Placebo Power for Asthma

Placebo Power for Asthma

Asthma is a bad disease:

• 44,000 people have an asthma attack.
• 36,000 kids miss school due to asthma.
• 27,000 adults miss work due to asthma.
• 4,700 people visit the emergency room due to asthma.
• 1,200 people are admitted to the hospital due to asthma.
• 9 people die from asthma.

That is the daily toll of the disease. Anyone who has trained in or practiced primary care has seen at least one death from asthma and has a healthy respect for how the disease can slowly progress in patients and how hard an attack can be to break. The are many ways to die and the suffocation of uncontrolled asthma looks particularly unpleasant.

The potential for morbidity and mortality from asthma was one of the reasons I was surprised that the study Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma was approved by an IRB. Treating a potentially serious disease with three kinds of placebo is a little dangerous. But if there one thing I have noted in the pseudo-medicine world is the damnedest studies get approved by IRB committees. It would be interesting to see what, if any, CAM studies have been denied and why.

The results of the NEJM article were interesting and further demonstrated the worthlessness of the placebo effect, the only effect that pseudo-medicine have to offer. Sham acupuncture (an archetype for a redundant phrase) or sham inhaler did nothing to alter lung function in asthmatics.

Not a surprise and unfortunately inner-city asthmatics suffer from a double whammy. One is a lack of confidence in inhaled corticosteroids (ICS), the mainstay of asthma care. The other is relying on herbals (herbs, teas and rubs) or other CAM for the treatment of asthma. Avoiding real medications and relying on the ineffective placebo of pseudo-medicines leads to inadequate asthma care:

The use of herbal remedies was associated with lower adherence to ICSs and worse outcomes among inner-city asthmatic patients

and

Negative ICS beliefs and CAM endorsement were common and associated with uncontrolled asthma.

Typical headlines from the NEJM paper included Placebo Effect Powerful in Asthma and The Power of Placebo.  Power?  Powerful?

The result of relying on such power may be death, since

Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma.

Real diseases need real treatments.

Points of Interest 9/16/2014
Points of Interest 9/15/2014