Placebo and nocebo effects

Krishna: First let me deal with ‘alternative medicine’.

Several Researchers have tested alternative medicines like Homeopathy using scientific methods. What results did they get? These are evidence based facts:

And some ayurvedic medicines have found to be ineffective and harmful too …

Ayurveda is ancient science. You have to validate its claims. But some ayurvedic practitioners are refusing to submit their medicines for testing saying that there is no need to do that which is highly irresponsible way to avoid authentication. This is making scientists to doubt their claims.

So based on these results, some alternative treatments have been marked a s pseudo-science by scientists.

Some of the alternative medical practices that have been marked as pseudo-science:

Acupuncture, dry-needling, acupressure, alternative cancer treatments like using cow’s urine, aromatherapy, bio-rhythms, brain gym, chiro-practice, chromotherapy, colon cleansing, body detoxification, crystal healing, faith healing, diet therapies, naturopathy, oil pulling, reiki, reflexology, therapeutic touch, urine therapy, … and the list goes on.

But people still go for them despite scientists’ warning and get cheated.

Now let me deal with the placebo effect. A substance - usually pharmacologically inert preparation - or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect is termed as a placebo. Placebos have been used in clinical trials for a long time, and are an essential part of research into new treatments. They are used to help test the effectiveness of a new health care treatment, such as a medication. It is an inert or innocuous substance used especially in controlled experiments testing the efficacy of another substance (such as a drug).

Researchers use placebos during studies to help them understand what effect a new drug or some other treatment might have on a particular condition.

For instance, some people in a study might be given a new drug to lower cholesterol. Others would get a placebo. None of the people in the study will know if they got the real treatment or the placebo.

Researchers then compare the effects of the drug and the placebo on the people in the study. That way, they can determine the effectiveness of the new drug and check for side effects.

A placebo is a fake or sham treatment specifically designed without any active element. A placebo can be given in the form of a pill, injection, or even surgery. The classic example of a placebo is the sugar pill.

There are two types of placebos: Pure or inactive placebos, such as sugar pills or saline injections. Impure or active placebos, such as prescribing an antibiotic for a viral infection or a vitamin even though the patient doesn't need it.

Then you asked, “Is the placebo effect of alternative medicine, especially Ayurvedic medicine, greater than that of allopathic medicine?”

A placebo is a placebo whether you are dealing with ayurveda, homeopathy or allopathy.

Sometimes a person can have a response to a placebo. The response can be positive or negative. For instance, the person's symptoms may improve. Or the person may have what appears to be side effects from the treatment. These responses are known as the "placebo effect"(when they are positive). The negative effects are called as Nocebo Effects.

Research on the placebo effect has focused on the relationship of mind and body. One of the most common theories is that the placebo effect is due to a person's expectations. If a person expects a pill to do something, then it's possible that the body's own chemistry can cause effects similar to what a medication might have caused.

But, this is very important, identifying the molecules in the drugs that really work, and studying how they work (actual mechanism) in different set of conditions is extremely important to pin point the accuracy and authenticity. Understanding the body's healing mechanisms is important too. Because 'feeling better' does not actually 'cure' you of deadly diseases like cancer. Placebos might work for migraine but don't work for malaria or cancer!

Researchers need to assume that the placebo effect is part of every drug effect, and that drugs can be said to work only to the extent that they worked better than placebos. An accurate measure of drug efficacy would require comparing the response of patients taking it with that of patients taking placebos; the drug effect could then be calculated by subtracting the placebo response from the overall response.

Earlier most of these reasons have traditionally been linked to psychology, based on mechanisms like expectancy — the set of beliefs that a person brings into treatment, the comfort and reassurance s/he gets while dealing with a 'doctor' that talks 'sweetly and softly'. The 'rituals' embedded in the doctor-patient encounter are fundamental to the placebo effect, where a suffering person puts his or her fate in the hands of a trusted healer. The placebo effect is a biological response to an act of caring.

It is like a baby getting comfort from her mother's sweet talk (sing-songy way) and the action of arms-cradling. The baby stops crying! Isn't that a miracle?!

But placebo effect responses vary from person to person. That made scientists think different mechanisms 're at play. An enzyme called COMT affected people’s response to pain and painkillers. Levels of that enzyme, researchers found, were also correlated with Parkinson’s disease, depression and schizophrenia, and in clinical trials people with those conditions had shown a strong placebo response. COMT was also correlated with pain response — another area with significant placebo effects. It is not possible to assay levels of COMT directly in a living brain, but there is a snippet of the genome called rs4680 that governs the production of the enzyme, and that varies from one person to another: One variant predicts low levels of COMT, while another predicts high levels. When scientists analyzed the I.B.S. patients’ DNA, they found a distinct trend. Those with the high-COMT variant had the weakest placebo responses, and those with the opposite variant had the strongest. These effects were compounded by the amount of interaction each patient got: For instance, low-COMT, high-interaction patients fared best of all, but the low-COMT subjects who were placed in the no-treatment group did worse than the other genotypes in that group. They were, in other words, more sensitive to the impact of the relationship with the healer.

Scientists also found that the rs4680 gene snippet is one of a group that governs the production of COMT, and COMT is one of a number of enzymes that determine levels of catecholamines, a group of brain chemicals that includes dopamine and epinephrine. (Low COMT tends to mean higher levels of dopamine, and vice versa.) Researchers point out that the catecholamines are associated with stress, as well as with reward and good feeling, which bolsters the possibility that the placebome ( how genomics might influence the role of the placebo in patient care and clinical research) plays an important role in illness and health, especially in the chronic, stress-related conditions that are most susceptible to placebo effects.

The new approach, therefore, is - the placebo effect is not just some constant to be subtracted from the drug effect but an intrinsic part of a complex interaction among genes, drugs and mind (1).

Now that I explained why some people feel the placebo or nocebo effects more, you will realize now that they don’t depend on the substance given but on ‘several other things’.

Footnotes:

1. Some Qs people asked me on science and my replies to them - part 122