Rheumatology meets placebo-nocebo science: At last!
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I am thrilled to introduce our cover story this month, “‘Exploring the Power of Their Mind’: Data May Offer Clues to Harnessing the Placebo Effect,” to the readers of Healio Rheumatology. I say this for several reasons.
First, as discussed by our esteemed faculty — which include Luana Colloca, MD, PhD, MS, Ted J. Kaptchuk, MD, and Bharat Kumar, MD — there is power in the placebo effect. It is not, as thought in years gone past, a phenomenon of merely imagining you are feeling better, but rather the biologic effect of harnessing the same neural signaling pathways that occur during healing in many domains of illness.
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As noted in the discussion, it is not going to drive viral load to non-detectable levels or cure cancer, but it can meaningfully improve quality of life and relieve many of the complaints and great concerns our patients have, such as pain and fatigue, by harnessing the same neural pathways that modulate these domains that we seek to treat with drugs.
For a generation or more, the field of rheumatology has either ignored, and more often eschewed delving into, the field of placebo science. More often, our field has viewed the placebo responses negatively, as so often robust placebo responses in randomized controlled trials have limited the approval of new therapeutics because, inexplicably, they are so high! We have all seen placebo responses of more than 50% in diseases such as rheumatoid arthritis, lupus and others, and generally just shrugged.
As our panelists point out, when placebo pathways are engaged, there are palpable and meaningful changes that can occur in the symptoms and manifestations our patients often care about the most. The best part of all of this is that we are now learning how to harness this in our daily practice. In the old days, this was just called “good doctoring,” while today we are now beginning to understand it as a teachable therapeutic modality and skill.
Data now support the idea that we can manipulate these pathways and harness their power by refining and exploiting our advanced communication skills, including how to better communicate our empathy and frame our treatments and plans accurately, but positively, whenever possible. The best part of this modality is that no trickery is required!
Finally, I want to end my editorial comments with a recommendation and a personal note. First, for those of you currently or newly inspired to take a deep dive into the field of placebo-nocebo science, I strongly recommend reading Placebo Effects Through the Lens of Translational Research, a recent, open-access and landmark book in the field, in which Dr. Colloca is the lead editor. It has been described as a work “integrating current knowledge on placebo research in health care to develop comprehensive and adequate strategies for better symptom management and treatment responses.” I was privileged to contribute a chapter to this outstanding publication and was honored to do so particularly as an outsider to the field.
Secondly, I want to express my personal gratitude to Dr. Colloca for her friendship and generosity as she so patiently discussed her science with me as an outsider and helped me refine my ideas regarding how to further explore the intersection of placebo-nocebo science with rheumatic, immunologic and infectious diseases.
I will close by sharing with you that, for several years, I have unsuccessfully entreated the American College of Rheumatology annual meeting planning committee to present a plenary session on this topic. Having served in this capacity many times, I totally understand the intense competition for high impact topics, but I am keeping my fingers crossed for this year’s meeting as I think our fields have finally collided. That is my take. What’s yours? Please share your thoughts with me at calabrl@ccf.org or at rheumatology@healio.com.
- For more information:
- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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