Placebos could improve link between medical outlooks

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Study of the placebo effect — the role of medically inactive treatments in healing — could help to bridge the divide between mainstream and alternative medicine, a National Institutes of Health (NIH) meeting was told this week.

Stephen Strauss, director of the National Center for Complementary and Alternative Medicine, has been trying to heal the rift that has, if anything, deepened since Congress forced a reluctant NIH to research alternative medicine in 1992. He is encouraged that 20 other NIH institutes and offices helped to organize the meeting, and that several institute directors took part.

Sugaring the pill: research may help convince those who find the placebo effect hart to swallow. Credit: FRANCOISE SAUZE/SPL

Gerald Fischbach, director of the National Institute of Neurological Disorders and Stroke, described the placebo effect as complex and poorly understood. He suspects that it has some biological basis, perhaps involving specialized nerve cells that respond to the expectation of treatment.

Steven Hyman, director of the National Institute of Mental Health, said that the increasing acceptance of such concepts may explain why researchers are paying more attention to placebos. For example, there is growing evidence that repeated exposure to a stimulus can reconfigure the brain's circuitry.

But it may be difficult to tackle such issues until the study of placebos gains broader acceptance, and psychologists, neuroscientists and social scientists become more willing to join forces. The NIH now offers more interdisciplinary grants, but Hyman is worried that young scientists may shy away from the problem, because of the potential for failure in an untested field.

The presence of so many senior NIH researchers at the meeting contrasted with the past hostility towards Strauss's centre. Former NIH director Harold Varmus tried unsuccessfully to cut its budget, even as the overall NIH budget rose. And the institute's last director, Wayne Jonas, was often a lightning rod for criticism. Strauss has received broader support because he appears to be trying evaluate alternative medicine using the best available science, and he sees the placebo effect as key.

“It is a very important issue for our institute because of all the preconceived biases as to how these traditional therapies must be operating — that they must be operating merely through the placebo effect,” Strauss says.

David Korn, vice-president for research at the American Association of Medical Colleges, said that Strauss is doing a good job in narrowing the gap between orthodox and alternative physicians. And he applauds Strauss's focus on the placebo effect, which he believes will help all physicians.

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