Saturday, March 3, 2007

The placebo effect

As far as I can remember I have always been opposed to, or at least skeptical towards the use of medicine that has not been properly tested and compared to placebos . I think that medicines should be tested extensively before they are released on the market. If you will, I am a bureaucrat in these matters, but why? Before I dwell further into this it is probably good with a definition of the placebo effect, here is one:

"A physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance."

But this sounds great does it not? If this is true then we can stop all administration of conventional medicine and thereby avoid all the associated side effects. As long as we can convince patients that water will heal them, it will, right? Just as a parenthesis, I think this is how homeopaths achieve their results. They are after all administering water with no active substance left in it.

The problem with a heavy reliance on placebos is that people would have to have a certain state of mind in order for a placebo to have any effect. Perhaps it is possible to create this state of mind by saying, for instance, that water will cure whatever it is the patient is suffering from. However, if this deception became a standard medical procedure I think that in the end people would cease to believe the doctors and then the placebo effect would disappear, and we would have no effective cures. Now some will probably object and say that it is not deception, but I think it is. If they were honest they should say that the medicine might have an effect, depending on whether you believe in it or not, and that is different. Similarly, if doctors would, on a large scale, tell their patients that they were getting for instance Prozac when in fact they were only given sugar, then this scam would eventually be detected and people would start to distrust their doctors which would diminish the placebo effect. In sum, apart from requiring doctors to lie to their patients, using placebos on a large scale would only achieve results for as long as doctors were able to keep their deception in the dark.

In the above I have tried to reserve some space for a few positive words. It should be clear by now that placebo effects are dependent on the state of mind of the person taking the placebo, it is not an intrinsic property of the substance that is taken. This means that certain therapies, such as for instance homeopathic medicine, will work on some people (probably those who believe in it) but not on others. Thus if we were to analyze the set of beliefs that a particular patient has then it should be possible to give that patient whatever he or she believes in and achieve an effect. In essence I am saying that if someone believes that acupuncture will achieve miracles, then give them acupuncture, or if someone thinks that homeopathic medicine is good against headaches, then, by all means, give them their homeopathic substances. However, because the placebo effect is rarely as strong as the effect of conventional medicine, I think this approach should be confined to less serious conditions.

I see one further application or lesson from the above. I think that doctors should do their best to encourage their patients. Make them feel good, and tell them that they can help themselves in the healing process (not a lie). I think that a lot could be achieved by giving patients a sense of their intrinsic ability to heal themselves. The first essay I wrote at Lund University was about this. If you are interested you can read it here.


Anonymous said...

great entry & cute picture


rasmussenanders said...

Thank you, glad you thought so

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