The Placebo Effect

I know it’s important to compensate for the placebo effect when you’re testing a new medicine or procedure, but . . . what exactly is it?

Medicine A is the substance being tested.
Medicine B is the sugar pill.

Group 1 gets Med A, Group 2 gets Med b, and Group 3 gets nothing at all. At the end of the test, Group 1 is doing great because Med A actually worked pretty well. Group 3 is dropping like flies from the original illness. But Group 2 has some people that are dying off and some people who got better because . . . ?

Just believing your getting a medicine shouldn’t make much of a difference, should it? Or, if it does, why haven’t we harnessed this power of suggestion as an actual therapy?

Bueller? Bueller?

Belief counts for a lot. Without going into a big hairy rant, belief is the underpinning of miracle cures, voodoo curses and much of psychological therapy. It’s the old mind/body you-are-what-you-think schitck.

I usually regard this as the huge random factor in medicine. There’s been a bunch written on patient’s role in healing, e.g. those w/ strong faith recover better, the debilitating physical results of depression, etc.

Briefly, it’s so well known that when testing, belief must be compensated for. If a person is told and believes this the wonder drug that will save them, dang if they aren’t more likely to fare better.

As a personal aside, my father died of cancer. It was colon cancer and spread to the liver. The doctor told us that it was terminal, to expect 5 months at the most and NOT to tell my father. It was very tough, watching the ravages of chemo etc. when we knew it was futile. But in fact he lived about 2 and a half years more, and some of it was GOOD time. We had to agree w/ the doctor that the crucial factor was my father’s strong will. His will to live had not been sapped by hearing a death sentence pronounced. A wise doctor, that.

My dad has talked to me about the common practice of double-blind tests, in which the administers of treatments don’t even know which group you are in. The philosophy here is that even the faith of the person treating you has a significant effect.

Right - mind over matter. The mind can do amazing things and science does not experiment enough in that area. I read recently that scientists did find that people who prayed do better than those who don’t. As for doctors who tell patients they only have so much time to live – well, I hope this is something the medical schools have learned NOT to do. Self-fulfilling prophecy; if you’ve got a serious illnes and the doctor has told you you’re gonna die in 6 months, you probably will.

I use the same thing at work. If I have a student who cannot use hand tools if his life depended on it. I let them work out of my personal tool box and tell them I keep all the new tools in my box. They usually settle down right away.
My tools are just as old as theirs the only difference is mine are polished nice and shiny.

Ive always found it easer to get forgiveness rather than permission.

Boy the part about telling patients they have a terminal illness is a really tough issue.

There are cancers and other conditions out there that we know we can’t beat. We also “know” Stephen Hawkings can’t have lived this long with ALS, and that people do rarely beat incredible odds.

There are some cancers that tend to have more miracles than they deserve. Melanoma and renal cell (kidney) cancer are both almost universally fatal once they have metastasized, and do not respond well to conventional chemotherapy and radiation treatments but a small number appear to go away entirely with immunotherapy (interferon, and other cytokines). A very small number go away entirely spontaneously.

I do feel strongly that patients and their families should be allowed to know what is going on. When in this kind situation, I will usually say something along the lines of “The chances of surviving this are very small”, and then let the patient and family ask whatever questions they want the answers to.

I have seen too many cases in which families have spent enormous sums of money, the patient has had long stays in big-city hospitals, and opportunities to do things that they would like to do have been missed because of pursuing futile therapies.

There are many ways of fighting a terminal illness. You can refuse to accept that it is terminal, and pursue chemo and other treatments that might prolong your life. You can go to alternative providers who offer (IMO) largely false hope. You can go on a cruise with your spouse & leave him/her good memories of your time together. You can look up people you’ve feuded with and make peace. You can visit your kids that have scattered to the winds.

But to be able to do what you want with the time left, you have to know how things really are. A terminal diagnosis is a horrible thing to tell someone about. But it is also an opportunity many families with victims of accidents, shootings, and other sudden deaths wish they had.

Sue from El Paso

I’m addicted to placebos. I could quit any time, but it wouldn’t matter.

I love Steven Wrightisms.

The placebo effect has been waaaaaayyy overemphasized by MDs and they keep using the notion against patients constantly. But I admit that there are a lot of stupid, suggestible doctor-worshipping patients out there who will believe anything an MD says. They are as much to blame as the miserable collection of very unscientific MDs we have today, because they make it possible for there to be so many of that sort of MD.

Certainly the pronouncing of how long someone has to live has little to do with drug or procedure testing that includes placebos, other than the common notion of physiological response to suggestion, and the crosstalk blathered here adds to the confusion of both. The ethical issues are different. I appears that Majormd makes a reasonable compromise on the issue of life-expectancy announcement.

But in general, MDs filter right down there at the bottom with lawyers in respect to lies and half-truths. I haven’t experienced the life-expectancy-announcement problem in respect to myself or any relative, but I’ve had lies and deceit from MDs on just about every other count.

Once occurred after some standardized physiological testing on me. The Stanford-associated MD tried to steer me away from the problem I had presented with, because he had nothing for it but needed my business. He told me that the test result on total bilirubin could indicate I had cancer. When I said forget it, he said he was writing such into my medical record. I got a copy of the record from his staff later on. Of course, there was no such thing in the record. For kicks, I then complained to his county (San Mateo) medical association to see what kind of garbage they would give me. They said he told me just what he was supposed to have said under the circumstances. Of course, everyone knows that, particularly in CA-US, MDs can do no wrong, because MDs control all the legality of what MDs do. Short of killing off several dozen people with excessive drug prescriptions, they never get cramped in style at all, and the worst they get then is kicked out of the particular state, after which they just set themselves up in another one. And the problem has gone way downhill since I lodged that complaint.

A later MD lie to me, or at least a statement of extremely low fractional truth, came when my mother died under his care. Well, she was then 93 and minor strokes had left her mentality and speech very debilitated, in the context of a so-called congestive heart condition, so the loss didn’t necessarily represent any big failure on his part, or loss of a life that had much meaning, and I and others knew there were better MDs around for someone in my mother’s condition but I had failed to try to get her switched, but. . .when I spoke to him on the phone after her death, he simply said she had died peacefully in her sleep at the hospital, after having been brought there complaining, as she had done before, of inability to breath reasonably. Well, I went down and read the medical record at the hospital. For some reason, that hospital kept a very straight blow-by-blow record. She had tangled with ICU staff, yanking IVs out and whatnot, while calling for my father, who was never informed, and so they had drugged her up and she had died an hour or so later. . .yes, in her sleep. I suspect the manner of handling that sort of patient in an ICU was not at all up to standard, but I can’t claim I know that. What I do know is that that MD is one of about 95% of MDs who just routinely lie. I could give you a dozen other examples.

Ray (And constantly, now, the public is begged by MDs to fight on their side against HMOs – to regain care lost because MDs ran health-care costs into the ground to the point where their racket had to be restrained.)

If you go to the self help section of a bookstore, you will find several books on the mental aspect of healing.

Some reasons why these are not used:

Non-medical interventions take a lot of work on the part of the patient. Medicine, you go to the doctor, he gives you a prescription, you take it, and usually get immediate results. Non-medical interventions require much more work.

Because of the level of work required by the patient, it’s hard to prove these techniques with double- or even single-blind tests in the same way that medicines can be.