The biggest headache for any drug-company executive is the placebo. A placebo, or sugar pill, is used in controlled drug trials precisely to show that the drug in question works.

One of two groups of patients is given the active drug, while the other group is given the placebo, but neither knows who got what. The assumption is that far more patients will show improvements on the drug than on the placebo. Upon this assumption is built the entire edifice of modern medicine.

Nevertheless, in practice, so many patients receive the same relief and even the same side effects with a placebo as with the drug itself that a placebo often is not a true control.

Placebo power

The power of the placebo was best illustrated by a group of patients treated for Parkinson’s disease, a motor system disorder in which the body’s system for releasing the brain chemical dopamine is faulty. The standard treatment for Parkinson’s is a synthetic form of dopamine.

In a study at the University of British Columbia, a team of doctors demonstrated with PET scanning that, when patients given placebos were told they had received dopamine, their brains substantially increased the release of their own stores of the chemical.

In another dramatic instance, at Methodist Hospital in Houston, Dr Bruce Moseley, a specialist in orthopaedics, recruited 150 patients with severe osteoarthritis of the knee and divided them into three groups.

Two-thirds were either given arthroscopic lavage (which washes out degenerative tissue and debris with the aid of a little viewing tube) or another form of debridement (which sucks it out with a tiny vacuum cleaner).

The third group were given a sham operation: The patients were surgically prepared, placed under anaesthesia and wheeled into the operating room. Incisions were made in their knees, but no procedure carried out.

Over the next two years, during which time none of the patients knew who had received the real operations and who had received the placebo treatment, all three groups reported moderate improvements in pain and function. In fact, the placebo group reported better results than some who had received the actual operation.

Raising the game

The placebo problem has been raised to another degree of complexity after Harvard’s professor of medicine Ted Kaptchuk decided to run a trial in which participants with irritable bowel syndrome were given a placebo but told that they indeed taking a sugar pill, while the other half of the group were given nothing at all/ The placebo group were also told that placebos have been shown to create powerful mind-body self-healing.

Kaptchuk found that nearly two-thirds of his placebo group reported improvements in their symptoms — even more than had improved on powerful new IBS drug called alosetron in a recent trial.

Drugs or thoughts?

This raises the very basis question I’ve wrestled with for a long time: do pharmaceutical drugs ever work? Is it ever the chemical itself that heals, or is the mental expectation of healing enough to marshal the body’s healing mechanisms?

Other research bolsters the idea that the healer, or even the healing ritual itself, may be more powerful than any actual medical agent. A recent study of 83 rheumatoid arthritis patients attended by a homeopath concluded that the consultation with a sympathetic practitioner—rather than the remedy itself —was the cause of physical improvements noted by the patients.

Sometimes the expectation of healing can be a large factor in positive results. In one healing study of patients suffering from clinical depression, all the patients improved, even the control group, which did not receive healing, largely from the psychological boost created by the possibility of healing.

Healing rituals

There is also the power of healing rituals – the idea of ‘taking something,’ even if that something is known to be fake. In a recent analysis of 46,000 heart patients, half of whom were taking a placebo, the patients taking a placebo fared as well as those on the heart drug. The only factor determining survival seemed to be belief that the therapy will work and a willingness to follow it religiously.

Those who tended not to survive were those who had been lax with their regimen, regardless of whether they had been given a placebo or an actual drug.

Studies like these suggest that what we take doesn’t matter; the connection with the healer, the healing words and practices, the expectation of healing — in other words, our thoughts about healing — are always what turns out to be the true healer.

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