Nothing for something

The revelation of the medical trial in which dummy pills worked as well as famous drugs for all but the most severely depressed has understandably made both pharmaceutical companies and patients miserable. But for the individuals who placed their hopes on these drugs, there is nothing to be down about.

The depressed who felt better after taking medicine may feel like the purchasers of a medieval elixir that proved to be piss. But, apart from unstoppable calamities such as cancer and cardiac arrest, there is strong evidence that a positive outlook can improve outcome. In a television documentary last year, Professor Richard Dawkins proved that homeopathic medicine is scientific idiocy and yet that it improves the condition of numerous patients. He concluded that the system worked because homeopathic practitioners were able to give time and hope to those who felt abandoned by conventional medicine.

It's surely not fanciful to imagine a similar effect from antidepressants. Depression, at a basic level, is a loss of belief in the usual ways of getting through the day: habit, optimism, energy, hope. Exercise might be a better solution than drugs, but a bottle of vodka worse. If faith in a pill works, then the confidence trick involved is entirely benevolent except for the false profits of the drug barons. Instead of damning Prozac, we should be cheering placebos.

Ideally, the controversy over happy pills would be solved by an experiment in which GPs were able to give dummy pills to patients they thought likely to respond more to the packet than the contents. The prescription of pretend remedies is currently outlawed by medical regulators, and for good reason. The licensing of lying might clearly affect the doctor-patient relationship and there would also be practical difficulties. Would those on the flour-and-water tablets pay the same for their fix as those getting expensive chemicals?

Yet the question of whether GPs are being restricted in their range of treatments is a useful one. Without ever having been Amy Winehouse, there was a spell in which, after a knee injury, I became too fond of a brand of over the counter anti-inflammatory tablets. When grim gastric consequences ensued, my GP suggested that a pack of frozen peas applied to the swollen area would have results at least as effective. After briefly feeling that I had asked for Marcus Welby MD and got Captain Birdseye, this advice proved cheaper, better and safer. Good and strong doctors have always been willing to send their patients away with nothing: suggesting rest, exercise or walking past the pub rather than into it.

But this approach to medicine has been compromised by the increasing tendency of patients to treat the surgery as a children's party, their bottom lips wobbling if they don't leave with a big rattling bag of goodies. And you don't have to be a conspiracy theorist to see that the prescription of sleep and clean living do not make vast profits for corporations with swanky views of Lake Geneva. Drug companies are no keener than car manufacturers on the merits of brisk walks. The rise of private medicine, in which the patient is more customer than supplicant, has encouraged this tendency, resulting in the over-prescription of ineffective antibiotics and a generation of children chemically coshed after being diagnosed with fashionable strings of letters that used to be known as growing up.

The sadness is that, if winter viruses and attention deficit disorders were able to be treated with packs of placebos, the patients would be just as happy and the mock medication would, almost certainly, have identical results. But, if the prescription of trick pills is logistically and ethically impossible, we need to look at ways of increasing the range of treatments available.

Imagine a surgery in which the doctor was able to hand out gym membership, a holiday, a labrador, a shopping voucher: in other words, a creative kind of placebo. Clearly, there will be practical difficulties with this approach. Some patients will feel cheated if they leave the surgery with anything less than a glittering silver punch-pack of something with an old Latin or Greek name and a new Swiss-American one, and will switch to a rival or a private doctor.

Others, frankly, come to their doctors chiefly in need of a hug, a remedy which could not be widely offered without the risk of a rush of physicians being struck off. Even so, the crisis over the efficacy of antidepressants offers a lesson and an opportunity. Instead of becoming obsessed with the allegation that pills don't work, we should focus on the fact that placebos do.

Pressures of demand and supply on either side of the consulting room have created a culture of drugs or nothing. Of course, some will continue to need drugs, but it would be sensible to explore the range of ways in which doctors can give nothing, which can also be something. This outcome might be depressing for the pharmaceutical companies, but at least they would have a large stockpile of remedies available.

Mark Lawson