Involved patients key to success
Three large double-blind randomized controlled trials that were recently published in peer- reviewed medical journals found that patients who adhered to placebo medications had the same clinical outcomes as patients who adhered to actual medications.
More importantly, patients who adhered to their placebo medications observed significant increases to their health status and survival time.
The first was the Beta Blocker Evaluation of Survival Time study, published in Contemporary Clinical Trials. It found that patients who adhered to placebo medications for heart disease reduced their risk of total mortality by 39 per cent.
Adjusting for other variables did not influence the outcome. The authors concluded, “Trial data support a strong association between adherence to placebo study medication and total mortality.”
The second study, which reviewed patients with coronary heart disease, was published in the American Heart Journal. It found that patients who adhered to their placebo medications lowered their risk of total mortality by 48 per cent. Again, statistically adjusting for other factors did not change the end result.
The authors concluded there was a “strong association between adherence to placebo study medication and mortality.”
The third study reviewed patients with left ventricular dysfunction and was published in the Journal of General Internal Medicine. Its authors found that overall survival increased by 48 per cent for those who adhered to their placebo medications. The authors stated: “Better adherence to placebo was associated with markedly superior health outcomes, including total mortality and incident cardiovascular events.”
These three studies are not the only ones to report this important finding. I previously wrote about a 2006 systematic literature review and meta-analysis published in the British Medical Journal.
Authors of that review studied a wide range of chronic diseases from heart disease to diabetes to HIV. They found that patients who adhered to their actual medications reduced their risk of premature mortality by 44 per cent, while at the same time those who adhered to placebo medications also reduced their risk by 44 per cent.
The three new randomized trials offer information consistent with the review published in the BMJ. The overall conclusion is that patients that adhere to their therapy, even if that therapy is a placebo, have positive health outcomes.
The implications are enormous. If cost is the only consideration, the research suggests that many patients with chronic conditions could be treated successfully with placebos — assuming that they could remain blind to the fact they are taking sugar pills. If health outcomes are the main concern, the research suggests that adherence to treatment is more important for many chronic conditions than the specific intervention.
This makes sense. Most experienced health-care practitioners can tell within a few minutes of the initial intake if a patient will do well.
This research implies that most patients who participate in their wellness will do well, regardless of the intervention they receive.
Conversely, most practitioners can also tell within the first few minutes if a patient will do poorly. On average, patients who don’t participate in their care do not do well, regardless of the intervention they receive.
This, too, makes sense. Approximately half of patients who are prescribed pharmacological intervention do not fill their first prescription. Of the rest who do, approximately half quit anyway.
As well, very few patients engage in behaviour modification.
Even after a new diagnosis of a life threatening disease, most patients will not quit smoking and even fewer will exercise, change their diet or quit abusing alcohol.
If adherence or patient participation is the central requirement for recovery, and not the actual intervention itself, much more effort will have to be put toward identifying non-adherent patients. Once they are identified, greater effort to promote adherence will be required.
At the very least, practitioners should access the Pharmaceutical Information Program system to determine if their patients are filling their prescriptions.
If individuals are not, medical clinics should book recall appointments.
Once patients return, they should be offered reminder systems and various social support mechanisms to promote adherence.
Meanwhile, patients with chronic disease who are already adherent need minimal attention. They will do well regardless of what care providers do, even if the treatment prescribed is a placebo.