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MD Expertise: The Science of Anti-Aging

Mind Over Matter: the Placebo Effect

Published August 20, 2009 10:36 AM by Richard A. Baxter, MD
Not long ago I was doing an interview with a reporter on a story about anti-aging supplements, and she said something that caught me by surprise. Her question was: Why do some people swear by things that science hasn't proven to work? Isn't the fact that these things seem to help some people good enough?

It reminded me of a Steve Martin gag when he was hosting Saturday Night Live. (I know I am dating myself with that reference!) His opening monologue went something like this: "Now, I don't recommend using drugs or anything like that, but I discovered these pills that will really blow your mind: placebos, man. You gotta try them." The interesting thing is, the placebo effect is real and for some, they really will get high from a sugar pill if they believe they will.

Because of this, clinical trials for new drugs and medical devices typically include a requirement to be "double blind" and randomized. Double blind means that neither the prescribing doctor knows which subjects are getting the test drug and which the inert placebo, and the randomization is a process analogous to flipping a coin for each subject enrolled. This is important in order to eliminate bias, so results cannot be influenced, but it is also necessary because some of the people in the placebo group will still get better. Only by determining whether a significantly higher percentage of the ones on the active treatment were helped can it be said that the drug was effective.

That is why testimonials and what researchers call anecdotal reports are scientifically meaningless. Regardless of how dramatic the individual story, it implies nothing about the effectiveness of the drug or supplement without objective data. But what does it say about the mind-body connection, that for some the expectation of a result is enough to achieve the result?

We do have some evidence of how it works from a study on the use of levodopa, a natural brain transmitter that is deficient in Parkinson's disease patients. This particular study found an unexpectedly high percentage of responders in the placebo group, which they determined was due to an uptick in production of the substance in the brain naturally. Talk about mind over matter! On the other hand, if you don't mind spending good money on unproven therapies, then maybe it doesn't matter.

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