As Allied troops stormed the beaches of Italy, a nurse and an anesthesiologist anxiously watched a wounded soldier.  He was in severe pain and on the verge of shock, but their supply of morphine had run out.  The nurse told a benevolent lie: she promised pain relief while injecting her patient with salt water. To the amazement of both nurse and doctor, the patient’s pain was relieved, and his condition improved. The anesthesiologist who witnessed this marvel, Henry Beecher, returned from the war determined to study the real efficacy of drugs, and the placebo double blind clinical trial was born.

For the next fifty years placebos (Latin for “I shall please”), frustrated the drug industry. In this fascinating and award-winning expose, journalist Steve Silberman shows not only is the placebo effect potent, but it’s actually growing:

Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills. It’s not that the old meds are getting weaker, drug developers say. It’s as if the placebo effect is somehow getting stronger.

Read the piece to discover what’s suddenly causing our brains to become more powerful healers, but here’s a hint: the answer is a fascinating mix of marketing and cultural geography, and the development of the therapeutic relationship.

For doctors, the placebo effect also caused frustration—sure, sugar pills worked, but how could an ethical physician use them? Discovery would mean a lawsuit and a violation of the Hippocratic oath.  And yet the placebo was also one of the best medical tools: it worked by unlocking the body’s own healing systems and did not cause side effects.

Today, a new crop of researchers revisits this question and yields a fascinating discovery: apparently, placebos work even when patients know they’re placebos. In the early 2000s, Harvard researcher Ted Kaptchuk demonstrated in a trial of 80 volunteers suffering from IBS, that placebos produced twice as much relief as the “no treatment” group, results on par with the best real IBS medications.

In other words, you have drugs that are completely different in what they do chemically — even drugs that operate by opposing mechanisms — creating the same level of effect.

— Irving Kirsch

But placebo studies also pose interesting questions—in another blind comparison study, asthma patients given a placebo and a real medication reported feeling equally equal improvement from both.  But lung function only showed improvement from the medication. Which begs the question: how relevant is the patient’s well-being, and are there diseases in which a subjective measure is more relevant than an objective one?  In this interview, Irving Kirsch, author of The Emperor’s New Drugs, argues that all benefits from anti-depressants can be attributed to the placebo effect:

The more I learn, the more convinced I become that the benefits of drugs for depression are not biologically driven, but driven by the placebo effect. The thing that convinces me most is that nearly all drugs for depression — despite having very different chemical compositions — are of equal benefit. In other words, you have drugs that are completely different in what they do chemically — even drugs that operate by opposing mechanisms — creating the same level of effect.

And now we wrap up with some lighter reading and another lens through which to view medicine: a piece by humorist Dave Barry, detailing his own colonoscopy.

Image credit: Sean Winters via flickr