Tuesday, July 24, 2018

Medical Mystery of the Placebo By NORMAN COUSINS with SUSAN SCHIEFELBEN


Courtesy: From Reader’s Digest 1981. November.


From the frontiers of science and the far horizons of personal courage, these stories of medical triumphs and miracles will reaffirm your faith in the awesome powers of the human spirit. Dramatic victories and human triumphs.

Medical Mystery of the Placebo
By NORMAN COUSINS with SUSAN SCHIEFELBEN
Not long ago, two patients on anti-depressant drugs were each given the same pill, described to them as a new promising preparation.  The first patient was told that the pill would sharply reduce her bleak feeling and help her general physical condition.  The second patient was told that the pill was still experimental, would probably have some adverse side effects, but was worth taking nonetheless.
Each patient reacted in line with the predicted expectations.  How could the same pill produce such different effects?  The pill wasn’t a drug at all, but a placebo—an innocent milk sugar capsule.
The study of this strange-sounding agent [pronounced plahase-bo, from the Latin verb “to please”] is opening vast areas of knowledge about the way in human body heals itself and about the mysterious ability of the brain to order biochemical changes that are essential for combating disease.  In the classical sense, a placebo is an imitation medicine—generally a nocuous milk-sugar tablet dressed up likes an authentic pill.  Today, it is used most often in the testing of new drugs.  Effects achieved by the preparation being tested are measured against those that follow the administration of a “dummy drug,” or placebo.
But today the once lowly placebo is receiving serious attention from medical scholars.  Investigators have found substantial evidence showing that the placebo can actually act like an authentic therapeutic agent.  While the way it works inside the body is still not completely understood, some researchers theorize that placebos activate the cerebral cortex, which in turn may switch on the endocrine system.  Whatever the precise pathways through the mind and body, enough evidence already exists to indicate that placebos can be as potent as—and sometimes more potent than—the active drugs they replace.
It is obviously absurd to say that doctors should never prescribe pharmacologically active drugs.  There are times when such medications are absolutely essential.  But the good doctor is always mindful of their power.  There is almost no drug that does not have some side effects.  And the more vaunted the prescription—antibiotics, cortisone, tranquilizers, anti-hypertensive compounds, anti-inflammatory agents, muscle relaxers—the greater the problem of adverse side effects.
Moreover, studies show that most patients who reach out for medical help are suffering from disorders well within the range of the body’s own healing powers.  The good physician tries to distinguish effectively between the large number of patients who can get well without heroic intervention and the much smaller number who can’t.  Such a physician loses no time in mobilizing all the scientific resources available when they are necessary, but he is careful not to slow up the natural recovery process of those who need his reassurance more than his drugs.  He may, for such people, prescribe a placebo—both because the patient feels more comfortable with a prescription in his hand and because the doctor knows that the placebo can actually serve a therapeutic purpose.
The placebo, then, is not so much a pill as a process.  The process works not because of any magic in the tablet but because the most successful prescriptions are those filled by the human body itself.  The placebo is powerful not because it “fools” the body but because it translates the will to live into a physical reality by triggering specific biochemical changes in the body.  Thus the placebo is proof that there is no real separation between mind and body.  Illness is always an interaction between both.  Attempts to treat most mental diseases as through they were completely free of physical causes and attempts to treat most bodily diseases as though the mind were in no way involved must be considered archaic in the light of new evidence about the way the human body functions.
Placebos will not work under all circumstances.  The chances of successful use are believed to be directly proportionate to the quality of a patient’s relationship with a doctor.  The doctor’s attitude toward the patient and his ability to convince the patient that he is not being taken lightly are vital factors in the treatment of illness in general.  In the absence of a strong relationship between doctor and patient, the use of placebos may have little point or prospect.  In this sense, the doctor himself is the most powerful placebo of all.
How much scientific laboratory data have been accumulated on placebo efficacy?  The medical literature in the past quarter century contains numerous impressive studies, including these three:
·       An anestheologist at Haward is considered the results of 15 students involving 1082 patients.  He discovered that 35 percent of the patients consistently experienced “satisfactory relief” when placebos were used instead of regular medication for a wide range of medical problems, including severe post-operative wound pain, seasickness, headaches, coughs and anxiety.
·       During a large study of mild mental depression, patients who bad been treated with anti-depressants were taken off the drugs and put on placebos.  The patients showed exactly the same improvement as they had gained from the drugs.
·       Eighty-eight arthritic patients were given placebos instead of aspirin or cortisone.  The number of patients who benefited from the placebos was approximately the same as the number of benefiting from the conventional anti-arthritic drugs
Inevitability, the use of the placebo involves built-in contradictions.  A good patient-doctor relationship is essential to the process.  But what happens to that relationship when one of the partners conceals important information from the other?  Is it ethical—or wise—for the doctor to nourish the patient’s mystical belief in medication?  An increasing number of doctors believe they should not encourage their patients to expect prescriptions, for they know how easy it is to deepen the patient’s physiological and phychological dependence on drugs—or even on placebos, for that matter.  If enough doctors break this habit, there is hope that the patient himself will come to regard the prescription slip in a new light.
In the end, the greatest value of the placebo is what it can tell us about life.  For what we understand ultimately is that the placebo is only a tangible object made essential in an age that feels uncomfortable with intangibles.  If we can liberate our selves from tangibles, we can directly connect hope and the will to live to the ability of the body to meet threats and challenges.  Then the mind can carry out its difficult and wondrous missions unprompted by little pills.