October 18, 2008


Why "placebo" is not a dirty word: Yes, alternative medicine works mostly by the power of suggestion. But so do a lot of conventional treatments. (Robert Burton, Aug. 01, 2008, Salon)

The placebo effect has maddened the medical world for generations. But recent advances in brain imaging emphasize for me that “placebo” should not be regarded a dirty word. In fact, it is time to give placebo a new image and update its beneficial role in our modern medical armamentarium.

Folk psychology tells us that the placebo effect is, in large part, a function of patient suggestibility and that some of us are clearly more suggestible than others. For centuries, physicians have handed out inert colored water and sugar pills with the full knowledge that approximately a third of their patients will report feeling better. We assume that the degree of response is somehow a reflection of the psychological state of the patient -- the greater the degree of gullibility, the more likely he or she is to believe that a sugar pill will relieve aches and pains. But there's an unanticipated side effect of this assumption.

Attributing the placebo effect to gullibility is a subtle accusation of a patient's weakness and lack of sophistication. I suspect that many of us consciously or unconsciously look down upon those who are good placebo responders, as though you have to be a real dummy to believe everything the doctor tells or gives you.

But placebo serves a very real evolutionary function. At a time when there were no medicines, the placebo effect was all that stood between primitive humans and the agonies of injuries and illnesses. A look at the functional imaging scans shows how truly robust are the involved brain systems. These systems are here to stay. Even given our advanced state of medical knowledge, much of routine medical care -- from treating backaches to the common cold -- relies primarily upon reassurance and hope, not disease-specific treatments.

Given the choice, we'd all prefer to be placebo responders, though none of us want to be categorized as rubes. We complain about not getting enough quality time with our doctors, yet would never dream of directly asking for a prescription for a placebo. Instead, if we believe in conventional (allopathic) medicine, we might ask for an antibiotic for the common cold, with the rationale that, yes, it's only a virus, but perhaps the antibiotic will help. If we are inclined toward alternative medical treatments, we will plunk down a few bucks for a bottle of echinacea or a pack of zinc lozenges. To the extent that we feel better, we have invoked the placebo effect.

Keep in mind that whenever there is no specific well-substantiated treatment for a condition, the only alternative to glum acceptance and the proverbial stiff upper lip is to seek out a placebo. But don't tell us it's a placebo. Don't even hint that we are self-deluded suckers who might spring for a case of snake oil or a six-pack of eye of newt. Just as religion softens the blow of facing death, placebo softens the blow of facing life.

...is that it's placebo all the way down. Doctors can deaden pain, they just can't cure much.

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Posted by Orrin Judd at October 18, 2008 8:14 AM
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