Do not try this approach in your practice

Here at the PHC Primary Care blog, we try to provide useful tips which can be applied to everyday practice. The following tidbit is for interest only. We strongly advise you not to try this modality in your practice. At least not yet.

Let’s get right to the point. The subject of today’s post is placebos. We carried an excellent post about the placebo effect last year (http://phcprimarycare.org/?p=463). A study just published in Clinical Pharmacology and Therapeutics presents some remarkable new information about the placebo effect.

German researchers were interested in seeing whether the placebo effect could be used to replicate the physiologic effect of the immunosuppressive agent cyclosporine A. This drug is useful for preventing organ transplant rejection and can be used in rheumatoid arthritis. The study had a couple of arms. In one, 35 men received both cyclosporine A and a fruit flavored drink simultaneously. Subsequently, when given the fruit flavored drink alone, the men manifested similar degrees of T-cell suppression as when given cyclosporine A. The immunosuppression continued for 14 exposures of the fruit drink alone, before the effect dissipated.

Next, the researchers looked at 29 men who underwent the same conditioning using cyclosporine A and the fruit drink. The dissipation of the immunosuppressive effect of drinking the fruit drink was avoided by periodically pairing the fruit drink with a subtherapeutic dose of cyclosporine A. The dose of medication used was too low to have any physiologic effect, yet the physiologic effect was manifest.

I found this study amazing. Consider the possibilities. In the future, perhaps for some patients we can utilize the placebo effect to generate significant physiological changes. This could perhaps avoid the toxic side effects of some medications, while still reaping their benefits.

This approach is not yet ready for prime time. If I myself were to need organ transplant rejection prophylaxis at some future time, I will be reaching for the cyclosporine A and will leave the fruit juice in the fridge.

But this study is further confirmation of the strength of the placebo effect and the amazing power of the human brain.

Richard Fleming, MD

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