May 30, 2023 09:43 AM
https://news.cnrs.fr/articles/the-truth-...ebo-effect
EXCERPT: . . . “Conducted in the context of Léo Druart’s doctoral thesis (currently being published), our studies have shown that the placebo effect loses none of its efficacy if, instead of a standard “dishonest” inactive drug, you use an “honest”, or “open” version whose true nature is revealed to the patient, and – most importantly – provided certain precautions are taken beforehand,” explains the CNRS physiotherapist and rehabilitation expert Nicolas Pinsault, leader of the ThEMAS team.
In fact, scientists have known that a placebo can prove effective once the patient has been informed of the deception ever since the studies published in 2010 by Ted Kaptchuk’s team at Harvard Medical School in the US. [...] This led to a conceptual revolution and put an end to the idea that the placebo effect necessitates “intentional ignorance”.
However, subsequent research work determined the efficacy of a deceptive placebo versus that of an open one and showed that the latter was less effective. During a study in 160 volunteers,3 Cosima Locher and colleagues at the University of Basel in Switzerland compared the ability of a deceptive placebo (a cream presented as a “real” painkiller) with that of an open equivalent (the same product but this time presented as a placebo) to reduce the perception of a painful stimulation. Ultimately it appeared that the open placebo was 7% less effective than the standard version.
It was this observation that gave Pinsault and his colleagues, Léo Druart and SaraEve Graham-Longsworth, the idea for their study. “Our hypothesis was that it might be possible to restore some of the efficacy lost when revealing that a treatment is a placebo, by telling the patient about the neurophysiological mechanisms that underlie the placebo effect before administering the drug,” explains the scientist...
It should be pointed out that these mechanisms are now well established. Several studies performed in recent decades have demonstrated that the patient’s conviction that the placebo will improve their state may trigger various cerebral and physiological changes that are indeed likely to relieve their symptoms: a stimulation of immunity, changes to blood pressure or variations in the secretion of certain biological molecules such as cortisol (stress hormone), endorphins and enkephalins (neuromodulators produced naturally by our brains).
“Our idea was that patients’ awareness and understanding of these mechanisms could help them to better integrate the fact that, despite the absence of an active substance, a placebo could exert therapeutic activity. And that by doing this, it would enhance the response to an open placebo, bringing it closer to that seen with a deceptive equivalent,” Nicolas Pinsault adds. Hence the idea to test this hypothesis by assessing the efficacy of a deceptive placebo versus that of an open, “educated” one administered after the participants had been given these explanations. “To our knowledge, ours is the first study to have tested the “non-inferiority” of the efficacy of an educated placebo versus that of a deceptive version,” he emphasises.
[...] “Our results have restored the possibility of administering a placebo under ethical conditions,” Pinsault enthuses. “They could contribute to greater medical democracy, considering that an increasing number of patients want to understand how the treatments they are offered actually work, so that they can participate in the decisions regarding their health.”
[...] It nevertheless remains necessary to verify these initial results in individuals affected by real diseases and not just in those suffering from artificial pain. The scientists in Grenoble are hoping to start investigating the issue in about a year’s time. (MORE - missing details)
EXCERPT: . . . “Conducted in the context of Léo Druart’s doctoral thesis (currently being published), our studies have shown that the placebo effect loses none of its efficacy if, instead of a standard “dishonest” inactive drug, you use an “honest”, or “open” version whose true nature is revealed to the patient, and – most importantly – provided certain precautions are taken beforehand,” explains the CNRS physiotherapist and rehabilitation expert Nicolas Pinsault, leader of the ThEMAS team.
In fact, scientists have known that a placebo can prove effective once the patient has been informed of the deception ever since the studies published in 2010 by Ted Kaptchuk’s team at Harvard Medical School in the US. [...] This led to a conceptual revolution and put an end to the idea that the placebo effect necessitates “intentional ignorance”.
However, subsequent research work determined the efficacy of a deceptive placebo versus that of an open one and showed that the latter was less effective. During a study in 160 volunteers,3 Cosima Locher and colleagues at the University of Basel in Switzerland compared the ability of a deceptive placebo (a cream presented as a “real” painkiller) with that of an open equivalent (the same product but this time presented as a placebo) to reduce the perception of a painful stimulation. Ultimately it appeared that the open placebo was 7% less effective than the standard version.
It was this observation that gave Pinsault and his colleagues, Léo Druart and SaraEve Graham-Longsworth, the idea for their study. “Our hypothesis was that it might be possible to restore some of the efficacy lost when revealing that a treatment is a placebo, by telling the patient about the neurophysiological mechanisms that underlie the placebo effect before administering the drug,” explains the scientist...
It should be pointed out that these mechanisms are now well established. Several studies performed in recent decades have demonstrated that the patient’s conviction that the placebo will improve their state may trigger various cerebral and physiological changes that are indeed likely to relieve their symptoms: a stimulation of immunity, changes to blood pressure or variations in the secretion of certain biological molecules such as cortisol (stress hormone), endorphins and enkephalins (neuromodulators produced naturally by our brains).
“Our idea was that patients’ awareness and understanding of these mechanisms could help them to better integrate the fact that, despite the absence of an active substance, a placebo could exert therapeutic activity. And that by doing this, it would enhance the response to an open placebo, bringing it closer to that seen with a deceptive equivalent,” Nicolas Pinsault adds. Hence the idea to test this hypothesis by assessing the efficacy of a deceptive placebo versus that of an open, “educated” one administered after the participants had been given these explanations. “To our knowledge, ours is the first study to have tested the “non-inferiority” of the efficacy of an educated placebo versus that of a deceptive version,” he emphasises.
[...] “Our results have restored the possibility of administering a placebo under ethical conditions,” Pinsault enthuses. “They could contribute to greater medical democracy, considering that an increasing number of patients want to understand how the treatments they are offered actually work, so that they can participate in the decisions regarding their health.”
[...] It nevertheless remains necessary to verify these initial results in individuals affected by real diseases and not just in those suffering from artificial pain. The scientists in Grenoble are hoping to start investigating the issue in about a year’s time. (MORE - missing details)