Sugar Pills for Kids?

Harvard: Placebos are a key ingredient of any controlled clinical trial, the yardstick against which experimental drugs are measured. Placebos are also increasingly used as a treatment in their own right, as studies show that they make people feel better through a mind-body effect. But do parents find placebos acceptable for their children? A study published Nov. 15 in The Journal of Pediatrics, led by Harvard Medical School researchers at Boston Children’s Hospital, found the answer is mostly yes, provided ethical guidelines are followed.

“The question of placebos is more complex when it comes to children, since parents must make medical decisions on their behalf,” said Vanda Faria, a research fellow at HMS and first author on the study.
“Large placebo responses have been seen in a variety of pediatric conditions, and parents’ perceptions can influence how well placebos work,” said Faria, who is affiliated with the Center for Pain and the Brain at Boston Children’s and the Program in Placebo Studies and Therapeutic Encounter at Beth Israel Deaconess Medical Center.
“At the same time, little is still known about the potential harms of prolonged drug therapy on children’s development. Sometimes, the best intervention might not involve pharmacotherapy.”
David Borsook, HMS professor of anaesthesia at Boston Children’s and co-director of the Center for Pain and the Brain, is senior author on the paper.
Nuanced attitudes
The researchers used an online survey to ask 1,000 U.S. parents about their attitudes toward placebos. Their findings:

• 5 percent of parents agreed, at least somewhat, that use of placebo in clinical trials is vital for advancing new treatments.
• 86 percent of parents felt that giving their child a placebo is acceptable in some clinical care situations, while 5.7 percent said the use of placebos in children is always unacceptable.
• 5 percent agreed that placebos can cause physical changes in the body; another 32.8 percent “somewhat” agreed. In total, 83 percent believed a person’s mind can affect their health.
• While 80 percent agreed that taking advantage of the placebo response could improve children’s care, 96.5 percent felt it imperative to create ethical guidelines around this practice.
• 52 percent felt it is unacceptable for doctors to prescribe a placebo while calling it a real drug.
• 71 percent found it unacceptable not to explain that the treatment is a placebo.

When parents were given a list of 17 conditions, a majority considered placebo acceptable for only seven: the common cold, ear infection, occasional pain, anxiety disorders, mood disorders, sleep disturbance and ADHD.
Should kids know the truth?
The study had a number of limitations.
Parents responding to the survey were mostly white, half were college graduates and nearly all of their children were in good health.
Also, the survey didn’t distinguish between disclosing to parents versus disclosing to children that a treatment is placebo. So it’s possible parents might want the truth, but prefer to let their kids believe they’re receiving an active drug.
Faria believes the survey indicates the need for guidelines to support parents in deciding whether to agree to placebo use, and the need for transparency, at least with parents.
“Open-label placebo seems to be a promising adjuvant therapy with the potential to improve pediatric care, as acknowledged by the great majority of the parents we surveyed,” she said. “Future studies should continue to investigate its therapeutic role.”
Adapted from a post on Vector, the Boston Children’s clinical and research innovation blog.