Placebo Domingo
Can a glass of water cure? Can the power of suggestion be used to stop the human body’s inner demons dead in their tracks? Pondering these matters on a peaceful Sunday afternoon makes for an uncomfortable work week to follow. Yet we had better hope that researchers are every bit as curious as ourselves, for their answers may one day provide the key to a defensive arsenal that we never dreamed each and every one of us possesses.
Placebo therapy, unlike an aging tenor’s vocal cords, is just not going away. Its original praises were first sung back in 1955, when a groundbreaking scientific paper reported a 32% response rate of patients to placebos. Nothing has changed in the last half century, with clearly one-third of patients responding positively to therapeutic measures geared more toward their expectations than to proven physical alterations.
Thoughts and beliefs are extremely powerful healers. They not only affect our psychological states, but also cause our bodies to undergo actual biological changes. VIVA the placebos! They have been employed with some success in medical conditions ranging from arthritis and enlarged prostates to multiple sclerosis and psychiatric disease. Placebo controls and sham surgeries have been performed in an attempt to gauge the effectiveness of experimental surgical procedures for Parkinson’s disease. In those studies, the efficacy of implanted fetal pig cells for Parkinson’s was compared to simple burr holes drilled into patients’ skulls in the absence of subsequent cell implantation.
Like a heavy downpour on a Sunday holiday, however, placebos and placebo-controlled studies can reveal themselves to be much more than an inconvenience for a number of reasons. Before the sky clears, side effects, commonly known as the “nocebo” effect, may strike. Furthermore, in oncology, placebo-controlled studies, in which one group is administered an experimental anticancer drug and the other a placebo, are constantly debated and often unacceptable because of the risk they pose to the latter group by treatment delays. How would you like to be the one running those risks!
Opposition to the use of placebo pills in medical practice, while in a constant state of flux, has a hardcore base. There are those who decry the deceit, inherent in the use of placebos, and the undermining of the sacrosanct trust between patient and physician. Others take a more legalistic approach, asking where it is all going to end. If placebos were to become the status quo in many cases, then how would we discourage and prevent vineyards from bottling “placebo” vintages, museum curators from displaying masterpiece look-alikes, journalists from sanitizing the news, and congressmen from enacting extralegal activist bills? The slippery slope to chaos would gain momentum on soles made of placebo.
Now, while there are circumstances in which benevolent deception may be warranted, for example, in cases involving patient insistence on medications that are unnecessary and risky, as often occurs on oncology wards, those same patients feel betrayed upon hearing that they were given a placebo. So, it appears that while we cannot live with placebos, we can certainly live without them.
The essential questions still remain. Do placebos really work, and, if so, how so? Though definitive answers are not yet forthcoming, shades of gray are slowly but surely veering toward the opposite end of the color spectrum. We know that an inherent human potential to react positively to a healer exists, and that a patient’s stress can be reduced by doing something which might not be medically effective. That, coupled with the knowledge that stress can often trigger negative physiological reactions, has led many a “closet Einstein” to the simple placebic conclusion: cure the mind, cure the body. The proof is in your Sunday porridge. The symptoms of an enlarged prostate, for example, can be relieved by placebo tablets which, via a patient’s positive expectations of their benefits, can relax smooth muscle and subsequently increase urine flow by decreasing nerve activity affecting the bladder, prostate, and urethra.
As aging opera divas grow hoarse and our placid day of rest comes to a halt, perhaps we can count on an inert elixir to stretch vocal cords and erase those Monday blues.
© 2006, Albert M. Balesh, M.D. All rights reserved.
Placebo therapy, unlike an aging tenor’s vocal cords, is just not going away. Its original praises were first sung back in 1955, when a groundbreaking scientific paper reported a 32% response rate of patients to placebos. Nothing has changed in the last half century, with clearly one-third of patients responding positively to therapeutic measures geared more toward their expectations than to proven physical alterations.
Thoughts and beliefs are extremely powerful healers. They not only affect our psychological states, but also cause our bodies to undergo actual biological changes. VIVA the placebos! They have been employed with some success in medical conditions ranging from arthritis and enlarged prostates to multiple sclerosis and psychiatric disease. Placebo controls and sham surgeries have been performed in an attempt to gauge the effectiveness of experimental surgical procedures for Parkinson’s disease. In those studies, the efficacy of implanted fetal pig cells for Parkinson’s was compared to simple burr holes drilled into patients’ skulls in the absence of subsequent cell implantation.
Like a heavy downpour on a Sunday holiday, however, placebos and placebo-controlled studies can reveal themselves to be much more than an inconvenience for a number of reasons. Before the sky clears, side effects, commonly known as the “nocebo” effect, may strike. Furthermore, in oncology, placebo-controlled studies, in which one group is administered an experimental anticancer drug and the other a placebo, are constantly debated and often unacceptable because of the risk they pose to the latter group by treatment delays. How would you like to be the one running those risks!
Opposition to the use of placebo pills in medical practice, while in a constant state of flux, has a hardcore base. There are those who decry the deceit, inherent in the use of placebos, and the undermining of the sacrosanct trust between patient and physician. Others take a more legalistic approach, asking where it is all going to end. If placebos were to become the status quo in many cases, then how would we discourage and prevent vineyards from bottling “placebo” vintages, museum curators from displaying masterpiece look-alikes, journalists from sanitizing the news, and congressmen from enacting extralegal activist bills? The slippery slope to chaos would gain momentum on soles made of placebo.
Now, while there are circumstances in which benevolent deception may be warranted, for example, in cases involving patient insistence on medications that are unnecessary and risky, as often occurs on oncology wards, those same patients feel betrayed upon hearing that they were given a placebo. So, it appears that while we cannot live with placebos, we can certainly live without them.
The essential questions still remain. Do placebos really work, and, if so, how so? Though definitive answers are not yet forthcoming, shades of gray are slowly but surely veering toward the opposite end of the color spectrum. We know that an inherent human potential to react positively to a healer exists, and that a patient’s stress can be reduced by doing something which might not be medically effective. That, coupled with the knowledge that stress can often trigger negative physiological reactions, has led many a “closet Einstein” to the simple placebic conclusion: cure the mind, cure the body. The proof is in your Sunday porridge. The symptoms of an enlarged prostate, for example, can be relieved by placebo tablets which, via a patient’s positive expectations of their benefits, can relax smooth muscle and subsequently increase urine flow by decreasing nerve activity affecting the bladder, prostate, and urethra.
As aging opera divas grow hoarse and our placid day of rest comes to a halt, perhaps we can count on an inert elixir to stretch vocal cords and erase those Monday blues.
© 2006, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/07/2006 09:10:00 AM
1 Comments:
This comment has been removed by a blog administrator.
By
Anonymous, at Thursday, July 20, 2006 6:54:00 PM
Post a Comment
<< Home