Placebo treatment can significantly influence subjective symptoms. However, it is widely believed that response to placebo requires concealment or deception. We tested whether open-label placebo ...(non-deceptive and non-concealed administration) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome (IBS).
Two-group, randomized, controlled three week trial (August 2009-April 2010) conducted at a single academic center, involving 80 primarily female (70%) patients, mean age 47 ± 18 with IBS diagnosed by Rome III criteria and with a score ≥ 150 on the IBS Symptom Severity Scale (IBS-SSS). Patients were randomized to either open-label placebo pills presented as "placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes" or no-treatment controls with the same quality of interaction with providers. The primary outcome was IBS Global Improvement Scale (IBS-GIS). Secondary measures were IBS Symptom Severity Scale (IBS-SSS), IBS Adequate Relief (IBS-AR) and IBS Quality of Life (IBS-QoL).
Open-label placebo produced significantly higher mean (±SD) global improvement scores (IBS-GIS) at both 11-day midpoint (5.2 ± 1.0 vs. 4.0 ± 1.1, p<.001) and at 21-day endpoint (5.0 ± 1.5 vs. 3.9 ± 1.3, p = .002). Significant results were also observed at both time points for reduced symptom severity (IBS-SSS, p = .008 and p = .03) and adequate relief (IBS-AR, p = .02 and p = .03); and a trend favoring open-label placebo was observed for quality of life (IBS-QoL) at the 21-day endpoint (p = .08).
Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.
ClinicalTrials.gov NCT01010191.
While the Internet has become an integral part of the Western world, it has only just arrived in Africa. In Africa, as in much of the developing world, Internet usage rates below 1% are the norm. ...Fortunately, this situation is changing rapidly, as initiatives by the United Nations and private corporations attempt to bridge the global digital divide. While the overall outlook may appear positive, many issues could thwart the development of this technological revolution. At the level of ideas, concepts, and statistics, the Internet enjoys enthusiastic support, but it is the practical matters that will determine the pace of technological advancement.
Discusses the WorldTeach project in July 2001 in Namibia, design to teach computer and Internet literacy; technological difficulties and financial problems, computer and telecommunications equipment ...shortages, impact of AIDS epidemic, and policy implications. WorldTeach is a non-profit, non-governmental organization based at the Center for International Development at Harvard University which provides opportunities for individuals to make a meaningful contribution to international education by living and working as volunteer teachers in developing countries.
The Valsartan-Heart Failure trial formulated the hypothesis that combination therapy with angiotensin-converting enzyme inhibitors and β-blockers with an angiotensin-receptor blocker had a ...deleterious interaction. Furthermore, the Food and Drug Administration (FDA)-approved heart failure indication for valsartan included the statement that concomitant use of an angiotensin-converting enzyme inhibitor, a β-blocker was not recommended. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM)-Added and the VALsartan In Acute Myocardial Infarction Trial (VALIANT) provide reassuring evidence to support concomitant use of angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, and β-blockers. The FDA-approved heart failure indication for candesartan included the statement of additive benefits with angiotensin-converting enzyme inhibitors and β-blockers and led to a change in the valsartan label. These considerations have great clinical and public health importance given the increasing numbers of patients with heart failure, their high morbidity and mortality, and the relatively limited number of effective drug therapies
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