Exploring placebo effect
Dear Dr. Roach: My two girlfriends began a weight-loss program (we are all overweight by 35-50 pounds) with a medically supervised HCG program. They both have lost 20 pounds in three weeks. I know that the stock answer is that any severely restricted diet will give those results. But they both are full of energy, NEVER hungry, and they don’t have cravings or that deprived feeling that goes with dieting. Are there any statistics regarding the HCG program that you can pass on? My doctor just says that the Food and Drug Administration does not recognize this off-label use of the drug. There must be some medical studies on this. Please give me a real answer as to results and safety. — P.R.
ANSWER: While I am glad your friends have had a good experience, I can’t recommend HCG as a treatment to help people lose weight. A trial in 1973 showed benefit, but since then there have been four trials that compared injections of HCG with placebo injections, and there were no differences in weight loss, sensation of hunger or mood.
I often mention placebo in my columns, but while most people know that “placebo” just means an inactive substance, I don’t think I have really made clear how powerful the “placebo effect” can be. If you really believe that a treatment will help you, it is pretty likely to make you feel better. That effect is true whether it’s a prescription or over-the-counter medication, supplement, injection or surgery. Hypnosis and acupuncture also have the potential for the placebo effect.
For a medication, device or procedure to be considered effective by the FDA, it has to be proven to be more effective than placebo. That can be challenging, since as many as 30 percent of people can experience improvement with placebos. DEAR DR. ROACH: After seven years, I finally have been declared in remission from a most devastating case of dermatomyositis. During those seven years I had been, and still am, on prednisone. In the initial stage of the illness, I was on very high doses for quite a while. I have finally tapered down to 2.5 mg daily. I also have right leg nerve damage from shingles that had extended down the entire right leg, so walking is a challenge. I have to concentrate with each step I take, or I stumble like a sot. Is there any hope for improving this condition? I have always enjoyed exercise and even studied ballet professionally for several years in my younger days. Now I can’t even jump more than a few inches off the floor. — P.S.
ANSWER: Dermatomyositis is an autoimmune disease in which the body attacks the skin and muscles. Like many autoimmune diseases, such as lupus or rheumatoid arthritis, prednisone is a useful, even life-saving drug. However, it has very significant side effects, including damage to muscles, which add to the difficulties you faced. Combined with nerve damage from shingles, it is perfectly understandable why your ability to function is impaired.
The good news is that, indeed, there is hope for improving the condition. Your body still has the ability to improve function with exercise. The fact that you have been athletic in the past will make it easier, both mentally and physically. A physical therapist, and maybe an occupational therapist also, will be very helpful. The capacity of the body for self-healing is enormous, but you have to be ready to work hard. In the beginning, even a hundred-yard walk may seem like a marathon. You will have good days and bad days, but you will see steady progress.