Health Column: Re-thinking the placebo effect
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
I did it and I am a little embarrassed to admit it. As medical miscues go, it was perhaps a minor judgment lapse, but I did it several times. It was done with the best of intentions, but yes, at times, with a little frustration on my part that nothing else had worked. My Lutheran guilt pleads that it actually helped some of the patients. Yes, I administered B12 shots to patients who were tired and weak, but had very normal blood B12 levels. Why did I do it?
From the patient’s point of view, receiving an injection feels like something important is happening. Injectable B12 is a bright, cherry red liquid. Watching it being draw from the vial has a potent effect. Add the gleam of the sharp needle, the brief prick and burn of the injection and the physician’s encouraging words and you know that you have been treated.
Simply, the placebo effect is regarded as any treatment that improves a symptom or disease, but lacks specific effectiveness for the condition being treated. In one study, 96 percent of physicians polled believed that placebos can have positive effects. The placebo effect is both powerful and a part of every patient-doctor interaction.
While commonly used by physicians in the clinical setting prior to the 19th century, placebos fell out of favor with the emergence of modern medicine. Over the past two decades, however, our knowledge of what happens with the chemical activity in the brain and how it correlates with placebo mechanisms has greatly increased. The interest in use of placebos has been rekindled.
Recently the medical literature has been flooded with reports of increasing use of placebo therapies. In Denmark, for example, a survey of 553 physicians found that 86 percent of the general practitioners and 54 percent of the hospital doctors reported using placebo interventions at least once within the last year.
Nevertheless, the opinions about using placebos among physicians vary widely: “What is so bad from getting better from a placebo?” to “ I think it’s wrong to knowingly dispense placebos, even harmless ones. It is deceptive and undermines the doctor-patient relationship.”
Recall that some of us have B12 deficiencies or pernicious anemia and have a physiologic need for replacement of B12. This is not placebo effect.
What do you think about placebos? Would you want your physician to give you one if he or she thought it would help you? Would a placebo be detrimental to your relationship with your doctor? Please e-mail me your thoughts.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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