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.
