STEVE INSKEEP, Host:

We're learning more about the so-called placebo effect. You know, a placebo is a fake pill. It has no active ingredient. Doctors have known for a long time that people taking placebos often get better. Most people believe that's because patients think they might be getting real medicine.

NPR's Richard Knox reports that's not necessarily so.

RICHARD KNOX: For 16 years, irritable bowel syndrome has made Linda Buonanno's life miserable. So when she saw a TV ad about a study of IBS, she called right up to volunteer. But when they told her what the study was about, she thought they were kidding.

LINDA BUONANNO: I didn't really think it would work.

KNOX: The researchers told her if she signed up, Buonanno would be assigned to no treatment at all, or she'd be given placebo pills. And she'd be told up- front they were fake pills, with no real medicine in them. Call it an honest placebo.

BUONANNO: I said, how in the world is that going to work? But they said, well, it's mind over matter. I said, well, all right. Let me see how great my mind is.

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KNOX: Ted Kaptchuk of Harvard was the mastermind of the experiment.

TED KAPTCHUK: Everyone believes - the conventional wisdom in medicine is placebo only works if the patient thinks it's a drug.

KNOX: If that's right, a placebo involves deception. So it's not ethical for a doctor to prescribe one. But Kaptchuk did a survey that showed many doctors often prescribe placebos. So he decided to see if placebos can work even if patients know that's what they're taking. He talked his colleague Anthony Lembo into helping.

ANTHONY LEMBO: I actually didn't think we'd find very much or see that there was a significant effect. So I was a bit skeptical myself.

KNOX: Lembo's a gastrointestinal specialist at Beth Israel Deaconess Hospital in Boston. I asked him what he told Buonanno and other study participants.

LEMBO: This drug is something that will help you with your symptoms. There's a good chance of making you feel better.

KNOX: But what if I don't really - I know it's a placebo. It doesn't have any medicine in it. Doesn't that affect whether it's going to work or not?

LEMBO: It won't. This is a mind-body effect. And so you don't actually have to believe in it. You just need to take it regularly. And the drug will work over time if you give it a chance.

KNOX: And, lo and behold, most of the time, it did.

KAPTCHUK: Fifty-nine percent of our patients who were taking the placebo reported adequate relief - 59 percent compared to the people on the no- treatment: 35 percent. That's almost twice the size of improvement.

KNOX: Kaptchuk thinks it's more than the placebo pill itself. It's the whole ritual that makes the difference, what the doctor says and the ritual of pill- taking. Buonanno was one of the volunteers whose cramps, bloating and diarrhea magically went away while she was taking two placebos, twice a day.

BUONANNO: I was shocked that at the end of the three weeks when I went back to his office. I said can I have more of these? I know they're sugar tablets, but something's working. All right. He started laughing. And within three days after I wasn't taking it anymore, the symptoms came right back.

KNOX: Since the study was over, she couldn't get any more official placebos. So she went to a health food store and bought some of her own.

BUONANNO: I stuck it in my head that this is really helping out the IBS, and I've gotten rid of, I'd say, at least 70 percent of my problems.

KNOX: The study appears in the online journal P-L-o-S-ONE. Kaptchuk and Lembo admit the research raises a lot of questions. For instance, will the honest placebo effect work longer than three weeks?

LEMBO: You know, the follow-up studies will need to be a lot longer.

KNOX: And why did you choose just three weeks?

KAPTCHUK: Because we had no money to do a real big study.

KNOX: There's no big placebo manufacturer out there who wants to fund it?

(SOUNDBITE OF LAUGHTER)

KAPTCHUK: No, no.

KNOX: But with these intriguing data in hand, they hope to convince the National Institutes of Health to pay for a bigger, longer trial of honest placebos.

Richard Knox, NPR News.

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