Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, December 04, 2016

Placebo, Anyone?

"It's the symbols [symbolic effect], like the stethoscope. It's the repetitive rituals like taking pills, and, very importantly, it's the interaction between patient and a clinician who provides emotional support and mutual trust. Those are the active ingredients."
"[Three participants [in a controlled study] reported that the dummy pills [worked so well that it has to contain something]."
"Simply put, the doctor is medicine. The nurse is medicine. The chiropractor is medicine. They're more than just the bag of tricks that they have."
"It tells you whether the drug adds something to the context of care in the provider-patient relationship."
"It's about activating self-healing properties that all human beings have."
Dr. Ted Kaptchuk, director, program for placebo studies, Beth Israel Deaconess Medical Centre, Boston, Mass.
Several studies are suggesting there is a biological basis to the placebo effect.
Several studies are suggesting there is a biological basis to the placebo effect. Photograph: Alamy

A new study, published in the journal Pain, authored by Ted Kaptchuk, a professor of medicine at Harvard Medical School, comes to an intriguing conclusion. One that many doctors may have already long suspected, resulting from what they have experienced in their general practise, treating patients with various medical complaints. And whom those doctors prescribe 'sugar pills' for, masking them as potent drugs to help heal nonexistent ills, and finding that they work miraculously well.

We humans are extremely suggestible. When someone in authority, someone with specialized professional knowledge like a physician, informs us that something will succeed in helping to solve our medical condition as we perceive it to be, we believe that advice, act on it, and witness for ourselves the alterations in how we feel. That deep-seated urge to believe is also reflected in most peoples' lack of discernment in believing everything they read. In the context of medicine, however, it's a positive element; we want to believe, to help ourselves.

In the case of treatments of medical conditions, real or imagined, there are times when trust and belief in a protocol that offers no chemically-induced advantage other than what resides within ourselves, can be effectively appreciated for the good it may deliver. In the study that Dr. Kaptchuk conducted, one hundred patients suffering from chronic low back pain took part in a trial after having heard a 15-minute explanation of the placebo effect.

They were informed what the placebo represented, and then they were randomized into one of two groups; one to be treatment-as-usual, the other, placebo. The placebo group were given "placebo pills" placed in medicine bottles labelled as such whose directions read they were to take two capsules, twice daily. Both groups were to honour their usual regimen of prescribed medication (for the most part non-steroidal anti-inflammatories; aspirin/ibuprofen) throughout the three-week study.

Once the study period ended, the group taking placebos reported a 30 percent reduction in usual pain and the very same for maximum pain level. In comparison, the treatment-as-usual without placebos reported a 9 percent and 16 percent reduction respectively. As well, the placebo group noted in addition, a 29 percent drop in disabilities related to pain, while the opposite group realized no such improvement in their condition.

According to a survey dating from 2008, half of American physicians prescribe placebos for their patients when no treatment seemed available, in the knowledge that most often placebos have the effect of making patients feel better. This contravenes the American Medical Association's dictum that physicians may use placebos for diagnosis or treatment if the patient is informed of the fact that they are comprised of an inert cellulose material, or 'sugar pills', and the patient is in agreement with their use.

Dr. Kaptchuk's study points in the direction of understanding that medicine is comprised of more than diagnoses, procedures, surgeries, drugs and protocols, that healing powers lie in how people perceive and receive what they are told and the trust they place in what they are instructed to do. Other studies, predating Dr. Kaptchuk's have tested open-label placebo prescriptions and their effects on patients, concluding that the practise of prescribing placebos turns out to be beneficial for the patient.

One controlled trial focused on patients with irritable bowel syndrome. Similar to the back pain trial, the IBS study reflected quality benefits of a significant nature in comparison with no treatment at all. Fairly convincing for the continued use of placebos in appropriate situations. Along with the stipulation that patients should be made aware that what they are being prescribed are placebos, allowing their own subconscious reactions in view of the aforesaid, to take over.

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