Placebos and nocebos—Techniques to
optimize MS management?
by Allen C. Bowling, MD, PhD
In clinical trials, the “placebo effect” refers to the benefits
seen with sugar pills or other presumably inactive therapies. In discussions of medical therapies, the
focus is generally on the effectiveness of medications and not on
placebo effects. However, placebos
produce therapeutic benefits and,
though not fully understood, both
the placebo response and its lesser-known opposite, the “nocebo
effect,” offer valuable insights into
managing chronic diseases such as
MS.
Both CAM (complementary and alternative medicine) and
conventional medicine spark effects seemingly based on
expectations. Can the mysterious placebo effect be harnessed
to help manage MS? What about its dark side, the nocebo
effect? Can that be minimized?
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Placebos
Placebos are an essential com-
ponent of clinical trials. The
standard design for a trial is to
divide a large group of people
with a specific condition into
two groups, one of which
receives an active treatment,
such as an experimental medica-
tion, while the other receives
a fake treatment or placebo.
A good deal of planning goes
into making the two treatments
look and feel the same—and
in a double-blind trial, neither
the volunteers nor the health-
care professionals know who is
in which group. The response
of both groups is monitored.
Through a mysterious pro-
cess, the placebo group usually
exhibits some type of beneficial
effect. The response of the active
treatment group is then carefully
analyzed to see if it exceeds that
of the placebo group.
