The “placebo effect” is somewhat mysterious. It has proven to “treat” many things, including joint pain or migraines. But based on new research, it looks like some of us could be more susceptible than others simply because of our genes.
The study examined not only how we might be predisposed genetically, but it also examined the implications involved with this understanding. For example, would someone who is more apt to respond to a placebo be pushed down on a list of those looking to receive actually treatment?
It’s not really about physical response to sugar pills – but it clearly shows up psychologically in some ways from the beginning. PBS NewsHour checked in with the researchers on this.
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
“Everything from your physician’s mood to their office décor to whether or not they wear a stethoscope can have a profound influence on how some patients respond to treatment,” said co-author Kathryn Hall, a senior fellow at the Program in Placebo Studies at Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston.
The term being used to describe this predisposition is “placebome.” If this trait can be identified in people, then it raises deeper questions about how certain individuals could affect drug trials or experimental treatments. There are questions about what the implications actually entail and why there is a distinct difference, as NewsHour pointed out.
Take, for example, irritable bowel syndrome. Nearly 40 percent of IBS patients elicit a reaction to taking placebos. In 2012, Hall and her colleagues examined a trait that may explain why. They looked at a brain enzyme, catechol-Omethyltransferase (COMT), which influences the human perception of pain. COMT does so by controlling the production of dopamine within parts of the frontal lobes that govern motivation and our experience of rewards. The gene for COMT comes in two different forms – “met” and “val”, based on mutations in its DNA sequence. People who inherit two copies of the “met” gene from their parents live with extra dopamine in their rewards circuits and, as a consequence, are more sensitive to pain. Those with “val” harbor less dopamine and are more resilient to pain.
Although this research was based on IBS patients, it isn’t quite clear whether or not these placebo-sensitive mutations are effective for just any disorder or condition, as Jon-Kar Zubieta, a psychiatrist and radiologist at the University of Michigan, noted.
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Still unknown is whether these placebo genes generalize to other conditions. “[Some] people with irritable bowels have a [placebo] susceptibility in the frontal lobes that may not happen for someone with chronic lower back pain.”
Having these gene difference is also more prevalent in Caucasian people than African Americans, the story pointed out. So that further complicates the situation with studies and trials.
“Excluding people from trials is a concern, but I’m skeptical if it will happen in the near future,” says Frank Miller, a retired bioethicist with the National Institutes of Health. Most of the placebo-related mutations identified so far are common, so screening would remove larges swaths of potential patients, he said. Plus, the U.S. Food and Drug Administration could restrict who can ultimately purchase the remedy if it’s only tested on a subset of people, Hall says. “If the problem is that drugs don’t beat placebo, then we need better drugs,” says Miller.
A closer look at drug dosages for different individuals who are placebo responders might be a good attempt at a research-focused resolution, according to Hall.
