Placebo
Half of Doctors Routinely Prescribe Placebos (October 24, 2008)
The Art of Healing, and the Power of the Placebo
To the Editor:
Re “Study Finds Many Doctors Often Give Placebos” (news article, Oct. 24):
Many “effective” medications have only a marginal effect on disease processes or symptoms, and direct comparisons between competing treatments have been rare.
Wise doctors appreciate the weakness of many remedies and the scarcity of good information, yet continue to prescribe and hope. There is no clear line between placebo and “real” treatment.
Eric M. Wassermann
Bethesda, Md., Oct. 24, 2008
The writer is a neurologist and medical researcher.
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To the Editor:
It seems natural that doctors give placebos to patients, in spite of, or perhaps because of, the dictum that patients must know everything concerning their health.
If the prognosis is bad, knowing everything can lead to depression and loss of hope. A placebo may reassure a patient that the doctor cares.
Besides, doctors are not necessarily being dishonest in prescribing a placebo. That placebo may be better for a patient than all the side effects written in tiny print on some new medication.
Ethical challenges will always be present in the medical world.
Trish Hooper
Portola Valley, Calif.,
Oct 25, 2008
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To the Editor:
I was not at all surprised by the results of the survey of doctors. Doctors act as if every office visit must end with a prescription. The prescription pad signals the end of the visit in a graceful, caring way, and also reinforces for both parties the doctor’s special power. Nobody else can wield that pen on that paper.
Doctors may defend themselves by saying patients expect prescriptions, but doctors, because of the balance of power, are in the best position to alter those expectations. If they did, health care would improve, health would improve, and health care costs would go down.
Roberta Morris
Menlo Park, Calif.,
Oct.24, 2008
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Placebo is a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion.
Placebo controlled trials are trials where some participants take a placebo as a control and the others take the drug being investigated. Here the placebo is an inactive substance designed to resemble the drug being tested. It is used as a control to rule out any psychological effects which may show during testing. Most well-designed studies include a control group which is unknowingly taking a placebo.
The placebo effect or placebo response is a therapeutic or healing effect of an inert medicine or ineffective therapy,[1] or more generally is the psychosocial aspect of every medical treatment.[2] Sometimes known as a non-specific effect or subject-expectancy effect, the placebo effect (or its counterpart, the nocebo effect), occurs when a patient's symptoms are altered (i.e., alleviated or exacerbated) by a treatment, due to the individual expecting or believing that it will work. The placebo effect occurs when a patient is treated in conjunction with the suggestion from an authority figure or from acquired information that the treatment will aid in healing, and the patient’s condition improves. This effect has been observed since the early 20th century.
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It always struck me that a placebo was pretty damn impressive. Anything that could cue the body's own reserves, the body's individual pharmacy -- is nothing to be sneezed at. Wouldn't ANYTHING that could predictably do this be a 'miracle' substance or person? Non-toxic -- it would be the safest option .
I used to know a man who had documented the 'psychic surgeons' of the Philippine Islands over a period of time. At a certain point, he discovered that the psychic surgeons were palming chicken gizzards as the bloody clots that they seemed to be pulling out of a patient. When confronted with this, far from denying it, they said, "Well, duh, of course we are." It was not a ruse intended to cheat or deceive the patient. It was a piece of theater that was meant to be so authentic that EVEN THOUGH the patient KNEW it was an illusion, he/she would often feel great relief that something diseased had left him/her that he/she would get well, or experience healing. They said, only in the US are people so unsophisticated as to not understand the process, and to get indignant, as if they has been taken advantage of. Part of the theater of healing is the doctor/practitioner's authority and calm allowing the patient to let go of his fear and dread and allow the healing that the body was already attempting.
The opposite effect is the "nocebo" -- i.e. the doctor telling the patient that they have three months to live, and the patient obligingly dying in three months. Death by curse.*
