Tue 22 Apr 97 12:02
David Bloomberg
Long-Term Placebo Effect

 Power of Placebo Lasts for Years

 April 17, 1997

 NEW YORK (Reuters) - One dictionary defines a placebo as "a medicine
given merely to humor the patient." Another calls it an "inactive
substance given to satisfy a patient's demand for medicine." No matter
how you describe them, the power of placebos to convince patients that
they feel better has been observed for centuries.

 Now, a new study has found that the "placebo effect" can last for
years.

 Researchers testing the effectiveness of a new drug used for treating
enlarged prostates discovered that patients taking placebos - or fake
pills - showed significantly improved symptoms and urinary flow, even
after two years of treatment.

 The Canadian study involved 613 patients with benign prostatic
hyperplasia, or BPH, a condition that affects more than 80% of men
between the ages of 50 and 60. Nearly half of the group, 303 men, were
taking a placebo - a standard practice in drug testing. The other
patients with the condition were given the drug Proscar (finasteride),
made by Merck & Company. Neither the patients, nor their doctors, knew
what treatment they were assigned.

 For just over two years (25 months), the researchers analyzed the
effect of either the drug or placebo therapy on a patient's prostate
size, urine flow, symptoms, and adverse drug reactions. Tests showed
that patients taking finasteride averaged a 21% reduction in the size
of their prostates, while patients on placebo experienced an 8.4%
growth.

 To the researchers' surprise, however, urinary flow in the placebo group
improved significantly within the first five months, and remained improved
for the duration of the study.

 "What surprised us most was the durability of the response," said Dr. J.
Curtis Nickel, professor of urology at Queen's University, in Kingston,
Ontario. "We've always known that this disease responds to placebo. But
the previous studies were short -- 12 to 16 weeks, a year. Our study was
probably the longest."

 Although slightly more than 50% of the patients taking placebo showed
improvement during the stuy, most also reported side effects. More than
80% reported adverse effects from the "drug" such as nausea, sleepiness,
and dizziness. The most common complaints noted were impotence (6.3%) and
decreased libido (6.3%). Thirteen percent of patients on placebo reported
symptoms so severe that they discontinued treatment.

 "These results confirm our suspicion that placebo therapy not only works
and that the benefits are durable, but also that these benefits are not
without potential clinical side effects," said Nickel.

 Patients with smaller prostate glands did the best on placebo, according
to the study, with more than 15% of them showing significant improvement
at two years. Men with larger prostate glands showed some initial
improvement on placebo, but the effect faded. "At the end of two years,
they were no better than they were before," said Nickel.

 When patients were finally told what treatment they were on, those on
placebo were confused, says Nickel. "They wanted to know if we perhaps
had made a mistake. They wanted to continue to feel as good as they did."

 Nickel believes the findings have important implications for both
doctors and patients. "As physicians, we stop many medications because
the patient feels a little nauseated, tired, dizzy, and we think it might
be related to the drug. So we stop it and the patient gets better. Was
that a real drug effect, (or a placebo effect)?"

 The study results were announced at the annual scientific meeting of
the American Urological Association in New Orleans.