June 29, 2006 -- People who take pills as prescribed do better than those who don't -- even if they're only getting sugar pills, Canadian researchers find.
To see if drugs really work, researchers usually split study participants into two groups. One group gets the active drug. The other gets placebos -- identical-looking but inactive sugar pills. If people taking the drug do better than the people who take a placebo, the drug is thought to work.
Time and again, researchers have found that people who take placebo pills do better than expected. It's called the placebo effect. Now Scot H. Simpson, PharmD, and colleagues at the University of Alberta, Canada, report that at least part of the placebo effect depends on how properly people take their pills.
Simpson's team analyzed 21 clinical trials that studied nearly 47,000 people. Nearly 20,000 of them got placebos instead of active drugs. Regardless of whether they took active drugs or placebos, those who took their pills the way they were supposed to had 44% fewer deaths than those who didn't take their pills as prescribed.
"Good adherence to drug therapy is associated with positive health outcomes," Simpson and colleagues conclude. This "supports the existence of the healthy adherer effect, whereby adherence to drug therapy may be a [characteristic of people with] overall healthy behavior."
The Canadian researchers looked at studies of drugs used to help people with heart attacks, HIV infection, type 2 diabetesdiabetes, immune suppression after heart transplant, and other conditions. Except in the two studies where the drug being tested was harmful, proper pill takers did better than those who missed doses.
There's a message here about what actually heals patients, suggests Betty Chewning, PhD, director of the Sonderegger Research Center at the University of Wisconsin, Madison, School of Pharmacy. Chewning's editorial accompanies the Simpson study.
"Healing lies not in the treatment but rather in patients' emotional and cognitive processes of 'feeling cared for' and 'caring for oneself,'" Chewning writes. "The meanings people attach to the 'pill' and 'behavior of the healer' are the key to the mind-body connectionmind-body connection leading to health outcomes."
Taking pills as prescribed, Chewning says, simply shows that patients are caring for themselves -- and that they believe their doctors are caring for them, too.
The Simpson study, and the Chewning editorial, appear in the July 1 issue of the BMJ.