The cure is all in the mind The curereally is all in the mind

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A HARMLESS sugar pill - or placebo - can cure as many as half of those suffering from depression and its use could drastically reduce the cost burden on the NHS, according to a leading American authority.

The treatment is just as effective in treating moderate depression as expensive mainstream drugs such as Prozac, and can help with a series of other complaints, says Professor Walter Brown, who has written a new study drawn from 20 years of medical evidence. Its use would trim a huge amount off the bill for anti-depressants in the NHS, he says, where GPs alone prescribe pounds 191m worth of pills a year.

But the British Medical Association, while acknowledging the existence of the placebo effect, has expressed concern about the ethics of prescribing placebos.

"About half of patients with mild to moderate depression are helped by a placebo, and 20 to 30 per cent of the more severely depressed," says Prof Brown, the clinical professor of psychiatry at Brown University Medical School, Rhode Island. "In the mildly depressed there is no difference in the response to placebo and the response to drugs, including Prozac, and psychotherapy."

The placebo effect can also help in a number of other ailments, says Prof Brown, who believes it is greatly underrated as an effective treatment in its own right.

The secret of the success of placebos is that although they are inert, they are surrounded by the trappings of medical treatment.

"The patient gets all the other things: the examination, the reassurance of an expert with a stethoscope and diplomas on the wall, and the hope they will get better. It is the whole package that creates the effect.

"Certain conditions do seem to be more placebo-responsive than others. Depression, anxiety, high blood pressure, asthma, and pain are all responsive," he says. Though, he adds, "no one is suggesting that someone with cancer or schizophrenia is going to get better with a placebo".

He says it also accounts for the use of alternative and complimentary medicines by conventional practitioners. "Convention- al clinics and hospitals are now bringing in alternative medicine practices, and my personal view is that you have to consider these treatments to be largely working by the placebo effect."

But not everyone feels they are appropriate. For Dr Joe Collier, consultant clinical pharmacologist at St George's Hospital, London: "It is one of those things that pleases doctors because they then become more powerful: 'Look what I'm doing. I'm giving you something to make you better but its only a placebo, aren't I clever'."

BMA chairman Dr Michael Wilks adds: "Not telling the whole truth is dangerous, and if you prescribe a placebo without telling the patient, there are ethical problems."