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Relief, If You Please

Feb 11, 2013 ● By Anonymous

Does your head hurt? Do you have an achy back? Nauseated? Depressed? Most folks with any of these symptoms would head to their doctors’ offices, hoping for relief. Can you give me something? But what if your doctor listened sympathetically and gave you a bottle of sugar pills? Would you feel cheated? The fact is that a little sugar pill might be just as effective at relieving your symptoms as an actual pharmaceutical prescription. The term for this is “The Placebo Response” based on the Latin verb placebo—“I shall please.” This phenomenon has been discussed since the 1920s, but was popularized by Harvard professor H.K. Beecher’s 1955 work, The Powerful Placebo. Beecher’s interest stemmed from his years as an anesthetist during WWII, when he saw that an innocuous shot of saline, delivered when morphine was unavailable, could had similar painkilling results. According to medical author Faith Brynie, writing in Psychology Today, the effect is a “complex interplay of anatomical, biochemical, and psychological factors” in which the brain produces endorphins, releasing dopamine and pain-suppressors into the system. As a result, patients may obtain relief from their symptoms (and avoid any negative or dangerous drug side affects). Long dismissed as a “statistical annoyance,” the placebo effect is now viewed by researchers as “an important part of the healing process.” Placebos can take many forms: pill, liquid, injection, even faux procedures or operations. The use of placebos is a staple in clinical drug trials, which compare their results with that of proposed pharmaceuticals. Currently, the FDA requires that all drugs surpass two out of three trials against placebos in order to be approved. When a drug turns out to be no more effective than a placebo, researchers refer to it as “crossing the futility boundary,” and the trial is abandoned. Placebos do not work for all people or in all instances. (A preliminary study published in the journal PLoS ONE even suggested that individuals with certain genetic variations linked to the release of dopamine might be more susceptible to the placebo effect.) The response is more likely with subjective symptoms connected to the voluntary nervous system, such as pain control, asthma, insomnia, depression, Parkinson’s, and irritable bowel syndrome. In such studies, the critical element seems to be patient expectation of a therapeutic benefit, in effect, a belief in potential success. Ted Kaptchuk, director of Harvard’s Program in Placebo Studies and Therapeutic Encounters, co-authored a study of Irritable Bowel Syndrome (IBS) sufferers in which patients were actually told that the drugs they were given were, in fact, placebos. However, researchers also told them that the faux drugs would be effective against their symptoms. Amazingly, 59 percent of those on placebos got better, compared to only 35 percent who reported improvement without treatment. In other studies, patients who were told that they would feel worse generally did. (This is known as the nocebo effect.) A 2008 survey found that almost half of the physicians in the U.S. occasionally prescribe placebos for their patients (including prescribing vitamins or antibiotics for viral infections, just to please the patient). But are good intentions enough to justify the deception? Some feel that prescribing placebos is an ethical violation that might harm the patient doctor relationship. Ironically, studies have shown that an empathetic and positive attitude on the part of physicians can be, in itself, a placebo. Physicians who take time with patients and assure them that relief is possible are more likely to produce a positive outcome, because such behavior raises patients’ expectations about relief. Physician as placebo is not a new concept. In ancient Rome, the Galen Pharmacopeia contained 820 placebo remedies and states “He cures most successfully in whom the people have the most confidence.” Then, should “I shall please” be the new motto of the medical profession? Physicians need look no further than their hallowed professional oath. Found on the Johns Hopkins University website, the Modern Hippocratic Oath, taken by all its medical graduates, includes the following: “I will remember that there is an art to medicine as well as a science, and that warmth, sympathy, kindness, and understanding may outweigh the surgeon’s knife and the chemist’s drug.” What’s Up? does not give medical advice. This material is simply a discussion of current information, trends, and topics. Please seek the advice of a physician before making any changes to your lifestyle or routine.

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