Why herbs and supplements sometimes appear to “work”

An AP report by Maria Cheng that came across my local paper this morning is spurring me to tread briefly into the realm of some award-winning writing by my PLoS Blogs colleague and Wired contributor, Steve Silberman. Steve’s Wired article, The Placebo Problem, won the 2010 AAAS Kavli Science Journalism Award for magazine writing.

Therein, Steve took apart the growing problem faced by drug companies of the placebo effect in clinical trials – where an inert pill used to control for psychological expectations of benefit by study participants becomes so pronounced that active drugs are faced with a large statistical hurdle to overcome in showing significance.

The use of the placebo in medicine has largely been viewed as unethical, predominantly because it entails a degree of deception on the part of the caregiver. However, placebos are often given without truly deceptive intent – consider the use of antibiotics for colds due to viruses.

Today’s AP article addresses a recommendation by the German Federal Medical Association (Bundesärztekammer) that doctors there consider the use of placebos even when patients are not informed of their intent. The article cites US clinicians as being starkly opposed to such use – although we many of us may soon find ourselves left with nothing but placebos if the GOP has its way.

I’m not having luck finding the original source for this recommendation. The photograph in the AP article shows Dr. Peter Scriba holding a report entitled, Placebo in der Medizin, but I can only find online this 151-page PDF from last summer. With a document of this size, I suspect that there may be some more complexity to this recommendation. So, if any of our German readers can steer us in the right direction to find the original source in support of yesterday’s press conference by Dr. Scriba, I’d be grateful. (Update: I’ve now found the site – the press release was on 2nd March – and I’ll be sifting through the German today.)

But what caught my eye more was the closing quote from a patient who said that she would try a placebo even knowing that it wasn’t active:

Some Germans didn’t seem averse to the idea of being prescribed less medication since the new placebo recommendations were issued, but said trusting their doctor was paramount.

Monika Sommer, 59, said she would take a placebo if her doctor recommended it.

“I would be willing to try it,” she said in Berlin. “If you don’t know, you have faith in the idea that you are getting something that will help and often, psychologically, that is enough.”

“You just need something to take,” she added.

You just need something to take.

That, my friends, is what drives 90% of the dietary supplement industry.

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9 Responses to Why herbs and supplements sometimes appear to “work”

  1. Indeed… And what of the recent finding that placebos work even if the patients are told they’re placebos? Surely that alleviates much of the ethical worry?

  2. tooearly says:

    “You just need something to take.

    That, my friends, is what drives 90% of the dietary supplement industry.”

    As opposed to:
    You just need something to give.

    THAT my friends is what drives 90% of the prescription drug market.

  3. David Kroll says:

    @Michael – Informed use of placebos is less of an ethical dilemma but still has pitfalls.

    @tooearly – I know you’re trolling but while the pharmaceutical industry has its issues, I’ll take a rationally-designed pharmaceutical with known biological activity and pharmacokinetics before I’d take an herb of unknown content and poor or non-existent bioavailability. If you’re a regular reader, you’ll know that I strongly support the study of natural product remedies. But to imply that the dietary supplement industry is not a profit-driven industry just like Big Pharma is deceptive.

  4. Doc in Ontario says:

    “You just need something to take,” she added.

    Sounds very familiar.

    “The desire to take medicine is perhaps the greatest feature which distinguishes man from animals”. William Osler

    Osler was right … again !
    :)

    Placebos would help, but in Ontario, they would have to be funded by OHIP.
    I’m pretty sure that’s not going to happen. :) What side effects would you list on the Placebo pill box ? Side Effects: None ? Side Effects: a list of every possible human emotion or sensation (The mind CAN do almost anything).

    I’ve contemplated a few times, but never actively done it, just telling patient X that Vitamin Y did help with vague problem Z. I do sometimes just go along with their ideas … which is a kind of super placebo … as it was the patient’s idea.

    Patient: Doc, do you think eating less gluten will give me better energy ?
    Me: Interesting ! …. Yeah, I think it could … why do you ask ?
    Patient: I read about it online and I was thinking of trying it.
    Me: I say go for it. Healthy eating can help alot of people’s energy ! Great idea. You might try going for a walk in the evenings it is also good for healthy digestion and would be a great supplement to your reduced gluten idea.
    Patient swallows their self-prescribed placebo pill.
    Patient happy.
    Doctor happy.
    Win Win.

  5. Kevin Parker says:

    I have been taking some supplements like Acai and Green tea extract and red wine extract. Probably should just improve my diet instead but have had difficulty doing so. Wondering if you would prefer your whole diet to be of known biological activity. Reading Micheal Pollen shocks me about the stories of where our food comes from and what might be in it(thinking of the potatoes chapter in Botany of Desire). Makes me wonder what else I don’t know.

  6. Stephen Bosch says:

    Actually, I don’t think the distinction between “supplements” and “pharmaceuticals” or “drugs” is value-neutral, nor is it terribly helpful.

    I prefer a modifier like “evidence-based”, for two reasons. One, it draws attention to the question of whether the evidence supports the assertion made about a substance. Two, it is dispassionate. It does not matter whether the substance is patented or not, or whether it came from a green plant or a chemical plant.

    There are examples of “natural” products that have shown effectiveness in double-blinded, multi-center, placebo-controlled trials. There are also drugs — on the market today — whose trial evidence is seriously questionable. I’m one of those who say that drug companies need to be on a much shorter leash than they have been.

    Finally — the physician-supervised off-label use of drugs is rampant. And for those uses, there is often NO trial evidence (viz amitryptiline as a migraine prophylaxis. What little evidence there is, is very shaky. How did this become the consensus first-line treatment in the United States?).

    There is one thing I’ll agree on, though, and that is the need for product standards, whether that product is synthetic or natural.

  7. tooearly says:

    “But to imply that the dietary supplement industry is not a profit-driven industry just like Big Pharma is deceptive”
    Not quite sure where you saw that in my comment. My comment was about the extraordinary pressure doctors (I am one) feel to give their patients something (read: prescription drug) especially given how little time they have to spend actually listening to them.
    What does your articles title have to do with what you have written anyhow? Herbs and supplements (but not prescription drugs) only appear to work becasue of the placebo effect/
    Your bias is quite clear.

  8. tooearly says:

    precisely.

  9. Georg Michaelis says:

    I am from Germany. The experts of the German “Bundesärztekammer ” actually say, that the conscious use of placebo in therapeutic practice as acceptable. Precondition is, however, that in the particular case, no proven effective (pharmaco-) therapy is available, there is relatively little discomfort and chance of success of a placebo treatment in this disease.