler MD, Assistant Professor of Medicine at HMS.

The study concluded that treatment with the albuterol inhaler resulted in a 20% increase in FEV1 (maximum forced expiratory volume in one second), a measure of lung capacity. This compared with an increase of around 7% in each of the 2 placebo treatments as well as the 'no treatment' control.

Dr Wechsler continued, "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."

However, a subjective placebo effect does exist, according to patients who reported statistically significant symptomatic improvement with albuterol, as well as with the placebo inhaler and with sham acupuncture. For patients who received no treatment at all, little improvement, if any, was reported.

Whilst researchers were at first surprised to find no placebo effect, as soon as they saw patients' subjective descriptions of how they felt following both the active treatment and the placebo treatments, it became clear that the placebos were as effective as the active drug in helping people feel better.

The findings suggest that physicians should reconsider the implications of subjective, patient-reported outcomes in clinical trials, and consider having a 'placebo for the placebo' to monitor a patient's natural history.

"Despite beneficial effects on objective physiological outcomes, pharmacologic therapy may not provide incremental benefit on subjective symptoms provided by placebos," Wechsler added. "But while placebos remain an essential component of clinical trials to validate objective findings, assessment of natural history is essential in the final assessment of patient-reported outcomes."

"This research demonstrates once again that the very act of treatment, as a kind of ritual, can be a powerful benefit for the patient," says Emma Costin of Simpson Millar LLP. "As well as resolving the problems of disease by way of active therapies, the concept of receiving care is a vital ingredient to the health care model. At a time when some patients have declining faith in healthcare professionals, this may be an important part of the mix."


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