Dear Dr. Roach: I read 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.
University of Alberta
Dear Professor: 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 isn’t necessary for a placebo to work, and I think it, 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?
Dear J.: 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.
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