Friday, November 1, 2019

Placebo Palliative—Part 1 (11/1/19)


The so-called “placebo effect” has been around, in one form or another, for millennia. In its simplest form, it is the relief that one gets from a treatment that has no medical basis. It stems from a person's expectations of the treatment, rather than from the intervention of any active medicine. The root of the word is from Latin “I shall please.” Throughout history, the placebo effect has often been derided as a fake or fraudulent type of treatment, but both the medical and psychological sciences today recognize it as real.

In fact, it is responsible for the use of double-blind medical and psychological tests, wherein neither the patient nor the personnel delivering the treatment know if the procedure is real or not. That is because subtle hints transmitted by the caregiver may give away the truth of the treatment. Of course, this is exactly what many practitioners depend on, as the examples below demonstrate.

One of the first modern experiences of the placebo effect occurred during WWII in Italy, when an American physician, Henry Beecher, who specialized in pain relief, found himself conducting surgeries on wounded American soldiers. Medical supplies ran low, just as Beecher needed to operate on a badly-wounded soldier. The usual pain reliever, morphine, was exhausted. Desperate to perform the surgery, Beecher gave the wounded man an injection of diluted salt water—lying to him that it was a powerful anesthetic. The soldier calmed himself and endured the operation with very little pain.

Beecher was forced to repeat the ruse several times in the heat of battle and with short supplies, and it worked every time. Back home after the war, Beecher and his Harvard colleagues performed several controlled studies that confirmed the efficacy of placebos. They showed that imaginary medications worked! A few years later he published a paper which argued that clinical trials on any new drug must be conducted as a double-blind test, meaning that neither the experimenter nor the patient knows if the treatment is real or just a placebo, since the experimenters could reveal the truth through subtle clues, if they knew.

The placebo effect was once again recently confirmed in a clever study at Dartmouth University, which demonstrated the power of a physician's attitude, when administering medications. The study randomly and arbitrarily assigned a group of undergraduate students, some to be patients and some doctors. The “doctors” were given a cream to be used to treat induced (but harmless) burns in the “patients.” Half of the doctors were told that the cream they had was real medicine and the rest were told they had a placebo. The kicker was that all the creams were fake—all were placebos.

Those “doctors” who administered what they thought was a legitimate treatment found that their patients got pain relief—better than those who thought they were using a placebo. Why did it work, despite the fact that all of the creams were the same and were bogus? Careful analysis of videos showed that the “doctors” who believed their salve was effective showed their confidence in their conversations and facial expressions, while those who believed their treatment was fake revealed their disbelief in a similar manner, even though they tried not to show their bias. The “patients” responded to the nonverbal positive empathy and faith of their “physician.”

More on placebos next time…

No comments: