Wednesday, January 04, 2006

"Harnessing the power of placebos"

...without sugar pills. Emily Singer, LA Times:
Sham treatments, medical science is learning, can have a powerful effect on health. Researchers have found that administering sugar pills and saline injections can ameliorate pain, depression and anxiety. Such treatments can reduce tremors and other symptoms in Parkinson's patients, lower blood pressure in those with hypertension and open up airways in people who suffer from asthma.

Researchers have even shown that sham knee surgery can alleviate arthritis pain and sham chest surgery, angina pain.

Now doctors want to harness that power as a tool for treatment — without resorting to trickery.

This is not as far-fetched as it sounds. Scientists are learning more about the response of the brain to placebos and about the various elements of treatment that help a patient feel better.

Say you go to the doctor with a headache, and your doctor secretly gives you a candy mint rather than an aspirin. That fake pill gives you an expectation that you will feel better — and the so-called placebo effect kicks in, and you do. If that were all the placebo effect was about, doctors would be stuck. Deceptively prescribing a candy instead of medicine to a patient in pain is not considered ethical behavior.

Luckily, other aspects of the doctor's visit — such as the whole doctor-patient interaction — play a role in placebo healing as well.

"The response to placebo is not just a response to an inactive pill, it's a response to the entire treatment situation," says Dr. Walter Brown, a psychiatrist at Brown University in Rhode Island. "It's everything: going to an expert, talking about the problem, getting a diagnosis and a plausible treatment."

Researchers are studying the best ways to capitalize on these cues...
(-emphasis added)

Update: Joel asks if he's hearing doubletalk in this article (see comments). What do you think?

8 Comments:

Blogger Joel said...

I blinking here.

Do I hear doubletalk?

8:52 PM  
Blogger shrinkette said...

Joel, you are perceptive. It's as though we're saying, "We won't actually tell the patient we're prescribing magic beans, but we will try to find out what else seems magical to the patient, and play that up in our interaction." The "sham" is the act, not just the magical powers that we wish for in the pill itself.

Human suggestibility and the power of belief are still not well researched or well understood. Are people less concerned when a pain pill has a large placebo effect? It seems more problematic when an antidepressant or anxiolytic produce placebo responses. There's also a 'reverse placebo effect' to contend with; some patients get so much worse on sugar pills! Some complain of terrible "side effects" before the pills even dissolve in their GI tracts.

9:51 PM  
Blogger Dr. Charles said...

a good issue, and one that needs to be invoked carefully when you're sure that you're not missing anything else. i don't like the feeling of being a snake oil pusher, but at the same time realize that in some situations it can help. chiropractic?

9:13 AM  
Anonymous Anonymous said...

Authoritarian/patriarchal v. contractual consultations styles are part of this debate.
A canecutter from St Elizabeth will believe in me when I tell hime to stop smoking, and do it.
An educated executive, specially from The States or Europe, won't.
Are my patients happier when I prescribe "cold medicines"? No, because I don't, but I suspect they would be happier, get better quicker and be out of the room faster.
But then research showed that doctos were prescribing antibiotics for viral illnesses because they thought their patients wanted them. The patients, post consultation, revealed to the researchers that they didn't.
We must allow our patients belief in our knowedge, experience (hence our magical power to take over and look after). We mustn't denigrate however their intelligence by selling them a lie.

2:57 PM  
Blogger Joel said...

This comment has been removed by a blog administrator.

11:52 PM  
Blogger Joel said...

I feel good. When a psychiatrist says "you noticed" you know it's got to be close to dead on. :)

I must admit that sometimes I trick myself into comfort. But that's me doing the work, me putting the secret in the back of my mind so that I can get things done. It's my happy illusion.

A therapist can counsel me to try that, I think, but s/he can't deceive me. That's where I draw the line.

11:53 PM  
Anonymous Ross said...

Psychiatrists need to think about the impact on patients who don't get better.

Over the years I've had doctors emphasize how powerful an anti-depressant is, or how studies show it gives such good results.

I never got much benefit from any of them and now have a hard time knowing what I should believe from a doctor, and what is just placebo-talk.

I would have preferred honesty and a setting of realistic expectations.

10:38 AM  
Anonymous Anonymous said...

Ross,
You should be familiar with the research showing that placebos work just about as well as SSRIs in depression treatment.

See Antidepressants Versus Placebos: Meaningful Advantages Are Lacking
by Irving Kirsch, Ph.D., and David Antonuccio, Ph.D., Psychiatric Times September 2002 Vol. XIX Issue.

Oh, but psychiatrists never tell you that because it shows that they really have no idea about what they're talking. From Freud onwards, psychiatry simply poses as science, eager to glom up its prestige and rigor, yet unwilling to subject to its rigors.

Instead, you get intueri and her self-absorbed, nauseating navel gazing masquerading as effective care.

6:39 PM  

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