Placebo ef­fect doesn’t need de­cep­tion to work

Cape Breton Post - - IN MEMORIAM/ADVICE/GAMES - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med. cor­nell.edu or re­quest an or­der form of avail­able health newslett

DEAR DR. ROACH: I hap­pened to come across your re­cent ar­ti­cle on the placebo ef­fect.

As a pro­fes­sor of phys­i­ol­ogy, I un­der­stand per­fectly your ad­vice. And I sort of feel that the placebo ef­fect can be a good one. If some­one feels “re­lief” from tak­ing a harm­less sub­stance, what’s the mat­ter with that? I’m talk­ing here about non-life-threat­en­ing con­di­tions, of course. In­deed, it is be­cause this ef­fect ex­ists that one needs ran­dom­ized, con­trolled clin­i­cal stud­ies in or­der to es­tab­lish a real ther­a­peu­tic ef­fect for a phar­ma­co­log­i­cal agent. In other words, don’t knock it!

But what’s your take on the fol­low­ing: I would imag­ine that the placebo ef­fect can work only if the sub­ject is not in­formed that its ef­fec­tive­ness hasn’t been es­tab­lished. If you tell the pa­tient that the treat­ment has not been “proven,” wouldn’t that blunt the ef­fect? Isn’t this why in a con­trolled trial, the pa­tients aren’t in­formed of which treat­ment they’re re­ceiv­ing?

Why not tell the pa­tient some­thing vague, like: “Well, some peo­ple do feel bet­ter tak­ing this sup­ple­ment, so there is no harm in you try­ing it.”

I have been told that it is “un­eth­i­cal” to pro­mote a placebo, and cer­tainly there would be many sit­u­a­tions where that would be so. But, for ex­am­ple, a pa­tient ap­proaches the physi­cian with a con­di­tion for which there is no real “cure” (like the com­mon cold) and won­ders whether sup­ple­ment X would be ben­e­fi­cial. Why would giv­ing a vague re­sponse, as il­lus­trated above, be “un­eth­i­cal”? -- Pro­fes­sor Emer­i­tus W. Reuben Kauf­man, Univer­sity of Al­berta.

AN­SWER: I ap­pre­ci­ate pro­fes­sor Kauf­man’s thought­ful com­ments. I tend to agree with gen­tly pro­mot­ing the use of pos­si­bly help­ful sup­ple­ments (in what pro­fes­sor Kauf­man calls the “vague re­sponse”) -as­sum­ing, of course, that the sup­ple­ment is not harm­ful.

Al­though it seems coun­ter­in­tu­itive, telling peo­ple that a placebo is a placebo does not seem to stop its be­ing ef­fec­tive. I once had an ini­tial visit with a pa­tient and saw “yel­low placebo No. 1” on his med­i­ca­tion list, and when asked, he told me he knew it was a placebo but it was the only one of the pills that worked for him.

Re­searchers at Har­vard are us­ing a placebo, but are telling the par­tic­i­pants that the pill they are get­ting con­tains no ac­tive in­gre­di­ent. Ini­tial tri­als with this ap­proach showed a very sig­nif­i­cant re­duc­tion in symp­toms. An “hon­est” or open-la­bel placebo may be as ef­fec­tive as many med­i­ca­tions, with less risk of side ef­fects and at much lower cost.

De­cep­tion is not nec­es­sary for a placebo to work, and in my opin­ion, is ul­ti­mately harm­ful to the pa­tient-physi­cian re­la­tion­ship.

DEAR DR. ROACH: Most of­ten, when I brush my teeth, my blad­der mus­cles start to contract and I must uri­nate im­me­di­ately. Does this con­di­tion have a name, and are there oth­ers who have this prob­lem? -- J.

AN­SWER: I hadn’t heard of this be­fore, but a quick search showed that this is not at all un­com­mon. The best an­swer that I can give is that it is most likely due to con­di­tion­ing: You have got­ten so used to uri­nat­ing about the time you brush your teeth that the two are con­nected at a deep level in your brain.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.