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Asthma Test Patients Report Improvement Where Doctors See None

Asthma patients reported the same relief from sham treatments as with a real medicine, even though a clinical test found that only the drug worked, in a surprise twist from a Harvard study analyzing the placebo effect.

Study patients said their symptoms of wheezing and coughing were improved just as much with a placebo inhaler or pretend acupuncture as with an albuterol inhaler, a standard treatment, according to a paper today in the New England Journal of Medicine. Still, when using a test to measure lung function, doctors only saw improvement in those given the albuterol inhaler, the study found.

The findings show that a placebo effect can be strong enough to rival the effects of an active medication in patients with asthma, the researchers said. Future studies will look at this mind-body interaction and may help researchers better understand how this placebo effect occurs, said Michael Wechsler, the paper’s lead author.

“Our goal is to really try and understand how the mind works, how the body deals with drugs and how the body responds to different stimuli whether it’s real drugs or whether it’s a placebo,” said Wechsler, associate director of the Brigham and Women’s Hospital Asthma Research Center and an assistant professor at Harvard Medical School in Boston, in a July 12 telephone interview. “The mind is very powerful. It’s important for doctors to practice the art of healing. Just laying your hands on a patient, just giving them some intervention will result in their feeling better in many circumstances.”

Objective and Subjective Testing

The researchers chose to study asthma patients because there are both standard objective tests and subjective tests that can be given, and an attack can be easily reversible with treatment, Wechsler said. Asthma, a chronic inflammatory disorder of the airways that causes wheezing, shortness of breath and coughing, affects about 34 million Americans, according to the American Academy of Allergy, Asthma and Immunology.

The study included 39 patients with chronic asthma. Each patient had 12 medical visits in which they were randomly assigned to receive treatment with the active albuterol inhaler, the placebo inhaler, sham acupuncture or no intervention at all.

Though patients in all groups reported statistically significant improvement compared with no treatment, a separate test to measure lung capacity found that only patients who were given the active drug inhaler showed significant improvement. Those patients had a 20 percent increase in lung capacity compared with about a 7 percent increase for the placebo inhaler, sham acupuncture and no intervention.

‘Powerful’ Placebo Effect

Placebos “may not necessarily have a significant effect on the underlying disease process but just the ritual of treatment can be very, very powerful,” Wechsler said. “It is important for asthma patients to recognize that even though they may feel OK, there may still be underlying inflammation/disease that needs to be addressed by real medicine.”

Daniel Moerman, who wrote an accompanying editorial in the journal, questioned the researchers’ conclusions that “the patients’ reports were ‘unreliable,’ since they reported improvement when there was none.” Future studies should look at whether these findings hold true in other diseases such as depression and post traumatic stress disorder, he said.

“It’s quite possible to give people inert tablets and they end up feeling much better,” said Moerman, a professor emeritus of anthropology at the University of Michigan-Dearborn in a July 12 telephone interview. “The one thing we can be sure of it’s not the placebo that did that because the placebo was inert. Even though the placebo is inert, that doesn’t mean it doesn’t carry meaning.”

Doctors “have to take seriously what their patients tell them about how treatments affected them,” he said.

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