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Why the Placebo Effect Threatens Big Pharma

New research sheds light on the placebo effect, threatens Big Pharma Harvard researcher Ted Kaptchuk. He has long theorized that the placebo effect is a biological response to an experience between a patient and doctor.

The more intense and focused the experience, the more healing occurs. Take acupuncture, for example, which is an intense experience known to cure a wide range of maladies with little scientific evidence to explain why.

“Rituals [like acupuncture] trigger specific experiences of the healer and patient, reinforced by the special-but-familiar surroundings, evoke a healing response that operates independently of the treatment’s specifics,” wrote Kaptchuk. “It seems that if the mind can be persuaded, the body can sometimes act accordingly.”

To learn more about this seemingly unexplainable phenomenon, Kaptchuk teamed up with molecular biologist Kathryn Hall to study the complex biochemical processes that occur when someone experiences the placebo effect.

Kaptchuk’s research seeks to prove:
How the placebo effect works
Why the effect works for some people and not others
Why the effect works for some conditions and not others

Overall, Kaptchuk wants doctors to accept the placebo as a legitimate treatment method.

What is the placebo effect?

The term “placebo” (Latin for “I shall please”) refers to a harmless medication presented as “real” treatment. The term “placebo effect” describes the phenomenon whereby a sick patient gets better from such a treatment.

The effect is bizarre, but well documented. Conditions that respond to placebos as well as they do to drugs include: back pain, depression, migraines, PTSD, postoperative pain, and irritable bowel syndrome. Placebos have even been known to facilitate healing and change a person’s blood chemistry.

For these reasons, the FDA requires all new drugs to outperform placebos in two independent trials. This rule implies the placebo effect is legitimate and more effective than drugs which fail to achieve FDA approval.

What this means is that society recognizes placebos as important but does not treat them as such. And while every single clinical trial is essentially a study of the placebo effect, the effect itself remains woefully underexplored.

In the meantime, doctors won’t use it because they can’t explain how it works; and Big Pharma isn’t interested because there is no money in sugar pills. It is this very irony that Kaptchuk hopes to solve.

“What makes our research believable to doctors?” asks Kaptchuk. “It’s the molecules. They love that stuff.”
So far, Kaptchuk and his colleagues have determined that a person’s placebo response is related to an enzyme called COMT. The more COMT present, the lower the placebo response (and vice versa).

“For years, we thought the placebo effect was the work of imagination,” says Hall. “Now, through imaging, you can literally see the brain lighting up when you give someone a sugar pill.”

Further studies revealed the effects were compounded by the patient-doctor experience. The more attention a patient received, the more likely they were to respond to a placebo. Patients with low COMT and high interaction showed the most improvement.

Patients with low COMT performed worse than other groups when they received no treatment. This suggests individuals with low COMT are particularly sensitive to the impact of the patient-doctor experience.

These findings reflect the widespread belief that a placebo only works if you believe it works. And part of that belief is associated with a patient’s faith in his or her doctor.

As noted by The New York Times, the team’s research could have massive implications for clinical drug trials and for drugs themselves.

Moving forward, Hall now seeks to identify the biochemical group she calls the “placebome.” As she points out, COMT is among a group of enzymes associated with brain chemicals dopamine and epinephrine. These chemicals are associated with stress and good feelings – which heightens the possibility that her so-called placebome plays a key role in a person’s overall health, especially when it comes to the stress-related conditions most susceptible to placebo treatment.

Hall predicts the placebome will turn out to be a chemical pathway along which healing signals travel; it will be the place where the brain translates the act of caring into physical healing.

Kaptchuk is excited about Hall’s discoveries, but is worried where further research might lead. “Once you start measuring the placebo effect in a quantitative way, you’re transforming it to be something other than what it is,” says Kaptchuk, who remains convinced the placebo effect cannot be fully defined by science.

“Will this work destroy the stuff that actually has to do with wisdom, preciousness, imagination – the things that are actually critical to who we are as human beings?” he asks. “I don’t know, but I have to believe there is an infinite reserve of wisdom and imagination that will resist being reduced to simple materialistic explanations.”

Kaptchuk and Hall presented their findings last month at a meeting of the Society for
Interdisciplinary Placebo Studies held in the Dutch city of Leiden.

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