[Paleopsych] NYT: For Chronic Fatigue, Placebos Fail the Test

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Health > For Chronic Fatigue, Placebos Fail the Test
http://www.nytimes.com/2005/03/29/health/29tire.html
March 29, 2005

    By NICHOLAS BAKALAR

    Many doctors believe that sugar pills are likely to be effective for
    patients with chronic fatigue syndrome, trusting that a placebo will
    help relieve the mental and physical exhaustion that characterize the
    illness.

    But a new study has found that people who have the syndrome respond at
    a lower rate to placebos than patients with other diseases. The paper
    was published in the March-April issue of Psychosomatic Medicine.

    Studies suggest that placebos relieve the symptoms for about 30
    percent of patients suffering from a wide variety of illnesses.
    Migraine headaches, for example, respond at a rate of about 29 percent
    to placebo treatment, major depression at about 30 percent and reflux
    esophagitis at about 26 percent.

    In some diseases, placebo treatments are even more effective - 36 to
    44 percent of patients with duodenal ulcers improve on placebos,
    depending on how many of the treatments are offered each day.

    But by pooling results from more than two dozen studies, the
    researchers, led by Dr. Hyong Jin Cho, a professor of psychiatry at
    King's College London, found that, among people with chronic fatigue
    syndrome, only 19.6 percent responded to placebos, not the 50 percent
    found by previous, less systematic studies.

    To Dr. Cho, the results were both unexpected and disappointing: he
    says he believes placebos can be a legitimate and useful form of
    medical treatment. He concluded not that placebos were unhelpful in
    treating chronic fatigue but that their use should be perfected.

    "At the clinical practice level," he wrote, "the overall low placebo
    response emphasizes the need to enhance" the placebo effect in
    treating the illness.

    To many doctors, chronic fatigue syndrome seems like a perfect
    candidate for placebo treatment, Dr. Cho and his colleagues write. Its
    symptoms are often indistinct: in addition to general fatigue,
    patients complain of muscle and joint pain, headaches, memory
    impairment and mood disturbances. Moreover, the symptoms frequently
    fluctuate over time, and they are more acute when the patients are
    paying close attention to them.

    The illness has no cure, and the Centers for Disease Control and
    Prevention estimates that as many as 500,000 Americans suffer from it.

    Dr. Cho and his colleagues speculate that the skepticism about the
    illness on the part of health care professionals may damage the trust
    between doctor and patient - a factor that may influence the effect of
    a placebo.

    According to the study, placebos presented as medical or
    alternative-complementary treatments have a greater effect with
    chronic fatigue patients than do those offered as psychiatric
    interventions. The researchers suggest that this may be because most
    patients have a firm prior belief that the illness is physical. They
    make no judgment about the accuracy of that belief.

    But Dr. Brian Fallon, an associate professor of psychiatry at Columbia
    University, offers a different interpretation. The fact that chronic
    fatigue syndrome responds so poorly to placebo treatment, he said,
    provides evidence that the syndrome has a physiological basis, though
    one that is still poorly understood.

    "The finding by Dr. Cho and colleagues will come as no surprise to
    patients with C.F.S. who experience debilitating fatigue despite
    numerous treatment interventions," Dr. Fallon said. "That the placebo
    response in C.F.S. was far lower that in primary psychiatric disorders
    such as depression highlights the distinct nature of C.F.S. and how
    little we know."

    Whatever conclusions may be drawn from the study's results, Dr. Cho
    says he sees placebo treatments as important.

    "Many alternative therapies may provide a cure that depends on this
    powerful placebo effect," he said in an e-mail message. "I'm not using
    the term pejoratively, since empathy and time spent with the patient
    by the professionals in this area are indeed of important therapeutic
    value."