Harnessing The Placebo Effect - Deliberate use

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Deliberate Use Of The Placebo Response May Improve Both Patient Satisfaction And Treatment Efficacy.

Harnessing the Placebo Effect
MIROSLAV BACKONJA, WALTER A. BROWN
Brown University

Dr. Brown is Clinical Professor of Psychiatry, Brown University Program in Medicine, Providence, R. I., and Tufts University School of Medicine, Boston.


Medicine's Recent History:

Not very long ago, the rituals and symbols of healing constituted the bulk of the physician's armamentarium. In the early decades of the 20th century, most of the medications that doctors carried in their black bags and kept in their office cabinets had little or no pharmacologic activity against the maladies for which they were prescribed. Nevertheless, their use in the appropriate clinical context was no doubt frequently beneficial.

http://www.hosppract.com/issues/1998/07/cebrown.htm

Words as Placebos:

Patients do not want the physician simply to supply a list of possible treatments. Rather, they want the physician to say something along the lines of, "There are several treatment options for this condition. Let's talk about choosing one of those," and then provide a rationale for selecting a particular treatment. If the choice is left entirely up to the patient, an important reason for seeing the physician is removed; i.e., getting authoritative healing advice. Still, in many cases physicians would be well advised to ask patients what they think the best treatment might be before making a recommendation. Patients often have thoughts about treatment that they may be reluctant to share. Yet it is important to know about them, because those ideas can guide the physician to therapy that will be most acceptable to the patient, resulting in improved compliance and efficacy.

Those treatments may or may not be in the realm of alternative medicine...I believe that there are circumstances under which physicians should encourage the use of alternative treatments. Physicians who find that advice disturbing should remember that the disorders for which conventional medicine offers definitive, powerful treatment represent a minority of the afflictions that beset humanity. Typically those are acute conditions (e.g., bacterial infections, fractures and other trauma), certain types of cancers, and selected chronic conditions such as insulin-dependent diabetes. With many chronic conditions, conventional treatments are incompletely efficacious and often have significant side effects. Those are the conditions for which people tend to seek alternative medicine. To my mind, the theories underlying many forms of alternative medicine are unconvincing, at best. Nevertheless, in many instances, the use of alternative medicine makes sense. With conditions that are self-limited, or are relatively minor, or for which there is no fully satisfactory conventional treatment, alternative medicine may offer a superior healing environment--which is to say, its practitioners make far better use of the placebo effect.

On the other hand, physicians who understand the placebo effect can minimize patient defections to alternative medicine.

At times, encouragement may be at odds with informed consent. When, for example, a patient who is about to undergo a straightforward surgical procedure, such as a cholecystectomy, anxiously asks the surgeon, "Doctor, am I going to make it?" what should the surgeon say? Traditionally, the response would be to encourage the patient: "You're in good hands here, everything will be fine." I have posed this scenario to a variety of physicians, both residents and attendings, and found that some consider themselves obligated to list the possible complications and the risk of death, even if the mortality rate from the procedure is minuscule. Given what we know about the placebo effect, one could speculate that assuring the patient that the outcome will be good may reduce the patient's stress level. This, in turn, may lead to a more stable physiologic state that enhances the likelihood of a good outcome. In short, reassurance may be medically indicated in such cases.

When offering reassurance, the physician needs to appreciate and accommodate differences among patients...Some patients are reassured by detailed information about their condition and its treatment, while others find those details intimidating or distasteful. Not every patient likes being a partner with the physician; some want to bask in dependency on the physician and his or her authority. They simply want to be told what to do. That tends to be particularly true of patients who are facing a serious illness. Part of the art of medicine is to gauge the degree of information and independence appropriate for each patient.

http://www.hosppract.com/issues/1998/07/cebrown.htm

About Hospital Practice Articles:

Hospital Practice articles provide comprehensive information on new developments and problem areas in medicine and clinical research. The emphasis is on applying medical knowledge directly to patient care. Authors are nationally recognized experts in their fields.

http://www.hosppract.com/about.htm

[drm604]

1. Interesting post.

Thanks.

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2. You're welcome.

[RedOnce]

3. New Link - while the article's original link is down:

Harnessing the Placebo
Google: "Hospital Practice: The Placebo Effect" and click on the "Cached" link.