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Pleasing Placebo

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IF SYMPTOMS PERSIST

By DR. JOSE PUJALTE JR.

“Go, said Jesus, your faith has healed you.”

— Mark 10:52

New Testament, The Holy Bible.

Dr. Jose Pujalte Jr.

Dr. Jose Pujalte Jr.

The verse is not exactly complete. The rest of it is “Immediately, he received his sight and followed Jesus along the road.” Is there an overlap between miracles and placebos? “Placebo” means “I shall be acceptable or pleasing” and comes from the Latin “placere” (to please). A placebo can be a sugar pill, an empty oral capsule, injectable triple distilled water or normal saline solution – anything that constitutes a sham treatment. While the word itself appeared in the late 18th century, placebos have been used since ancient times. Dr. Plinio Prioreschi, in his A History of Medicine – Volume III: Roman Medicine (Horatius Press, 1996) reviewed the herbs and drugs used by Roman physicians. He concluded that most of the therapeutic effect of drugs was from the placebo effect (defined below) and the natural tendency of the body to heal itself (vis medicatrix naturae).

Placebo effect. MedicineNetcalled the placebo effect as “a remarkable phenomenon in which a placebo… can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful. Expectation plays a potent role in the placebo effect. The more a person believes they are going to benefit from a treatment, the more likely it is that they will experience a benefit.”In clinical trials, the placebo response is the subject’s measurable reaction to the placebo and the placebo effect in this context, is the difference between the response versus no treatment.

Why does it Work? In psychology, a placebo works by two explanations. One is the expectancy theory, in which the patient “expects” a positive effect from the placebo. In a controlled, randomized study of 180 cases of knee osteoarthritis (New England Journal of Medicine July 2002), one group had the knee debrided (cleaned) and another lavaged (washed) by arthroscopic or keyhole surgery. The third group (placebo) underwent sham surgery with actual 3 small incisions for the portal holes but no arthroscopy. Significantly, “the intervention groups [did not] report less pain or better function than the placebo group.” While the study served as some sort of opprobium to extended indications of arthroscopy, it did show by the results that the placebo patients expected to get better even if it was fake surgery. The other hypothesis is Pavlovian conditioning.

Honest Placebo. In the classic use of a placebo, the patient does not know that the medicine is chemically inactive but improves anyway. But what if the patient is told, “Here, this is a placebo (pill, injection, etc.), take it,” will she get better? This is what Dr. Ted Kaptchuk, a medicine professor at Harvard Medical School, precisely did in 2009 for Irritable Bowel Syndrome (IBS) patients. This was the first open-label placebo or honest placebo study. The results were interesting: twice as many study subjects who knowingly took placebo pills reported symptom relief compared to those who did not receive treatment. They also doubled their rate of improvement until it almost equaled the effects of two IBS medications. These were reported by Alexandra Sifferlin in a Time magazine article (August 2018).

Counterview. The problem of course can lie in the misuse or abuse of placebos. The American Medical Association (AMA) Code of Ethics states that physicians may use placebos for diagnosis and treatment only with the patient’s cooperation and consent; placebos should not be given to “mollify a difficult patient.” The placebo enterprise is booming and online. Amazon sells 40 sugar pills for around P1,000. A whole bag of empty gelatin capsules retails for P500. Surely, doctors should take the lead in harnessing the power of placebos. The miracle is that a placebo works. But whether it is snake oil or science is still debatable.

E-mail jspujalte@yahoo.com

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