“Taking a pill” is a central healing ritual in modern society. Most of us have gone through this experience many times throughout their lives. Our conscious and subconscious mind has a deep understanding of the curative potential of this ritual. We know what to expect: symptom relief, enhanced performance, or elimination of bacteria. The repeated experience of the pill-taking ritual has conditioned our body to automatically respond in supporting ways. For studies that demonstrate that pill taking experience works for the placebo effect, please refer to the chapter “How Placebos Work”. For know, let us remember that the following:
Placebos work better if they are embedded in a meaningful context that creates expectations and taps into the patient’s experience.
Adhering to the therapeutic plan works for active drugs as well as for placebos. Some call this ‘patient compliance’. I prefer a term that is less ‘top-down’ and more compatible with the idea of an empowered team in which the patient has a more pro-active, central and self-asserting role. When Individual Treatment Plans (ITP) are developed in collaboration with the patient, then Adherence or Compliance will improve.
The issue of ‘Patient Compliance’ is highly relevant for patient health and for pharmaceutical sales. Studies estimate that about 50% of all treatment benefits are lost because patients do not refill their prescriptions or do not take their drugs according to schedule.
The relationship between adherence and therapeutic benefit is relevant for both, drugs and placebos.
The Coronary Drug Project Research Group (1980) evaluated the efficacy and safety of various drugs used in the long-term treatment of coronary heart disease. As expected, the group found that patients who adhered to their treatment protocol during the 5-year follow-up had a significantly lower mortality than those who did not take their prescriptions regularly. The surprising finding was that patients who received pure placebo pills during the trials and took them as prescribed were also more likely to survive than those in the placebo group who did not adhere to the plan. This study was not originally designed to investigate placebos, but it does provide us with hypothesis generating results that can be formulated as follows:
Hypotheses on long-term placebo use:
- A) placebos can provide long-term benefits
- B) placebo adherence improves therapeutic efficacy