Sunday, May 9, 2010

The magic cure - The Boston Globe

You're not likely to hear about this from your doctor, but fake medical treatment can work amazingly well. For a range of ailments, from pain and nausea to depression and Parkinson's disease, placebos--whether sugar pills, saline injections, or sham surgery--have often produced results that rival those of standard therapies.

In a health care industry fueled by ever newer and more dazzling cures, this phenomenon is usually seen as background noise, or even as something of an annoyance. For drug companies, the placebo effect can pose an obstacle to profits--if their medications fail to outperform placebos in clinical trials, they won't get approved by the FDA. Patients who benefit from placebos might understandably wonder if the healing isn't somehow false, too.
But as evidence of the effect's power mounts, members of the medical community are increasingly asking an intriguing question: if the placebo effect can help patients, shouldn't we start putting it to work? In certain ways, placebos are ideal drugs: they typically have no side effects and are essentially free. And in recent years, research has confirmed that they can bring about genuine improvements in a number of conditions. An active conversation is now under way in leading medical journals, as bioethicists and researchers explore how to give people the real benefits of pretend treatment.

In February, an important paper was published in the British medical journal the Lancet, reviewing the discoveries about the placebo effect and cautiously probing its potential for use by doctors. In December, the Michael J. Fox Foundation announced plans for two projects to study the promise of placebo in treating Parkinson's. Even the federal government has taken an interest, funding relevant research in recent years.

But any attempt to harness the placebo effect immediately runs into thorny ethical and practical dilemmas. To present a dummy pill as real medicine would be, by most standards, to lie. To prescribe one openly, however, would risk undermining the effect. And even if these issues were resolved, the whole idea still might sound a little shady--offering bogus pills or procedures could seem, from the patient's perspective, hard to distinguish from skimping on care.

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