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Patient beliefs should be considered before prescribing medication
Barrett B. Ann Fam Med.2011;312-322.
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When it comes to treating symptoms of the common cold, patient beliefs and feelings should be taken into consideration, according to results of a recent study.
Bruce Barrett, MD, PhD, of the University of Wisconsin, and colleagues set out to determine if severity and duration of illness caused by the common cold are influenced by randomized assignment to open-label pills vs. conventional double-blind allocation to active and placebo pills, or no pills at all.
The researchers report in their study that participants randomly assigned to the no pills group were more likely to have longer and more severe illnesses than participants who received pills. For the subgroup “who believed in echinacea and received pills, illnesses were substantively shorter and less severe, regardless of whether the pills contained echinacea,” the authors wrote.
“Results of this trial do not support a powerful placebo effect in common cold,” the researchers wrote in the study. “The data, however, are consistent with modest placebo effects attributable to receiving pills, regardless of the content of those pills.”
In the controlled trial, Barrett and colleagues investigated the severity and duration of illness caused by new-onset common cold among 713 participants aged 12 to 80 years randomized to four groups: Those assigned no pills, those blinded to placebo, those blinded to echinacea, and those assigned open-label echinacea.
Compared with the no-pill group, results indicated the blinded-placebo group experienced shorter illness duration (7.03 vs. 6.87 days) and less severe illness (286 vs. 264 points).
In addition, those blinded to echinacea experienced shorter illness duration (6.34 vs. 6.76 days) than those in the open-label echinacea group, and severity points were 236 and 258, respectively.
Further, a subgroup of 120 echinacea-believers blinded to the placebo experienced 2.58 days shorter illness (95% CI, –4.47 to –0.68 days), and 26% lower severity scores (–97.0; 95% CI, –249.8 to 55.8 points) compared with those who received no pill, regardless of whether the pills contained echinacea.
“We interpret the results reported here as suggestive of placebo effects in common cold, especially among those who believe in a therapy, but conclude that these effects are not large, but instead, are limited and nuanced,” according to the researchers.
“People should feel free to take safe cold medicines that they believe in and doctors should consider patients’ beliefs before prescribing medicines,” Barrett told Infectious Diseases in Children. – by Ashley DeNyse
Disclosure: Dr. Barrett reports no relevant financial disclosures.
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Although many inside and outside medicine discuss the placebo effect, Barrett and colleagues' study of the common cold has refined our understanding of the "powerful placebo." In this study, patients given no pill had longer and more severe illnesses than any of the other three groups of enrollees given pills (echinacea, blinded echinacea or placebo). Even more interesting is that those who believed in echinacea, no matter if they knowingly received echinacea or some other pill, had improved symptoms. The results by Barrett and colleagues are intriguing especially when considered in conjunction with the recent study published by Wechsler and colleagues in people with asthma (Wechsler et al. N Engl J Med 2011; 365:119-126). In the asthma study, those who received albuterol were the only group to have significantly improved FEV1 compared to all other groups. However, all of the groups receiving treatment (medication, sham acupuncture or placebo) had symptom improvement compared with those who did not receive any treatment.
There is much more to learn about the mechanism underlying the power of the placebo and ultimately, how to harness this power to benefit patients and others.
Jonathan Mansbach, MD, MPH
Assistant Professor of Pediatrics
Harvard Medical School
Children's Hospital Boston
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