"More effektive fake medicine": IG Nobel Prize for the research of Lieven A. Schenk, Tahmine Fadai and Christian Büchel
“Fake medicine that causes painful side effects can be more effective than fake medicine that does not cause painful side effects": The jury found this research result astonishing and amusing enough to award the “IG Nobel Prize” for Medicine 2024 to Dr. Lieven Schenk, Dr. Tahmine Fadai and Prof. Christian Büchel from Project A02 of the SFB/TRR 289. As is so often the case with this award, which only seems absurd at first glance, there is an important finding behind it - in this case with major implications for patients.
A bizarre ceremony, a worthless prize: the scientific community celebrates its freedom at the award ceremony for the “IG Nobel Prizes”. And it shows that research can often be hilarious at first glance - and thought-provoking at second glance.
“How side effects can improve treatment efficacy: a randomized trial” is the title of the publication in the journal Brain, which was ‘honored’ with the IG Nobel Prize (to the publication). In the article, Schenk, Fadai and Büchel describe their observation that the effect of a medical treatment can be enhanced if people experience mild side effects.
To demonstrate this, the researchers administered a nasal spray to volunteers that supposedly contained either a painkiller or a placebo. The test participants were then asked to assess how strong a heat stimulus was on their arm. The trick was that all the nasal sprays actually contained a placebo substance. In some cases, however, the heat stimulus was reduced in order to simulate an effect; and for some participants, capsaine was also mixed into the spray, which causes a slight burning sensation in the nose. The result: when there was a burning sensation in the nose, the heat stimulus on the arm felt less painful for the test subjects - even though no painkiller was administered at all. It was therefore the supposed side effect that had reduced the pain.
The findings are a problem for clinical studies - but an opportunity for therapy
Prof. Katja Wiech, Dr. Helena Hartmann and Prof. Ulrike Bingel comment on the very serious and important implications of these results for medicine and clinical research in the same issue of the journal. They explain that this effect is a problem for clinical studies: if side effects increase the effect of a test substance, it can no longer be compared with a placebo without side effects - and can therefore no longer be measured correctly.
In therapy, on the other hand, noticeable side effects could possibly not only be a burden, but even a therapeutic opportunity. However, only under certain circumstances, the scientists write: For example, this presumably only applies to mild side effects that are not perceived as threatening by the individuals. And the individual expectations and previous experiences of those affected certainly also play a role.
In any case, the results give reason to re-evaluate side effects - and to investigate whether they can be useful for patients not only experimentally, but also as part of a therapy. In the spirit of the “IG Nobel Prizes”, which are awarded by the US journal “Annals of Improbable Research” for research that “first makes you laugh and then makes you think”. (Here is the link to this year's ceremony.)