[Paleopsych] NYT: For Chronic Fatigue, Placebos Fail the Test
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Wed Mar 30 19:27:25 UTC 2005
Health > For Chronic Fatigue, Placebos Fail the Test
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
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
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
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